Cornea and its adaptation to environment and accommodation function in veiled chameleon (Chamaeleo calyptratus): ultrastructure and 3D transmission electron tomography.

We investigate the ultrastructural features and 3D electron tomography of chameleon (Chamaeleon calyptratus) which is a native of desert environments of Saudi Arabia. The corneas of the chameleon were fixed in 2.5% glutaraldehyde containing cuprolinic blue in sodium acetate buffer for electron microscopy and tomography, and observed under a JEOL 1400 transmission electron microscope. The thin cornea (21.92 µm) contained 28-30 collagen fibril lamellae. The middle stromal lamellae (from 13 to 19) contained keratocytes with a long cell process and filled with granular material. The CF diameter increased from lamella 1 (30.44 ± 1.03) to Lamella 5 (52.83 ± 2.00) then decreased towards the posterior stoma. The percentage of large CF diameters (55-65 nm) was very high in the lamellae L14 (38.8%) and L15 (85.7%). The mean PGs area of the posterior stroma (448.21 ± 24.84 nm2 ) was significantly larger than the mean PGs area of the anterior, (309.86 ± 8.2 nm2 ) and middle stroma 245.94 ± 8.28 nm2 ). 3D electron tomography showed the distribution of PGs around and over the CF. Variable diameters of CFs in the anterior stroma may provide compact lamellae which may restrict the low wavelength of light. Variable diameters of CFs in the anterior stroma may provide compact lamellae which may restrict the low wavelength of light. This accommodation function is achieved by bending of the cornea. During bending the anterior stroma was stretched and the posterior stroma was compressed due to the presence of small CFs. The middle stroma remained stiff due to the presence of large CFs. Large proteoglycans not only maintain hydration for a longer period of time, but also act as a lubricant to neutralise the shear forces in the anterior and posterior stroma during bending.

Ultrastructure Features and Three-Dimensional Transmission Electron Tomography of Dhub Lizard (Uromastyx Aegyptia) Cornea and Its Adaptation to a Desert Environment.

We report ultrastructural features and transmission electron tomography of the dhub lizard (Uromastyx aegyptia) cornea and its adaptation to hot and dry environments. Six corneas of dhub lizards were fixed in 2.5% glutaraldehyde and processed for electron microscopy and tomography. The ultrathin sections were observed with a JEOL 1400 transmission electron microscope. The cornea of the dhub lizard is very thin (~28-30 µm). The epithelium constitutes ~14% of the cornea, whereas the stroma constitutes 80% of the cornea. The middle stromal lamellae are significantly thicker than anterior and posterior stromal lamellae. Collagen fibril (CF) diameters in the anterior stroma are variable in size (25-75 nm). Proteoglycans (PGs) are very large in the middle and posterior stroma, whereas they are small in the anterior stroma. Three-dimensional electron tomography was carried out to understand the structure and arrangement of the PG and CFs. The presence of large PGs in the posterior and middle stroma might help the animal retain a large amount of water to protect it from dryness. The dhub corneal structure is equipped to adapt to the dry and hot desert environment.

Effectiveness of in-office blood pressure measurement by eye care practitioners in early detection and management of hypertension.

AIM: To investigate the number of hypertensive patients, the optometrist is able to identify by routinely taking blood pressure (BP) measurements for patients in "at-risk" groups, and to sample patients' opinions regarding in-office BP measurement. Many of the optometrists in Saudi Arabia practice in optical stores. These stores are wide spread, easily accessible and seldom need appointments. The expanding role of the optometrist as a primary health care provider (PHCP) and the increasing global prevalence of hypertension, highlight the need for an integrated approach towards detecting and monitoring hypertension. METHODS: Automated BP measurements were made twice (during the same session) at five selected optometry practices using a validated BP monitor (Omron M6) to assess the number of patients with high BP (HBP) -in at-risk groups-visiting the eye clinic routinely. Prior to data collection, practitioners underwent a two-day training workshop by a cardiologist on hypertension and how to obtain accurate BP readings. A protocol for BP measurement was distributed and retained in all participating clinics. The general attitude towards cardiovascular health of 480 patients aged 37.2 (±12.4)y and their opinion towards in-office BP measurement was assessed using a self-administered questionnaire. RESULTS: A response rate of 83.6% was obtained for the survey. Ninety-three of the 443 patients (21.0%) tested for BP in this study had HBP. Of these, (62 subjects) 66.7% were unaware of their HBP status. Thirty of the 105 subjects (28.6%) who had previously been diagnosed with HBP, still had HBP at the time of this study, and only 22 (73.3%) of these patients were on medication. Also, only 25% of the diagnosed hypertensive patients owned a BP monitor. CONCLUSION: Taking BP measurements in optometry practices, we were able to identify one previously undiagnosed patient with HBP for every 8 adults tested. We also identified 30 of 105 previously diagnosed patients whose BP was poorly controlled, twenty-two of whom were on medication. The patients who participated in this study were positively disposed toward the routine measurement of BP by optometrists.

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.

Assessing the role of optometrists in the control of systemic hypertension in Saudi Arabia.

The low level of awareness, treatment, and control of systemic hypertension is a global problem, but it is much more serious in Saudi Arabia. This study examines the contribution made by Saudi optometrists in detection and management of patients with systemic hypertension. We surveyed a sample of 250 optometrists practicing in Saudi Arabia to evaluate the level of knowledge and awareness of their role in combating systemic hypertension. A 48.4% response rate was obtained from practicing optometrists. Of those responding, optometrists were very positive towards the use of blood pressure (BP) monitors in optometric practice on a routine basis. Forty-six percent of the optometrists had access to a BP monitor, and about 93% of these respondents actually used the monitors during clinic consultations. Automated monitors were the most common (54%). Fifty-one percent and 49% of the optometrists reported that they did routinely question their patients about high BP and about their current BP medications, respectively. The less frequently asked question concerned the cholesterol level of the patient (21%). The tests most widely used by the optometrists while examining hypertensive patients was direct ophthalmoscopy with red free filter (56%) and the least was binocular indirect ophthalmoscopy (21%). Optometrists were more likely to refer patients suspected of systemic hypertension on the basis of elevated BP (74%) and presence of retinal hemorrhages (72%), but were less likely to refer patients with changes in arteriolar reflex (41%). The opinions were very positive towards the routine monitoring of BP within the Saudi optometry profession, as optometrists indicated that they had time within an eye examination to measure BP, it was financially rewarding (56% of respondents), and patients appreciated it (64% of respondents). Despite half of the optometrists having access to BP monitors (predominantly automated devices), many of the optometrists were unsure if they were trained enough to monitor BP in such patients. There is urgent need to train optometrists on the use of BP devices, interpretation of readings, and use of additional diagnostic tests during such eye examinations.

Comparison of the influence of nonpreserved oxybuprocaine and a preserved artificial tear (thera tears) on human corneal thickness measured by two pachymeters.

PURPOSE: To compare the effect of nonpreserved oxybuprocaine and preserved artificial tears on central corneal thickness (CCT) obtained by 2 pachymeters. METHODS: In this prospective, placebo-controlled study, involving a random sample of 100 eyes of 50 subjects, aged 24±2.3 years, CCT readings were obtained in 2 separate sessions with the Topcon SP-3000P and ultrasound pachymetry (USP), respectively, before, 5 and 10 min after instillation of a drop each of either oxybuprocaine hydrochloride (oxybuprocaine HCl) (group 1) or carboxymethylcellulose sodium, thera tears (group 2), and placebo. RESULTS: The baseline mean CCT for SP-3000P was 509±38 µm and 542±36 µm for USP. No statistical significant differences between baseline CCTs (P>0.05 for both devices) in both groups. In both group experimental eyes, neither SP-3000P nor USP-measured CCTs varied significantly from the control eyes at 5 (P>0.05) and 10 (P>0.05) mins postinstillation of drops in both sessions. In group one, the 95% confidence intervals (CIs) for the SP-3000P CCTs were similar at 5 (-16 to 17 µm) and 10 min (-16 to 17 µm), but in the USP-measured CCTs, it was wider at 10 min (-41 to 46 µm) than at 5 min (-30 to 41 µm) postinstillation. In group two, the 95% CIs at 5 and 10 mins postinstillation, respectively, ranged between -20 and 47 µm, -21 and 43 µm (SP-3000P) and -29 and 23 µm, -26 and 23 µm (USP). Within groups and between groups, variations in CCT were similar at both times intervals in all comparisons. CONCLUSION: Although oxybuprocaine HCl and thera tears consistently did not affect the mean CCT obtained by both devices at both time intervals, variation in SP-3000P measured CCT was more consistent in both sessions and narrower in relation to USP-measured CCT. It may be reasonable to suggest that measurements of CCT in normal patients be taken before examinations requiring instillation of anesthetics or such measurements when obtained postinstillation of either oxybuprocaine or preserved artificial tears be interpreted with caution.

Screening and structural evaluation of deleterious Non-Synonymous SNPs of ePHA2 gene involved in susceptibility to cataract formation.

Age-related cataract is clinically and genetically heterogeneous disorder affecting the ocular lens, and the leading cause of vision loss and blindness worldwide. Here we screened nonsynonymous single nucleotide polymorphisms (nsSNPs) of a novel gene, EPHA2 responsible for age related cataracts. The SNPs were retrieved from dbSNP. Using I-Mutant, protein stability change was calculated. The potentially functional nsSNPs and their effect on protein was predicted by PolyPhen and SIFT respectively. FASTSNP was used for functional analysis and estimation of risk score. The functional impact on the EPHA2 protein was evaluated by using SWISSPDB viewer and NOMAD-Ref server. Our analysis revealed 16 SNPs as nonsynonymous out of which 6 nsSNPs, namely rs11543934, rs2291806, rs1058371, rs1058370, rs79100278 and rs113882203 were found to be least stable by I-Mutant 2.0 with DDG value of > -1.0. nsSNPs, namely rs35903225, rs2291806, rs1058372, rs1058370, rs79100278 and rs113882203 showed a highly deleterious tolerance index score of 0.00 by SIFT server. Four nsSNPs namely rs11543934, rs2291806, rs1058370 and rs113882203 were found to be probably damaging with PSIC score of ≥ 2. 0 by Polyp hen server. Three nsSNPs namely, rs11543934, rs2291806 and rs1058370 were found to be highly polymorphic with a risk score of 3-4 with a possible effect of Non-conservative change and splicing regulation by FASTSNP. The total energy and RMSD value was higher for the mutant-type structure compared to the native type structure. We concluded that the nsSNP namely rs2291806 as the potential functional polymorphic that is likely to have functional impact on the EPHA2 gene.

Effects of inhaled fluticasone on intraocular pressure and central corneal thickness in asthmatic children without a family history of glaucoma.

PURPOSE: The aim of this study is to report the effects of fluticasone-inhaled corticosteroid on intraocular pressure (IOP) and central corneal thickness (CCT) of asthmatic children without a family history of glaucoma. MATERIALS AND METHODS: In this prospective study, 93 children were divided into two groups: 69 asthmatic children with no family history of glaucoma who were taking inhaled fluticasone propionate 250 µg daily for at least 6 months (Group 1) and 24 age-matched control subjects without asthma (Group 2). Three measurements each, of IOP and CCT, were performed with a hand-held noncontact tonometer and a noncontact specular microscope, respectively, over a 12-week period. The order of IOP and CCT measured were randomized at each visit. Between-group comparison and the relationship between CCT and IOP measurements were investigated. P < 0.05 was statistically significant. RESULTS: The mean age was 8 ± 2.4 years (range, 5-15 years) and 9 ± 2.9 years (range, 5-15 years) for Groups 1 and 2, respectively (P = 0.1337). The mean IOP was 14 ± 3.3 mmHg (range, 10-24 mmHg) and 14 ± 2.9 mmHg (range, 11-22 mmHg) for Groups 1 and 2, respectively (P = 0.3626). The mean CCT was 531 ± 30.1 µm (range, 467-601 µm) and 519 ± 47.0 µm (range, 415589 µm) for Groups 1 and 2, respectively (P = 0.1625). There was a weak but statistically significant correlation between IOP and CCT in Group 1 (Pearson's R = 0.3580, P = 0.0025). CONCLUSIONS: Inhaled fluticasone at the regular dose used in this study over a short period (6-24 months) was not associated with a significant effect on CCT and IOP measured with noncontact devices in asthmatic children between 5 and 15 years, without a family history of glaucoma. A weak correlation between IOP and CCT values in asthmatic children did exist.

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.

Performance of the PT100 noncontact tonometer in healthy eyes.

BACKGROUND: The purpose of this study was to assess the repeatability and reproducibility of the PT100 noncontact tonometer and to compare its consistency with the Goldmann applanation tonometer (GAT) in measuring intraocular pressure (IOP). METHODS: Triplicate IOP measurements were obtained on two separate occasions using the PT100 and GAT from randomly selected eyes in 66 healthy volunteers aged 22 ± 1 years. The repeatability and reproducibility of each techniques was assessed. Agreement between the techniques was statistically quantified using intrasession repeatability for each technique as the basis for comparison. RESULTS: Both techniques returned equal IOP values in the first measurement session (15 ± 3 mmHg). The second session showed a mean difference in average IOP (1 ± 0.71). The 95% limits of agreement between the techniques were -5.2 to 5.5 mmHg and -4.0 to 4.7 mmHg (sessions 1 and 2, respectively). These mean differences were not statistically significant (P > 0.05, paired t-test), with the PT100 underestimating IOP measurement by 1.00 mmHg. The mean intrasession IOP for GAT sessions 1 and 2 was 0 ± 0.90 mmHg and 0.04 ± 1.06 mmHg, respectively, and the corresponding mean IOP measurement difference for the PT100 was -0.06 ± 0.96 and -0.39 ± 0.94 mmHg (sessions 1 and 2, respectively; P > 0.05, paired t-test). Repeatability coefficients for the GAT IOP measurements were 1.8 mmHg and 2.1 mmHg for sessions 1 and 2, while the PT100 repeatability coefficient was 1.9 mmHg and 1.8 mmHg for sessions 1 and 2, respectively. The intrasession repeatability coefficient of both techniques for test-retest differences were within ±5 mmHg. CONCLUSION: The PT100 noncontact tonometer produced greater repeatability than the GAT in assessment of IOP, whereas GAT resulted in more reproducible results. Both techniques showed a close level of agreement on comparison, with the PT100 underestimating IOP measurement by 1.0 mmHg only, although this was not clinically or statistically significant. Of importance is that the IOP measurements using these techniques could be interchangeable in the IOP range studied here.

Evaluation of the intraocular pressure measured with the ocular response analyzer.

PURPOSE: Comparison of the magnitude and repeatability of the intraocular pressure (IOP) measured with the Ocular Response Analyzer (ORA) to that measured with the Goldmann tonometer. METHODS: Two sets of IOP measurements were made, for 89 eyes of eighty-nine subjects, approximately 1-week apart. Goldmann tonometry was performed subsequent to non-contact tonometry, in which the order of measurement was randomized between the ORA and the Topcon CT80 non-contact tonometer (CT80). Each method was assessed twice for intrasession repeatability. The limits of agreement between each non-contact pressure and that measured with the Goldmann tonometer were assessed once per session. The level of statistical significance was 0.05. RESULTS: The mean differences between the ORA-corneal compensated, Goldmann-correlated, and CT80-IOP (ORA-IOPcc; ORA-IOPg and CT80-IOP) versus the Goldmann IOP were -0.3 +/- 2.7 mmHg (mean +/- SD), -0.3 +/- 2.2 mmHg and -0.3 +/- 2.1 mmHg, respectively for session 1 and 0.3 +/- 3.0 mmHg, 0.2 +/- 2.2 mmHg, and -0.5 +/- 2.2 mmHg, respectively, for session 2. The repeatability coefficients were +/- 5.3 mmHg, +/- 4.2 mmHg, +/- 2.5 mmHg, and +/- 1.9 mmHg, respectively for ORA-IOPcc, ORA-IOPg, CT80-IOP, and Goldmann IOP in session 1 and +/- 3.8 mmHg, +/- 3.6 mmHg, +/- 1.6 mmHg, and +/- 1.9 mmHg, respectively for session 2. CONCLUSION: The repeatability indices for the ORA were poorer than those with the Goldmann tonometer and the CT80 in both sessions. However, the average IOP measured with the ORA did not vary significantly from those measured with the other two tonometers in either session. The ORA provides valid, repeatable measures of IOP.

On repeated corneal applanation with the Goldmann and two non-contact tonometers.

BACKGROUND: Several authors believe it is necessary to randomise the order in which contact and non-contact tonometers are used in comparison studies. This study was carried out to investigate the effect of repeated applanation on the measured intraocular pressure. METHODS: One set of measurements per session was made on each of three sessions (one session per day) with the Goldmann and two non-contact tonometers (Topcon CT80 and Keeler Pulsair EasyEye), in a pre-determined order, on one randomly selected eye of 120 subjects randomised to one of two groups. For session one, only the non-contact tonometers were used to assess the intraocular pressure of both groups. For session two, either non-contact or Goldmann tonometry was performed first and this order was reversed for session 3. Average intraocular pressures were compared between sessions to determine the presence or absence of effects on the intraocular pressure caused by prior repeated applanation with the Goldmann or either one (or both) of the non-contact tonometers. RESULTS: Prior applanation with a non-contact tonometer did not cause a significant (p > 0.05) reduction of the mean pressure measured with either non-contact tonometer. The mean pressure was slightly but significantly (p < 0.05) reduced (for both non-contact tonometers in both subject groups) when non-contact tonometry was performed after Goldmann tonometry. There was no significant difference (p > 0.05) between the pressures measured with the Goldmann tonometer prior to and subsequent to non-contact tonometry, in both subject groups. CONCLUSION: A small but statistically significant reduction in the intraocular pressure was found following applanation with the Goldmann tonometer but not with either one of two non-contact tonometers.

The effect of repeated applanation on subsequent IOP measurements.

BACKGROUND: In studies aimed at assessing the accuracy and repeatability of non-contact tonometers, the order in which these tonometers and the Goldmann tonometer are used is usually randomised despite studies in the literature that demonstrate an ocular massage effect that occurs post-applanation but not after non-contact tonometry. The purpose of this study was to investigate the effect of repeated corneal applanation on subsequent assessments of IOP. METHODS: Data were obtained from 65 left eyes of 65 young, oculovisual normals. Three sets of IOP measurements were obtained, one set with the Goldmann applanation tonometer and two with the Topcon CT80 non-contact tonometer (one set each before and after applanation with the Goldmann tonometer), in each one of two separate measurement sessions, one week apart. RESULTS: The average (and SD) IOP measured with the Goldmann tonometer in the first session (14.8+/-2.9 mmHg) did not vary significantly from the IOP measured with the non-contact tonometer (pre-applanation) in both sessions or with the average Goldmann IOP in the second session. The bias (mean difference +/- SD) between methods was 0.3+/-1.4 mmHg and 0.4+/-1.4 mmHg, respectively, for the first and second sessions, with the CT80 (pre-applanation) recording the higher IOP in both sessions. The within-session repeatability coefficients were +/-2.3 mmHg, +/-2.6 mmHg, +/-2.1 mmHg and +/-2.0 mmHg for the CT80 (pre-applanation) in the first and second sessions, and the Goldmann tonometer in the first and second sessions, respectively. Test-retest repeatability coefficients were +/-2.8 mmHg and +/-2.5 mmHg for the CT80 (pre-applanation) and the Goldmann tonometer respectively. Post-applanation with the Goldmann tonometer, there was a statistically significant (p<0.05) reduction (1.5+/-1.2 mmHg in session 1) in the IOP measured with the non-contact tonometer in both sessions. CONCLUSION: These results suggest that repeated corneal applanation leads to a statistically significant reduction in IOP on subsequent measurements.

Accuracy and reliability of the Keeler Pulsair EasyEye non-contact tonometer.

PURPOSE: To evaluate the accuracy and reliability of the Keeler Pulsair EasyEye noncontact tonometer in a normotensive population. METHODS: This masked prospective clinical study included 72 right eyes of 72 subjects. Two sets of intraocular pressure measurements were made 1 week apart. Intraocular pressure assessment with the Goldmann tonometer was always subsequent to that with the noncontact tonometer. Each method was assessed for within-session and test-retest repeatability and both methods were assessed for limits of agreement, twice. The level of significance for this study was 0.05. RESULTS: Both methods were repeatable within-sessions to within +/-2 mm Hg, and between sessions to within +/-3 mm Hg. Neither the within-session differences nor the between session differences differed significantly between the Goldmann tonometer and the Pulsair EasyEye noncontact tonometer. The mean differences (+/-SD) between both methods (0.1 +/- 1.6 mm Hg and 0.05 +/- 1.7 mm Hg, for the first and second sessions, respectively) were not statistically significant, but the intraocular pressure measured with the Pulsair EasyEye tonometer was consistently higher than that measured with the Goldmann tonometer. CONCLUSIONS: The Pulsair EasyEye noncontact tonometer is considered an accurate reliable method in the normotensive population studied but because of a systematic bias in a small number of subjects, it cannot be used interchangeably with the Goldmann tonometer.

Clinical investigation of the effect of topical anesthesia on intraocular pressure.

BACKGROUND/AIMS: Contact tonometry is generally considered more accurate than non-contact tonometry in the assessment of intraocular pressure (IOP). This study was designed to investigate the effect of ocular anesthesia, a pre-requisite for contact tonometry, on the IOP in a sample of visually normal subjects. METHOD: In a random sample of 120 young visually normal subjects (divided equally among three groups), the Topcon CT80 non-contact tonometer was used to measure IOP before, at the second minute and at the fifth minute following instillation of one drop of one of three eyedrops - carboxymethylcellulose sodium 0.5% (control), oxybuprocaine hydrochloride 0.4% and proparacaine hydrochloride 0.5%. RESULTS: The IOP measured before instilling the ophthalmic drops did not vary significantly among the three groups of subjects (p > 0.05). In the control group, the average IOP of 15.1 +/- 2.6 mmHg did not vary significantly (p > 0.05) 2 minutes and 5 minutes following instillation of one drop of Carboxymethylcellulose sodium. There were statistically significant reductions of IOP 2 minutes (p < 0.01) and 5 minutes (p < 0.001) after the instillation of one drop of oxybuprocaine hydrochloride. One drop of proparacaine hydrochloride caused significant reductions in the average IOP after 2 minutes (p < 0.001) and after 5 minutes (p < 0.001). CONCLUSIONS: One drop of topical proparacaine or oxybuprocaine may cause a small but a statistically significant reduction in IOP which could lead to lower IOP readings.

Repeatability of central corneal thickness measurements measured with the Topcon SP2000P specular microscope.

BACKGROUND: The non-contact specular microscope has become the method of choice for a quick, accurate and non-invasive assessment of central corneal thickness (CCT), which is an important variable to monitor before and after refractive surgery. The consistency of the results produced by such widely used methods/equipment must be assessed to determine their reliability. The purpose of this study was to assess within- and between-observer repeatability of, and to determine if a systematic bias exists in the measurements made by, the Topcon SP2000P specular microscope. METHODS: The CCT of the right eyes of 70 adult subjects, divided equally between men and women, was assessed on two separate occasions (4-7 days apart) by each of two examiners using the low-intensity auto mode of the SP2000P specular microscope. RESULTS: The average CCT values for men and women, measured by one observer, were 0.52+/-0.03 mm (mean +/- SD) and 0.52+/-0.04 mm, respectively. The average for the entire sample was 0.52+/-0.04 mm. Within- and between-observer repeatability were assessed by plotting the mean difference (for each subject) between two readings made by the same observer or one each by both observers against the combined average CCT reading of both sessions; the mean difference between two sets of observations was not significantly different from zero (P<0.05). For the first observer, the 95% limits of repeatability were between -0.015 and 0.017 mm. For the second observer, the 95% limits of repeatability were between -0.018 and 0.018 mm. For the between-observer repeatability, the 95% limits of agreement were between -0.016 and 0.016 mm. For both within- and between-observer repeatability, we found no systematic bias of the mean difference with the average CCT reading. CONCLUSION: The within- and between-observer limits of agreement we found were similar to those previously reported for the Topcon SP2000P specular microscope; the range of the 95% limits of repeatability were within +/-1 SD of the average CCT reading for both sessions. We suggest that a technique be considered reliable if: (1) the mean difference between two measurements does not vary significantly from zero, (2) there is no systematic bias of the mean difference with the magnitude of the measured quantity and (3) the error inherent in a measurement technique is within +/-1 SD of the average measurement of the two sessions.

Limits of agreement between the optical pachymeter and a noncontact specular microscope.

PURPOSE: To determine the limits of agreement between central corneal thickness (CCT) measurements made with the slit lamp-attached optical pachymeter and the SP2000P noncontact specular microscope. METHODS: Triplicate readings for CCT were obtained for each of 130 (right) eyes of 130 patients, using the slit lamp-attached optical pachymeter and then the SP2000P noncontact specular microscope. The average CCT measured by each method was compared. Subsequently, the mean difference between both sets of measurements was assessed, and the 95% confidence interval (limits of agreement) between both techniques was determined. RESULTS: The mean +/- SD CCT measured by the optical pachymeter was 543 +/- 34 microm and 532 +/- 34 microm for the specular microscope. We found a statistically significant (P < 0.001) mean bias of 10 mum between CCT values measured with both types of equipment, with the optical pachymeter returning the higher values. The coefficient of variation was 6.3% for the optical pachymeter and 6.4% for the specular microscope. CONCLUSIONS: The right eye CCT measurements made by the optical pachymeter are, on average, 10 mum thicker than those made with the SP2000P specular microscope, which suggests that both pieces of equipment cannot be used interchangeably to monitor CCT changes in patients. Excluding left eye measurements, the reliability of the optical pachymeter is identical to that of the noncontact specular microscope.