Eva Yebra-Pimentel

Central and peripheral corneal thickness measurement with Orbscan II and topographical ultrasound pachymetry

Purpose: To compare thickness measurements of the central 6.0 mm of the cornea obtained with the Orbscan® II topography system and topographical ultrasound pachymetry. Setting: School of Optometry, University of Santiago de Compostela, Galicia, Spain. Methods: In 24 right eyes, pachymetric measurements were taken at the center and 1.2 mm and 3.0 mm on the superior and inferior hemimeridians. A 1‐sample t test was applied to assess the significance of the relationship between Orbscan II and ultrasound methods. The relationship between the 2 was assessed by analyzing regression and plotting the differences against the mean corneal thickness. Orbscan II data were analyzed in 3 ways: (1) without the application of an acoustic equivalent correction factor; (2) with a correction factor of 0.92, as recommended by the manufacturer; (3) with correction using the equations derived in this study. The data were systematically compared with those of ultrasound pachymetry. Results: Before the correction factor was applied, the Orbscan II overestimated the corneal thickness at all locations, with the mean difference (48.15 &mgr;m ± 33.74 [SD]) significantly different from zero (P < .001). Differences increased toward the periphery, and the reliability of Orbscan II readings seemed to decrease with thicker corneas. After the acoustic equivalent was applied, the differences were significantly less; however, this effect did not seem clinically significant as large differences remained. When specific corrective equations were applied for each corneal location, the level of agreement between Orbscan II and ultrasound pachymetry improved substantially; the mean (–0.11 ± 15.22 &mgr;m) was not statistically different from zero (P > .05). Conclusions: The acoustic equivalent correction factor proposed by the manufacturer to obtain corneal thickness measurements with the Orbscan II compared to those from ultrasound pachymetry was not valid for all corneal topography positions. Orbscan II measurements agreed better with those of ultrasound pachymetry when equations for the central and each peripheral location across the topography were applied.

Accuracy of the new ICare rebound tonometer vs. other portable tonometers in healthy eyes.

Purpose. The ICare (Tiolat Oy, Helsinki, Finland) is a new portable tonometer that measures intraocular pressure (IOP) with a new rebound method, in which a very light probe is used to make momentary contact with the cornea in slow motion. The purpose of this study is to assess the accuracy of the ICare IOP measurements by comparing them against other portable tonometers: Perkins applanation tonometer and Tono-Pen XL digital tonometer (Medtronic Solan, Jacksonville, FL). Methods. Sixty-five young subjects were assessed with each of the tonometers. ICare tonometry was performed first, followed by Perkins applanation tonometry and Tono-Pen XL in a random order. Regression analysis was used to evaluate the relationship between the Perkins tonometer and the remaining tonometers used in this study. Tonometers were also compared by plotting the difference between the methods against the mean. The hypothesis of zero bias was examined by a paired t test and the 95% limits of agreement (LoA) were calculated. Results. ICare and Tono-Pen XL significantly overestimate IOP when compared with Perkins applanation tonometry. The mean of the difference between Perkins and ICare and Perkins and Tono-Pen XL was (mean ± standard deviation) −3.35 ± 2.28 mm Hg and −2.78 ± 2.53 mm Hg, respectively. The 95% LoA between Perkins tonometry and ICare tonometry were between −7.81 and +1.12 and between Perkins tonometry and Tono-Pen XL tonometry between −7.74 and +2.18. Conclusions. Compared with Perkins tonometry, the ICare tonometer allows clinicians to estimate IOP with a portable, rapid, and noninvasive method with similar reliability to that offered by Tono-Pen XL. Clinicians should be aware of the systematic overestimation of IOP with the ICare. Further research is needed to evaluate the performance of rebound tonometry in populations with higher IOP and assess the reliability of this technique in the early detection and follow up of glaucomatous patients.

Accuracy and precision of EyeSys and Orbscan systems on calibrated spherical test surfaces.

Background: It is important to know how well the surface topography can be measured with current devices for corneal topographic analysis. There are several applications that need an accurate and precise method to measure corneal shape and variations, such as the effect of contact lens wear and the different refractive surgery techniques. Purpose: The aim of this study is to compare the accuracy and reproducibility of the measurement of the central curvature on calibrated steel balls using the EyeSys videokeratoscope and the Orbscan corneal topography system. Methods: The videokeratoscope (EyeSys Corneal Analysis System 2000, version 3.1) and the Orbscan corneal topography system (Orbscan II version 3.0) were used by four trained investigators to measure a series of five uniform and calibrated test surfaces with known radius of curvature ranging from 6.13 to 9.00 mm. Result: No statistically significant difference was found between the videokeratoscope and Orbscan systems in relation to accuracy or precision. The 95% confidence limits showed a close agreement between both instruments. The mean bias was less than ± 0.05 mm for both devices. The precision of the instruments was found to be similar. Conclusion: The EyeSys seems to measure more accurately, but the accuracy of the Orbscan was also acceptable, suggesting that both instruments are accurate and precise enough for research and clinical purposes. However, further studies of accuracy and repeatability of topographical measurements on human eyes generated by different topographers are necessary.

Changes in Corneal Structure with Continuous Wear of High-Dk Soft Contact Lenses: A Pilot Study

Purpose. Despite numerous studies that have considered the effects of extended wear of high-Dk soft contact lenses on ocular physiology, little attention has been paid to the impact of such lenses on central or peripheral corneal thickness and curvature. The present study aims to report the time course of changes in corneal thickness and curvature that accompanies the 30-night continuous wear of new silicone hydrogel soft contact lenses in a neophyte population in a longitudinal study. Methods. Six subjects wore high-Dk lotrafilcon (Dk = 140) on a 30-night replacement schedule for 12 months. Only measurements from the right eye were considered for analysis. Topographical measurements of corneal thickness and curvature were taken. The same parameters were monitored for an additional period of 3 months after lens removal. Results. An almost homogenous increase in corneal radius of curvature was detected for all the locations studied, being statistically significant for the 4-mm cord diameter area. This effect was associated with a progressive thinning effect for the central cornea, whereas midperipheral and peripheral areas did not display such a thinning effect during continuous wear. These effects were still evident for the central cornea 3 months after contact lens wear discontinuation. Conclusions. Continuous wear of high-Dk silicone hydrogel contact lenses is associated with clinically appreciable changes in topographical corneal curvature, whereas only a reduction in corneal thickness is appreciated in the central area. This effect seems to be a result of mechanical pressure induced by these hybrid hyperpermeable materials, characterized by a higher modulus of elasticity. The small sample size compromises the conclusions addressed from this study, and further work will be necessary to confirm the present results.

Symptoms in a population of contact lens and noncontact lens wearers under different environmental conditions

Purpose. To investigate ocular symptoms related to dryness in an adult population of contact lens (CL) and non contact lens wearers (n-CL) using video display terminals (VDT) for different periods of time under different indoor conditions related to air conditioning (AC) and heating units (HU) exposure. Methods. A questionnaire was distributed to 334 people within a university population of which 258 were part of the n-CL group and 76 of the CL wearers to assess symptoms of ocular discomfort potentially related to dryness. Only soft contact lens (SCL) wearers (n = 71) were included for further statistical analysis because of the reduced number of people wearing other lens types. A 2:1 match by gender group of 142 subjects in the n-CL group was used as a control sample. Results. There was a marked difference between the prevalence of symptoms and the way they are reported by CL and n-CL wearers. Red eye, itching, and scratchiness are more common among CL wearers, but the difference is statistically significant only for scratchiness (p < 0.01, &khgr;2). The vast majority of subjects who reported symptoms often and at the end of the day are significantly more prevalent among CL wearers (p < 0.01, &khgr;2). Gender differences were also encountered. Female CL wearers reported more scratchiness than males in the n-CL wearing group (p = 0.029, &khgr;2) and in the CL group (p < 0.008, &khgr;2). Females wearing CL reported symptoms of red eye (p = 0.043, &khgr;2) and scratchiness (p < 0.001, &khgr;2) more significantly than those in the n-CL group. Within the CL group, the prevalence of symptoms occurring sometimes or often and at the end of the day was higher among females (p < 0.001, &khgr;2). The use of VDT was associated with a higher level of scratchiness among CL wearers (p < 0.05, &khgr;2). The number of hours working with VDTs seemed to be associated with an increase in the prevalence of burning sensation in the CL group (p < 0.01, &khgr;2), whereas symptoms like red eye and scratchiness also increased significantly among n-CL wearers. Compared to n-CL wearers, all symptoms increase in CL wearers in environments with AC and HU, except excessive tearing. However, these differences are only statistically significant for scratchiness. Conclusions. Our results show that people who wear soft CL and work with VDTs for longer periods of time are more likely to develop symptoms like eye burning and scratchiness than n-CL wearers. This risk could be higher for women than men. Scratchiness and the appearance of symptoms near the end of the day are typically associated with ocular discomfort during CL wear in this sample, and clinicians should question their patients about these symptoms to anticipate serious discomfort.

Contact Lens Hydrophobicity and Roughness Effects on Bacterial Adhesion

Purpose. This study was designed to assess whether hydrogel contact lens (CL) surface hydrophobicity and roughness affect Staphylococcus epidermidis adhesion. Methods. Bacterial adhesion experiments were performed on two unworn silicone hydrogel and three unworn conventional hydrogel CLs using the S.epidermidis strain CECT 4184. Microbial colonization was assessed by conducting counts expressed as colony-forming units. CL hydrophobicity was determined through water contact angle measurements and the roughness parameters such as mean surface roughness (Ra), kurtosis (Rku), and skewness (Rsk) were determined through atomic force microscopy in Tapping Mode. Results. The conventional CLs showed similar water contact angles (p > 0.05) and were classified as hydrophilic. The silicone hydrogel CLs yielded hydrophobic contact angles with no significant differences between them (p > 0.05). The lenses with the highest (nelfilcon A and ocufilcon B) or lowest (comfilcon A and omafilcon A) Ra values displayed a lesser or greater extent of spikiness of their surfaces, respectively. All lenses showed a predominance of peaks (Rsk > 0) over troughs. S. epidermidis adhered more to the hydrophobic CLs (p < 0.05). Omafilcon A and comfilcon A, which showed the lowest Ra values among the hydrophilic and hydrophobic lenses, respectively, returned the lowest bacterial adhesion scores (p < 0.05). Conclusions. Our results suggest that more hydrophobic CLs are more prone to S. epidermidis adhesion. Although the Ra appears to be related to S. epidermidis adhesion, the influence of Rku and Rsk on this variable remains unclear.

Soft Contact Lens Surface Profile by Atomic Force Microscopy

Purpose. This study was designed to qualitatively and quantitatively characterize the surface morphology of four unworn conventional hydrogel contact lenses (omafilcon, hioxifilcon, nelfilcon A, and ocufilcon B) and two silicone-hydrogel contact lenses (senofilcon A and comfilcon A) without surface treatment. Methods. Surface roughness was assessed using atomic force microscopy in Tapping ModeTM to determine the representative roughness parameters mean surface roughness (Ra), mean square roughness (Rms), kurtosis (Rku), and skewness (Rsk). To date, these last two parameters have not been used to characterize contact lens surfaces. Rku provides information on the distribution of spikes above and below the mean line, and Rsk provides information about the asymmetric roughness of surfaces. The surface topography of the lenses was also mapped in detail. Results. In all the lenses, higher Ra and Rms values were obtained when larger surface areas were examined. The daily replacement contact lenses (nelfilcon A and ocufilcon B) showed the highest Ra and Rms values but according to their Rku scores, their surface profiles were less spiky than the remaining lenses. On the contrary, the lowest Ra and Rms values were recorded for comfilcon A and omafilcon A, which also exhibited the spikiest surface profiles. All the materials except the hioxifilcon showed a predominance of peaks (Rsk >0) over troughs. Conclusions. The shape parameters Rku and Rsk are useful for characterizing contact lens surfaces, because they provide different yet complementary information to that offered by Ra and Rms. Precise knowledge of the shape profile of a contact lens surface will give an idea of its susceptibility to deposit formation or colonization by microorganisms.

Clinical evaluation of the new TGDc-01 "PRA" palpebral tonometer: comparison with contact and non-contact tonometry.

Purpose. The TGDc-01 “PRA” (Ryazan State Instrument, Ryazan, Russia) tonometer is a new portable small-sized tonometer that measures intraocular pressure (IOP) through the eyelid. The purpose of this study is to assess the repeatability of the TGDc-01 IOP measurements by comparing them against those obtained with Goldmann tonometer and with those from Perkins applanation tonometer, Xpert (Reichert, Depew, NY) noncontact tonometer, and Tono-Pen XL (Medtronic Solan, Jacksonville, FL) digital tonometer. Methods. Fifty-eight right eyes of 58 young subjects were measured with each of the tonometers. Noncontact tonometry was performed first, followed by Goldmann and Perkins applanation tonometer (in random order), digital Tono-Pen XL, and finally TGDc-01 tonometer (sitting and supine position). Correlation analysis was used to evaluate the relationship between the Goldmann tonometer and the remaining tonometers used in this study. Plotting the difference between the methods against mean was also done to compare the tonometers. The hypothesis of zero bias was examined by a paired t-test. The 95% limits of agreement (LoA) were also calculated. Results. TGDc-01 showed no statistical difference between the IOP measurements obtained in sitting and supine positions. A poor relationship between the TGDc-01 and Goldmann tonometer was found (r2 = 0.173; p = 0.001). Although the mean differences between Goldmann and Tonopen XL, Xpert, and TGDc-01 IOP measurements were statistically significant, the wider 95% LoA was observed when comparing the Goldmann and TGDc-01 tonometers. Computation of the 95% LoA resulted in a wide bias range when comparing the TGDc-01 with all the tonometers used in this study. Conclusions. The TGDc-01 “PRA” tonometer was not comparable with the other techniques used in the study. The wide dispersion range of the values obtained shows low repeatability of the TGDc-01 for screening purposes. These results could be because of the technique of measurement and/or interindividual variables.

Rigid gas permeable contact lens and corneal topography

We investigated the effect of high Dk daily wear rigid gas permeable contact lenses on corneal topography. Eight young myopic subjects wore hard contact lenses for 21 days. Corneal topography was monitored using the EyeSys system. It was measured every day during the next 21 days after the fitting. We recorded the corneal radius of curvature at 16 peripheral points approximately 1, 2, 3 and 4 mm along the four principal meridians (nasal, superior, inferior and temporal). Our study showed that daily wear RGP Forum 210 does not produce significant alterations of the corneal curvature as a function of time.

New software application for clarifying tear film lipid layer patterns.

Purpose: The lipid layer of the tear film limits evaporation during the interblink interval and also affects tear stability. This study was designed to validate a new software application designed to characterize the tear film lipid layer through texture and color pattern recognition. Methods: Using the Tearscope-plus (slit-lamp magnification ×200), the lipid layer was examined in 105 healthy young adults, and interference photographs were acquired with a Topcon DV-3 digital camera. The photographs were classified by a clinician experienced in examining lipid layer patterns (LLPs), and these classifications were used as the reference standard (reference examiner). Next, LLPs were graded using the new software and further by 2 observers (observer 1 and observer 2) with experience in examining the ocular surface. Results: Strong correlation was detected between the categories determined by the new application and reference examiner (Cramer V 0.85–0.93, P < 0.001). The classifications made using the new application and by observer 1 and observer 2 were also consistent although correlation was weaker (Cramer V 0.56–0.87, P < 0.001). For thinner LLPs, greatest correspondence with the reference was observed using the new software (96.6%), whereas the 2 observers showed better agreement when grading thicker patterns. Notwithstanding, agreement between the 2 observers and the reference examiner was good with at least 81% matched classifications. Best agreement (96.2%) was noted between the new method and observers 1 and 2 for recognizing meshwork patterns, whereas observers 1 and 2 showed greatest correspondence when classifying color fringe patterns. Conclusions: The new application can objectively categorize LLPs using the Tearscope-plus.