Uchechukwu L. Osuagwu

Comparison of the precision of the Topcon SP-3000P specular microscope and an ultrasound pachymeter

Aim: To compare the precision of the Topcon SP-3000P noncontact specular microscope (NCSM) and the DGH 500 ultrasound pachymeter (USP). Methods: Triplicate measurements of central corneal thickness (CCT) for 100 eyes were taken with an NCSM and a USP in 2 visits separated by 1 week. Repeatability was assessed by computing the differences between all 3 readings from each subject. Coefficients of repeatability and reproducibility were computed. Results: Mean CCT as measured by each instrument were: 518.53 ± 34.96 μm (range 417.33–592.67) and 516.94 ± 33.60 μm (range 431.67–582.67) for sessions 1 and 2 respectively, with the NCSM; 546.69 ± 36.62 μm (range 457.33–617.00) and 549.78 ± 35.26 μm (range 454.00–618.67) for sessions 1 and 2 respectively, with the USP. The ultrasound CCT measurements were consistently higher than those obtained with the NCSM in both sessions 28.17 ± 19.20 μm (mean ± SD, session 1) and 32.81 ± 14.04 (mean ± SD, session 2). The repeatability coefficient for the NCSM was better in both sessions than those for USP (±10 μm vs ± 12 μm in session 1 and ±8 μm vs ±10 μm in session 2). The reproducibility coefficient with the NCSM was half that with the USP (±21 μm vs ±41 μm). Conclusion: The SP-3000P NCSM is a more precise and reproducible instrument for measurement of CCT than the USP, but both instruments are reliable, useful instruments for measuring CCT.

Corneal biomechanical properties: Precision and influence on tonometry

PURPOSE To assess the precision and reproducibility of the corneal biomechanical parameters, and their relationships with the intraocular pressure (IOP) measured with the Goldmann tonometer and a noncontact tonometer. METHODS Readings for biomechanical properties and for IOP measured with the Goldmann and noncontact tonometers, were taken on one randomly selected eye of 106 normal subjects, on each one of two measurement sessions. Measurements with the ocular response analyzer (ORA) and the noncontact tonometer were randomized, followed by the measurement of central corneal thickness and with the Goldmann tonometer. RESULTS Repeatability coefficients for CCT, corneal hysteresis (CH) and corneal resistance factor (CRF) in Session 1 were ± 0.01 μm, ± 3.05 mmHg and ± 2.62 mmHg, respectively. The mean CCT, CH, CRF, Goldmann and noncontact tonometry did not vary significantly between sessions. Reproducibility coefficients for CCT, CH and CRF were ± 0.02 μm, ± 2.19 mmHg and ± 1.97 mmHg, respectively. Univariate regression analysis showed that CCT, CH and CRF significantly (P<0.0001) correlated with the IOP measured with the Goldmann and noncontact tonometers (and with the differences between tonometers) in Session 1. There were no significant correlations with the differences between tonometers in Session 2. Multivariate analysis revealed a minimal effect of CCT on Goldmann measurements but a significant effect on those of the noncontact tonometer. CONCLUSIONS Measurement of the biomechanical properties of the cornea, using the ORA, are repeatable and reproducible, affect Goldmann tonometry less than noncontact tonometry, and have a minimal influence on the difference in measured intraocular pressure between tonometers.

Evaluation of the Comparative Effect of Tetracaine on Central Corneal Thickness Measured by a Contact and Noncontact Pachymeter

PURPOSE To compare the effect of tetracaine 1% on central corneal thickness (CCT) measurements obtained by the ultrasound pachymetry (USP) and Topcon SP-3000P specular microscope. METHODS In the following sequence, SP-3000P before anesthesia, USP before anesthesia, SP-3000P 10 mins after anesthesia, USP 10 mins after anesthesia, CCT measurements were obtained from 100 randomly selected eyes of 50 oculo-visually young adults in 2 measurement sessions. RESULTS The CCT before instilling anesthetic did not vary significantly in each technique within session (P>0.05) and between sessions (P>0.05). Baseline CCT measurements obtained by the USP were significantly (P<0.0001) higher than that of SP-3000P by about 28 μm and 29 μm in sessions 1 and 2, respectively. A small but statistically insignificant increase in CCT (P>0.05) was observed 10 mins after instilling one drop of 1% tetracaine in both sessions of SP-3000P, whereas a statistically significant increase (P<0.05) in CCT in both sessions of USP was observed. The precision of the effects of anesthesia in the USP for sessions 1 and 2 was±15 μm and±31 μm, and in SP-3000P sessions 1 and 2, respectively, was±16 μm and±13 μm. CONCLUSION Topical anesthetic might have an effect on CCT measurements made with the ultrasound pachymeter. Such an effect could be due to instability of the tear film caused by the anesthetic, and this effect was not measurable with the SP-3000P suggesting that the difference in the principles of operation of both pachymetry devices might play a significant role in the detection of changes in CCT induced by topical anesthetic and the difference in CCT measurements observed between techniques.

Repeatability and interobserver reproducibility of Artemis-2 high-frequency ultrasound in determination of human corneal thickness.

Background The purpose of this study was to assess the repeatability and limits of agreement of corneal thickness values measured by a high-frequency ultrasound (Artemis-2), hand-held ultrasound pachymeter (DGH-500) and a specular microscope (SP-3000P). Methods Central corneal thickness (CCT) was analyzed in this prospective randomized study that included 32 patients (18 men and 14 women) aged 21–24 years. Measurements were obtained in two sessions, one week apart, by two examiners with three devices in a randomized order. Nine measurements were taken (three with each device) on one randomly selected eye of each patient in each measurement session. The coefficient of repeatability and interobserver reproducibility for the values of each method were calculated. The limits of agreement between techniques were also evaluated. Results There were no significant differences in CCT values between sessions for each of the three devices (P > 0.05). The repeatability coefficients for the Artemis-2 (±8 μm/±9 μm) were superior to those of the SP-3000P (±9 μm/±11 μm) and DGH 500 (±12 μm/±12 μm) in session 1/session 2 respectively, while the interobserver reproducibility index (differences between session 1 and session 2) was superior for the SP-3000P (±17 μm) with respect to DHG-500 (±29 μm) and the Artemis-2 (±31 μm). In session 1 and session 2, the limits of agreement between the techniques were 35 μm to −31 μm and 34 to −20 μm, respectively, for DGH-500 versus Artemis-2, 73 μm to 3 μm and 60 μm to 9 μm for Artemis-2 versus SP-3000P, and 58 μm to 22 μm and 72 μm to 10 μm for DGH-500 versus SP-3000P comparisons. The DGH-500 and Artemis-2 gave similar values (P > 0.05) in both sessions, but both (Artemis-2 and DGH-500) values were significantly greater than that of the SP-3000P (P < 0.05) in both sessions. Conclusion Repeatability was comparably good for the three techniques. However, interobserver reproducibility was approximately twice as good with the SP-3000P compared with the other two devices. The Artemis-2 CCT values consistently agreed with the DGH-500 and less so with the SP-3000P. The Artemis-2 provided CCT values that were, on average, 38 μm and 34 μm greater than that of the SP-3000P in session 1 and session 2, respectively.

Changes in ultraviolet transmittance of hydrogel and silicone-hydrogel contact lenses induced by wear.

Objectives: To evaluate the ultraviolet (UV) transmittance spectra of different contact lenses and assess the effect of wear on UV transmittance values and ocular protection factor (PF). Methods: Transmittance in the UV range (200–400 nm) of 216 contact lenses was measured before and after wear, using a spectrophotometer. The contact lenses used were ACUVUE TruEye, ACUVUE MOIST, ACUVUE OASYS, ACUVUE 2, ACUVUE DEFINE, DAILIES AquaComfort Plus, AIR OPTIX for astigmatism, FreshLook ONE-DAY lens, and Neo Cosmo. Results: This study indicates that the following contact lenses transmitted less than the American National Standards Institute (ANSI) of 5% or less of UVB: ACUVUE DEFINE, ACUVUE MOIST, ACUVUE 2, ACUVUE TruEye, and ACUVUE OASYS. All lenses also met the ANSI standard of less than 30% transmittance of UVA except for AquaComfort Plus, AIR OPTIX for astigmatism, and Neo Cosmo. FreshLook meets the UVA transmission standard but fell short of the UVB transmission standard by 3%. FreshLook and ACUVUE MOIST had the highest calculated PF (3.9) of the hydrogel group and were unaffected after wear. Of the silicone-hydrogels (SiHs), the PF for AIR OPTIX for astigmatism was the highest (10.6) before wear and increased after wear to a PF of 13.3. The results also show that, for the UVC region, significant differences exist in transmittance values before and after wear of all SiH lenses and all hydrogel lenses, except for Neo Cosmo. FreshLook and Neo Cosmo were the only lenses that showed no statistically significant differences in the UVA transmittance after wear. Conclusions: Ultraviolet-blocking contact lenses were effective in blocking ultraviolet radiation to safe levels recommended by ANSI, whereas non-UV blockers such as AquaComfort Plus and AIR OPTIX for astigmatism also showed UV-attenuation capabilities greater than the values previously reported. The Neo Cosmo contact lens transmitted greater than 86% UVB and 89% UVA, making it unsuitable for UV protection seekers. Transmission is modified after contact lens wear in almost all lenses but more so in the SiH lenses, probably because of the formation of biofilms on the lens surface.

Prevalence, use and sale of contact lenses in Saudi Arabia: Survey on university women and non-ophthalmic stores

PURPOSE To assess the prevalence and general knowledge of contact lens (CL) wear among women users and to examine the practice of CL dispensation by non-ophthalmic stores. METHOD One thousand four hundred and sixty-six female university students, between 16 and 31 years of age, and 1766 registered beauty stores in the region were randomly interviewed using self-administered questionnaires. The questions addressed general care/handling of CLs, CL case and solution hygiene practices by patients, the CL selection available in the shops, the type of instructions given to consumers, and who gives these instructions. RESULTS The prevalence of CL use was 70.2% (1029/1466). Fifty percent were part time users of CLs, and cosmetic reasons were the major reason (63.3%) for CL use. Approximately 38.7% of the respondents used CL without consultation with an eye care practitioner. The main purchasing locations were optical shops (51%), beauty salons (38%), and pharmacies (11%). Concerning contact lens care, 89.4% of the respondents adequately washed their hands before handling CLs and 72.7% changed their solutions daily, while 7.7% admitted to occasional overnight wear of their CL and 27.6% sometimes shared their CLs with friends. Interestingly, 80.3% of the 1327 shops sold CLs with no prescription, and 61.4% gave no instructions to the patients during purchase. CONCLUSION There is a high prevalence of CL use by female university students in Saudi Arabia, especially for cosmetic purposes. Although, there was good awareness with regard to general lens care practices, some users shared their lenses with friends, and the rate of sale of CLs without prescriptions in ordinary shops was high.

UV–vis light transmittance through tinted contact lenses and the effect of color on values

PURPOSE To assess the transmittance, in the 200-700nm electromagnetic radiation spectrum, by popularly used tinted soft contact lenses (CLs). METHOD The spectra transmittances of ultraviolet (UV)-blocking (I Day Acuvue Define, Freshlook ONE DAY) and non-UV-blocking (Durasoft 3, Tutti, and NeoCosmo) tinted soft CLs were tested. The transmittance of each lens, including nine different colors of Freshlook CL was recorded on spectrophotometer, and the data used to also calculate a UV protection factor (PF) for each lens brand tested, with a higher value indicating a higher level of protection. RESULTS The UV-blocking CLs significantly reduced UVC, UVB & UVA transmission and thereby meet the American National Standards Institution standard for class 2 UV blockers: a maximum of 30% transmittance of UVA and 5% transmittance of UVB wavelengths. In contrast, the Durasoft 3, Tutti, and NeoCosmo CLs demonstrated negligible UV-blockage. The Acuvue Define CL offered the greatest protection from UVC (PF=69) and UVB (PF=55), but with only 35% luminous transmittance, while the Freshlook CL (especially gemstone green) offered the best protection from UVA (PF=24) and showed about 55% translucency. Overall, the UV-blocking CLs performed equally well across the UV spectrum. Different colors of Freshlook CL transmitted statistically and clinically significantly different amounts of visible light but similar amounts of UVR. CONCLUSION Freshlook and Acuvue Define CLs which are designated as UV-blockers significantly reduced UVR transmission to safe levels whereas Tutti, NeoCosmo and Durasoft 3 did not. Transmission within the Freshlook CL family was more dependent on color in the visible light spectrum, but not in the UV-spectrum, where the gemstone green performing best among the tested colors.

Changes in retinal nerve fiber layer and optic disc algorithms by optical coherence tomography in glaucomatous Arab subjects.

Purpose To assess the difference in retinal nerve fiber layer (RNFL) and optic disc algorithms between glaucomatous and normal Arab subjects using optical coherence tomography (OCT). Methods RNFL thickness and optic disc parameters were obtained in 65 patients aged 50.1 ± 7.7 years. Percentage differences in all parameters were calculated and analyzed between groups. Results The mean RNFL thickness around the disc and at all quadrants was significantly thinner in glaucomatous eyes than in normal eyes (P < 0.01). The greatest decrease in RNFL thickness was observed at the inferior (39.5%) and superior (39.3%) quadrants and at 1 o’clock (43%) and 5 o’clock (40%) hour sectors. Significant differences were observed between glaucomatous and control eyes in all disc parameters (P < 0.005) assessed. The disc area, cup area, mean cup/disc ratio, and vertical and horizontal cup/disc ratios were significantly larger (P < 0.01), whereas the vertical integrated rim area, horizontal integrated rim width, and rim area were significantly smaller (P < 0.001) in glaucomatous eyes than in normal eyes. Conclusion Stratus OCT is still a valuable tool in the diagnosis of early glaucoma changes and, as such, its use should be encouraged in glaucoma clinics in Saudi Arabia. The best OCT parameters for detecting early glaucoma change were RNFL thickness in the inferior, superior, and 1 o’clock hour sector; the cup area; and the vertical integrated rim area of the optic disc.

One-Year Clinical Outcomes of a Two-Step Surgical Management for Keratoconus-Topography-Guided Photorefractive Keratectomy/Cross-Linking After Intrastromal Corneal Ring Implantation.

Purpose: To present the results of same-day topography-guided photorefractive keratectomy (TG-PRK) and corneal collagen cross-linking (CXL) after intrastromal corneal ring (ISCR) implantation in patients with keratoconus. Methods: Thirty-three patients (41 eyes) aged between 19 and 45 years were included in this prospective study. All patients underwent a femtosecond laser–enabled (Intralase FS; Abbott Medical Optics, Inc.) placement of intracorneal ring segments (Kerarings; Mediphacos, Brazil). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and keratometry readings remained stable for 6 months. Same-day PRK and CXL was subsequently performed in all patients. Results: After 12 months of completion of the procedure, mean UDVA in log of minimal angle of resolution was significantly improved (0.74±0.54–0.10±0.16); CDVA did not improve significantly but 85% of eyes maintained or gained multiple lines of CDVA; mean refraction spherical equivalent improved (from −3.03±1.98 to −0.04±0.99 D), all keratometry readings were significantly reduced, from preoperative values, but coma did not vary significantly from preoperative values. Central corneal thickness and corneal thickness at the thinnest point were significantly (P<0.0001) reduced from 519.76±29.33 and 501.87±31.50 preoperatively to 464.71±36.79 and 436.55±47.42 postoperatively, respectively. Safety and efficacy indices were 0.97 and 0.88, respectively. From 6 months up until more than 1 year of follow-up, further significant improvement was observed only for UDVA (P<0.0001). Conclusions: Same-day combined TG-PRK and CXL after ISCR implantation is a safe and effective option for improving visual acuity and visual function, and it halts the progression of the keratoconus. The improvements recorded after 6 months of follow-up were maintained or improved upon 1 year after the procedure.

Reliability and reproducibility of a handheld videorefractor.

Purpose To assess the performance of the 2Win eccentric videorefractor in relation to subjective refraction and table-mounted autorefraction. Methods Eighty-six eyes of 86 adults (46 male and 40 female subjects) aged between 20 and 25 years were examined. Subjective refraction and autorefraction using the table-mounted Topcon KR8800 and the handheld 2Win videorefractor were carried out in a randomized fashion by three different masked examiners. Measurements were repeated about 1 week after to assess instrument reproducibility, and the intertest variability was compared between techniques. Agreement of the 2Win videorefractor with subjective refraction and autorefraction was assessed for sphere and for cylindrical vectors at 0 degrees (J0) and 45 degrees (J45). Results Reproducibility coefficients for sphere values measured by subjective refraction, Topcon KR8800, and 2Win (±0.42, ±0.70, and ±1.18, respectively) were better than their corresponding J0 (±1.0, ±0.85, and ±1.66) and J45 (±1.01, ±0.87, and ±1.31) vector components. The Topcon KR8800 showed the most reproducible values for mean spherical equivalent refraction and the J0 and J45 vector components, whereas reproducibility of spherical component was best for subjective refraction. The 2Win videorefractor measurements were the least reproducible for all measures. All refractive components measured by the 2Win videorefractor did not differ significantly from those of subjective refraction, in both sessions (p > 0.05). The Topcon KR8800 autorefractometer and the 2Win videorefractor measured significantly more positive spheres and mean spherical equivalent refraction (p < 0.0001), but the J0 and J45 vector components were similar (p > 0.05), in both sessions. Conclusions The 2Win videorefractor compares well, on average, with subjective refraction. The reproducibility values for the 2Win videorefractor were considerably worse than either subjective refraction or autorefraction. The wide limits of reproducibility of the 2Win videorefractor probably limit its usefulness as a primary screening device.