Peer-reviewed Articles

Please use the archived list on the right to look at past peer-reviewed articles.


Doughty,M. J., Potvin,R., Pritchard,N., Fonn,D. Evaluation of the range of areas of the fluorescein staining patterns of the tarsal conjunctiva in man. Documenta Ophthalmologica 1995;89,4:355-371. [ Show Abstract ]

Fluorescein dye is commonly used to highlight the tarsal conjunctiva in man to facilitate diagnosis of papillary conjunctivitis. A quantitative analysis of the fluorescein-highlighted features could be useful in both assignment of severity grades as well as for objective comparisons but no data is available on the distributions of sizes (areas) of these features. An exploratory, range-finding study was undertaken to provide data on feature areas that might be encountered. After application of fluorescein, 35 mm photographs were taken at a fixed distance with zone 1/zone 2 (Allansmith) of the tarsal plate aligned perpendicular to the camera. The photographs were projected, an overlay of 150 to 180 contiguous features outlined by fluorescein made and planimetry used to assess the areas and area distributions of the features on tarsal plates clinically graded with stages 1 to 4 papillary hypertrophy. For zone 1 of the tarsal plate in asymptomatic subjects, a fluorescein solution highlights the limits of features that enclose an area averaging 30,000 μm2 (range 8000 to 120,000; median area of close to 35,000 μm2). The areas of these features were generally normally distributed and there was little variation in feature areas across the zone. At different stages of clinical papillary conjunctivitis, the areas of the negative staining patterns are larger. Averages of 60,000 to 90,000 μm2, median values of close to 70,000 μm2 and individual feature areas up to 350,000 μm2 were seen in mildly symptomatic patients. These distributions were generally heterogeneous and showed a skewed distribution. Areas averaging up to 0.755 mm2 (range 0.6 to 3.2 mm2) were measured in moderate to severe papillary hypertrophy.

Fonn,D., Gauthier,C. A., Pritchard,N. Patient preferences and comparative ocular responses to rigid and soft contact lenses. Optometry and Vision Science 1995;72,12:857-863. [ Show Abstract ]

Patient preferences and ocular responses were compared between rigid and soft contact lenses by randomly fitting 32 neophyte subjects with a rigid lens in 1 eye and a soft lens in the contralateral eye. Twenty-seven of 32 subjects completed the 3-month study and 16 subjects were willing to continue for an additional 3-month extension. Subjects preferred the comfort and handling of the soft lens but preferred the vision provided by the rigid lens and initially its ease of maintenance. There was also a marked preference for the soft lens when all aspects of lens wear were compared. Objectively, the rigid lenses were responsible for more ocular changes than the soft lenses. Palpebral aperture sizes of the rigid gas permeable (RGP) wearing eyes decreased significantly (0.5 mm; p < 0.05) compared to the soft lens wearing eyes. The incidence of corneal staining was significantly greater in the rigid lens wearing eye (50% RGP vs. 22% soft) but limbal injection was greater in the soft lens wearing eye (18% soft vs. 6% RGP). Refractive sphere, cylinder, and corneal astigmatism decreased in the rigid lens wearing eye after 3 months. This daily wear clinical trial has shown a marked subjective preference for wearing soft lenses with fewer short-term ocular effects.

Potvin,R. J., Fonn,D., Sorbara,L. Comparison of polycarbonate and steel test surfaces for videokeratography. Journal of Refractive Surgery 1995;11,2:89-91. [ Show Abstract ]

BACKGROUND: Assessing video imaging systems for measuring corneal topography often requires test surfaces. Steel bearings have been employed, but manufacturers caution that high reflectance (>90%) relative to the eye (<10%) may compromise test findings. The differences between steel and polycarbonate test surfaces are quantified in this study. METHODS: Images of a steel and a polycarbonate sphere of known radius of curvature were obtained with the Tomey/Computed Anatomy Topographic Modeling System (TMS, Cambridge, Mass). Analysis was performed on the raw video data files and the resultant surface curvature estimates. RESULTS: The raw video images differed sufficiently to affect image processing. Polycarbonate yielded consistently better images. Many steel images (approximately 25%) contained data points that could not be processed; calculated surface contour was more variable for these. Differences were less obvious when these images were removed from the pool. CONCLUSIONS: Results support the manufacturer's caution against the use of steel surfaces for testing or calibration of the TMS instrument. Problems appear due to the fundamental differences in the intensity distributions of video images captured from high- and low-reflectance surfaces.

Pritchard,N., Fonn,D. Dehydration, lens movement and dryness ratings of hydrogel contact lenses. Ophthalmic and Physiological Optics 1995;15,4:281-286. [ Show Abstract ]

Previous studies have shown that soft lenses dehydrate during lens wear. The purpose of this study was to determine the dehydration time course of 38% water content non-ionic Medalist(®), 58% ionic Acuvue(®) and 74% non-ionic Permaflex(®) lenses, and the relationship between dehydration and in vivo diameter, movement and symptoms of dryness. Nineteen subjects randomly wore three pairs of lenses, each for 7 h. Lens movement and diameter were measured in vivo and hydration after lens removal at 1, 3 and 7 h. Dryness was rated by the subjects using a visual analogue scale. A separate experiment was conducted to measure hydration changes after 7 continuous hours of lens wear. The water content of all three lens types decreased significantly over 7 h with Acuvue decreasing more than the Permaflex and Medalist(®) lenses in the interrupted and continuous experiments (ANOVA P < 0.05). Dehydration of Acuvue was significantly greater in the 7 h continuous experiment (9.0 ± 2.6% H2O, ANOVA P = 0.0062) compared to the interrupted experiment. Hydration levels measured for Acuvue lenses on subjects for control purposes at 0, 1, 3 and 7 h showed no difference over time (ANOVA P = 0.0711). Movement of Permaflex lenses decreased 0.60 ± 0.57 mm (ANOVA P = 0.0005) over 7 h and the in vivo diameter of Acuvue lenses decreased by 0.12 ± 0.16 mm (ANOVA P = 0.0569). Dryness ratings increased significantly and equally for all three lenses over 7 h (ANOVA P = 0.9833). No correlation was found between lens dehydration, movement, diameter and dryness with the exception of a weak significant (r = 0.5, P < 0.05) correlation between dehydration and dryness for Permaflex. The results of the study suggest that dehydration of soft lenses over a 7 h period does not significantly affect the clinical performance (dryness and movement) of the three lens types.

Regan,D., Simpson,T. Multiple sclerosis can cause visual processing deficits specific to texture-defined form. Neurology 1995;45,4:809-815. [ Show Abstract ]

We performed the following tests in 25 patients with multiple sclerosis (MS) and 25 age-matched control subjects: recognition of texture-defined (TD) letters; recognition of motion-defined (MD) letters; and recognition of luminance-defined (LD) letters of 96% and 11% contrasts. Six patients with normal visual acuity were abnormal on recognizing TD letters, of whom one gave normal results on all other tests. Eleven patients were abnormal on MD letter recognition, of whom four gave normal results on all other tests. Visual acuity for letters of 11% contrast were abnormally low in seven patients, of whom two gave normal results on all other tests. We conclude that the neural mechanisms underlying recognition of TD, MD, and low-contrast LD letters in subjects with normal visual acuity are sufficiently different that they can be differentially damaged by MS. Therefore, TD, MD, and LD letter tests provide complementary information. We suggest that the detection of TD letters can be disrupted by demyelination of long-range horizontal connections between orientation-tuned neurons in the striate cortex.

Simpson,T. L. A comparison of six methods to estimate thresholds from psychometric functions. Behavior Research Methods Instruments & Computers 1995;27,4:459-469. [ Show Abstract ]

There are many ways in which to estimate thresholds from psychometric functions. However, almost nothing is known about the relationships between these estimates. In the present experiment, Monte Carlo techniques were used to compare psychometric thresholds obtained using six methods. Three psychometric functions were simulated using Naka-Rushton and Weibull functions and a probit/logit function combination. Thresholds were estimated using probit, logit, and normit analyses and least-squares regressions of untransformed or z-score and logit-transformed probabilities versus stimulus strength. Histograms were derived from 100 thresholds using each of the six methods for various sampling strategies of each psychometric function. Thresholds from probit, logit, and normit analyses were remarkably similar. Thresholds from z-score- and logit-transformed regressions were more variable, and linear regression produced biased threshold estimates under some circumstances. Considering the similarity of thresholds, the speed of computation, and the ease of implementation, logit and normit analyses provide effective alternatives to the current ''gold standard''-probit analysis-for the estimation of psychometric thresholds.

Simpson,T. L. Vision thresholds from psychometric analyses: Alternatives to probit analysis. Optometry and Vision Science 1995;72,6:371-377. [ Show Abstract ]

Vision scientists and clinicians regularly obtain measures of vision and determine a person's vision threshold by choosing one of numerous methods of analysis. Analytical methods differ in their presumptions about the measures, in their complexity and in the ease of obtaining the threshold estimate. In light of these differences among so-called methods of psychometric analysis, the question is, "Do various analytical methods provide essentially equivalent vision threshold estimates or are there consequential differences that require consideration?" Measures of visual acuity, motion processing, and texture processing were obtained from 20 subjects. Each set of measures was analyzed by five psychometric methods: Logit Analysis, Normit Analysis, and linear regression of z-score transformed, logit transformed and untransformed probabilities vs. stimulus strength. The resulting thresholds were compared to the threshold obtained from Probit Analysis, which was used as a reference or "gold standard." Thresholds from the procedures were remarkably similar to those from Probit Analysis. In addition, examination of the speed of the procedures revealed that Probit Analysis was up to 10 times slower than some of the others. Considering the similarity of thresholds, the speed of computation, and the ease of implementation, Logit and Normit Analyses especially provide effective alternatives to the current gold standard, Probit Analysis, for the estimation of psychometric thresholds. In addition, z-score, logit, and linear regressions also produced unbiased threshold estimates under many circumstances, but the latter method should be applied with some caution.

Simpson,T. L., Regan,D. Test-retest variability and correlations between tests of texture processing, motion processing, visual acuity, and contrast sensitivity. Optometry and Vision Science 1995;72,1:11-16. [ Show Abstract ]

PURPOSE: To compare the test-retest variability (reliability) and the relations among clinical tests of texture and motion processing, visual acuity for high- and low-contrast letters, and the Pelli-Robson contrast sensitivity test. METHODS: In 20 normally sighted subjects, monocular visual acuity for letters of 96% and 11% contrast, Pelli-Robson contrast sensitivity, and motion-defined and texture-defined letter recognition thresholds were measured on each of two different days. RESULTS: Test-retest correlation coefficients were 0.75, 0.91, 0.61, 0.90, and 0.84 and bivariate test-retest regression slopes were 1.0, 1.1, 0.8, 1.0, and 1.2 for high- and low-contrast acuity, contrast sensitivity, and motion and texture processing, respectively. The inter-test correlations with both test and retest significant were as follows: visual acuity for high-contrast letters vs. visual acuity for low-contrast letters; and recognition threshold for texture-defined letters vs. acuity for letters of both high and low contrast. CONCLUSION: Test-retest variability for the tests of motion and texture processing were at least as low as for established clinical tests of high and low contrast acuity and contrast sensitivity. We conclude that these new tests offer a reliable means of obtaining clinical information which complements that provided by conventional tests with luminance-defined letters.

Sivak,J. G., Herbert,K. L., Fonn,D. In vitro ocular irritancy measure of four contact lens solutions: Damage and recovery. CLAO Journal 1995;21,3:169-174. [ Show Abstract ]

We measured the potential toxicity of four contact lens solutions using an in vitro approach in which the optical quality of the cultured bovine lens was measured as a function of exposure to each substance tested. This approach uses an automated scanning laser to measure the focal variability of lenses contained in special culture cells and maintained under long-term culture conditions. The products tested included three rigid gas permeable contact lens conditioning solutions (Boston Conditioning Solution(TM), Boston Advance Conditioning Solution(TM), and a new formulation of Boston Advance Conditioning Solution(TM) [Polymer Technology]) and one soft contact lens disinfecting system (OptimEyes(TM); Core Technologies). The results indicate a wide range of toxicologic potential that corresponds, on a relative basis, with published in vivo evaluation of the same substances. Moreover, the results demonstrate that this in vitro system can be used to evaluate the potential for recovery from damage caused by the four solutions tested.

Skaff,A., Cullen,A. P., Doughty,M. J., Fonn,D. Corneal swelling and recovery following wear of thick hydrogel contact lenses in insulin-dependent diabetics. Ophthalmic and Physiological Optics 1995;15,4:287-297. [ Show Abstract ]

Thick, 0.34 mm, 38% water hydrogel lenses were fitted, under a pressure patch, to one eye of 18 type I diabetic patients (aged 18-40 years) to assess the acute response to hypoxia and hypercapnia; the response was compared with that in 18 healthy, aged-matched nondiabetic subjects; the closed-eye lens wear was started mid-morning. Pre-lens wear assessments were made of acuity, intraocular pressure (IOP), central corneal thickness (CCT) and corneal appearance by biomicroscopy. The mean duration of the diabetes was 13±7 years and the Baseline CCT values were marginally greater in diabetic patients (600±33μm) compared with a group of non-diabetic control subjects (584±26μm; P>0.5). A 7.7±2.1% increase in CCT was measured after 3h lens wear in the diabetic patients while an average 10.6±2.4% increase in CCT was measured in the control subjects (P<0.05). The recovery of corneal thickness to baseline values in diabetic patients was slower (at 44.8±2.0% per hour) than the control subjects (53.9±2.1 per hour; P<0.05) although recovery of corneal thickness occurred in both groups within 2.5-3h, IOP values (non-contact tonometry) were higher in the diabetic patients than in the controls (14.5±2.9 vs 12.4±1.7mmHg; P<0.01). Overall, those corneas with greater baseline CCT values tended to swell less than those with lower baseline CCT values (r = 0.582). Positive correlations were also found between corneal thickness and IOP and blood glucose. The diabetic patients thus tended to have slightly thicker corneas (but this could be related to blood glucose or IOP rather than true corneal disease) and also had corneas that tended to swell less with a contact lens stress test (but this could be constitutively due to the slight oedema already present). The different corneal response in diabetic patients may thus be the result of physical determinants such as initial oedema and IOP and not the result of a disease of the cornea itself.