Repeatability of Noninvasive Break-Up Time Measurements using Keratograph Oculus 3.

AIM: The primary aim of this study is to evaluate the repeatability of noninvasive break-up time (NIBUT) measurement by keratograph when it is determined from one, two or three partial measurements, and to recommend a suitable methodology for practice. Another goal is to verify that repeated measurements do not affect the measured value. MATERIAL AND METHODS: Thirty-eight healthy volunteers (30 women and 8 men) aged between 19 and 50 years old were included in the study, in which only one eye of each volunteer was measured. The study was designed as a prospective one. Each subject adapted to the local conditions of the laboratory for 15 minutes and subsequently underwent two series of NIBUT measurements (test, retest) on an OCULUS 3 Keratograph. The minimum time interval between the two series was 10 minutes, in which each series contained three partial measurements approximately 3 three measurements in the given series. Repeatability was assessed by a Bland-Altman analysis and expressed as a repeatability coefficient. In every case, only the time of the first break-up of the tear film was monitored. RESULTS: The statistical analysis did not show statistically significant differences both between partial measurements of NIBUT in the individual series (p = 0.92, p = 0.81) and when comparing all six measurements (p = 0.95). The mean values of the partial measurements ranged from 13.6 s to 14.4 s. The repeatability coefficients were found to be 15.0 s, 12.1 s and 10.0 s for methodologies A, B and C, respectively. A supplementary analysis for 12 eyes with low NIBUT (< 10 s) showed statistically significantly better repeatability in this group, with coefficients of 7.0 s (methodology A), 6.0 s (B) and 4.6 s (C). CONCLUSION: Determination of NIBUT from three consecutive measurements (with a sufficient interval of ideally a few minutes) significantly improves repeatability. Such repeated NIBUT measurements do not have a significant effect on the measured value. The mentioned methodology for measuring NIBUT on a keratograph can be recommended for use in practice.

Crowding can impact both low and high contrast visual acuity measurements.

The adverse impact of adjacent contours on letter visual acuity is known as crowding but there is conflicting evidence that foveal crowding may be reduced or disappears under low contrast conditions. Potential differences in foveal crowding with contrast on clinical measurements of visual acuity, including test-retest repeatability, were assessed. Visual acuity was measured at the fovea on adult participants with normal vision under three different contrast levels (- 90, - 10 and - 5%). Three rows of 5 letters, each row differing in size by 0.05 logarithm of the minimum angle of resolution (logMAR) from largest to smallest were displayed at the center of a monitor. Crowding was varied by varying the separation between horizontally adjacent letters from 100% optotype size to 50%, 20% and 10% optotype size. Inter-row spacing was proportional to optotype size. Observers read the letters on the middle row only. Measurements continued by reducing the size of the letters until 3 or more errors were made and were repeated on two separate days. Visual acuity worsened as both letter contrast decreased and inter-optotype separation reduced (expressed as a percentage of letter width). When expressed in minutes of arc of separation the impact of crowding was the same across all contrasts. Crowding occurs for both high and low contrast charts and should be considered when assessing low contrast visual acuity. Test-retest repeatability showed little or no dependence on either contrast or inter-optotype separation.

Number of flankers influences foveal crowding and contour interaction differently.

Nearby flanking objects degrade visual resolution. If the flankers are similar to the acuity target, this influence is called crowding (CW), whereas if the flanking stimuli are simple bars then the phenomenon is known as contour interaction (CI). The aim of this study was to compare the influence of the number and position of flankers on foveal CW and CI to investigate possible differences in mechanism of these two effects. Five normal observers viewed single, foveally presented Sloan letters surrounded by 1, 2 or 4 flankers (either a Sloan letter or one-stroke-width bars), presented at several edge-to-edge separations. Single flankers were presented in the right, left, top or bottom position, 2 flankers were placed equally to the right and left or top and bottom of the central target, and 4 flankers were equally spaced in all four directions. Percent correct letter identification was determined for each type, number, position and separation of flankers and confusion matrices were constructed for separations equal to 20% and 100% letter width. Increasing the number of flankers caused an increase in the magnitude of both phenomena. CW showed a greater magnitude than CI for higher numbers of flankers. Analysis of confusion matrices suggests that in addition to the edge-to-edge interaction that appears to mediate CI, letter substitution and feature pooling contribute significantly to CW when higher numbers of flankers are presented. Foveal CW is more strongly influenced by an increase in the number of flankers than CI, which can be explained by the presence of additional interaction effects.

Technical Report: The Mechanism of Contour Interaction Differs in the Fovea and Periphery.

SIGNIFICANCE: Both foveal and peripheral contour interactions are based on, as yet, unexplained neural mechanisms. Our results show that, unlike foveal contour interaction, peripheral contour interaction cannot be explained on the basis of the antagonistic structure of neural receptive fields. PURPOSE: Foveal contour interaction is markedly reduced for mesopic compared with photopic targets. This finding is consistent with an explanation based on the antagonistic structure of neural receptive fields. However, no reduction was found for low-luminance targets in the periphery, possibly because the luminances used previously remained substantially above peripheral scotopic detection thresholds. In this study, we compared foveal and peripheral contour interactions for long-wavelength photopic and mesopic targets, which would be expected to significantly elevate the peripheral retinal detection threshold. METHODS: Five normal observers viewed a randomly selected Sloan letter surrounded by four flanking bars at several edge-to-edge separations (min arc). Photopic and mesopic stimuli were viewed foveally and at 6° peripherally through a selective red filter that ensured that mesopic targets were within 1 log unit of detection threshold at both retinal locations. RESULTS: Whereas the magnitude of foveal contour interaction was substantially less at mesopic compared with photopic luminance (20 vs. 46% reduction of percent correct, on average), no significant difference was observed in peripheral contour interaction, which had average mesopic and photopic magnitudes of 38 and 40%. Moreover, confusion matrices representing photopic and mesopic contour interaction differed in the fovea but not in the periphery. The extent of contour interaction did not change with luminance at either retinal location. CONCLUSIONS: Our results indicate that, although the characteristics of foveal contour interaction can be accounted for by the antagonistic structure of neural receptive fields, the same mechanism is not compatible with the characteristics of peripheral contour interaction.

Upturn of the contour-interaction function at small flanking bar-to-target separations.

Nearby flanking bars degrade letter identification and resolution, a phenomenon known as contour interaction. However, many previous studies found that the relationship between foveal letter identification and flanker separation is non-monotonic, with an upturn in performance at very small target-to-flanker separations. Here, we replicate this observation and show that a similar upturn occurs also for targets presented at 5 deg in the inferior field, if the target-to-flanker separation is sufficiently small. The presence and magnitude of the observed performance upturn depends on the flanking-bar width, being more evident for narrower compared to wider flanking bars. We interpret our results to indicate that neural interactions between nearby contours reduce performance when the target and flanking bars form discrete neural images. At sufficiently small separations, the images of the target and flanking bars can not be distinguished and performance is governed by the contrast of the target in the blended neural image.

Intraocular pressure response affected by changing of sitting and supine positions.

PURPOSE: To assess the intraocular pressure (IOP) time response to change in body position from sitting to supine and from supine to sitting immediately and during rest in each position. METHODS: Forty-four visually healthy volunteers were recruited for the study. The experiment consisted of the initial sitting position (baseline state), the subsequent lying period and the final sitting period. Both periods were 30 min long. The IOP was measured in the baseline state, immediately after each position change and then in minutes 5, 15, 25 and 30 during each period. The Icare Pro® rebound tonometer was used. RESULTS: The mean IOP increased after each position change (2.6 ± 2.4 mmHg after lying down and 2.1 ± 3.1 mmHg after sitting up) and then gradually decreased with time. The mean IOP was 1.41 ± 2.4 mmHg higher in the lying period than in the sitting period; the mean difference was smaller for the lower baseline (0.9 ± 2.2 mmHg) than the higher baseline (1.9 ± 2.5 mmHg). The mean IOP in the final sitting was significantly lower (2.5 ± 1.9 mmHg) than in the initial sitting position. The effect of sex was insignificant. CONCLUSIONS: There was an immediate increase in IOP as a response to both changes in the body position and the subsequent gradual decrease with time. The IOP difference between lying and sitting position was depended on baseline.

Contrast Energy and Contour Interaction.

SIGNIFICANCE: Contour interaction describes an impairment of visual acuity produced by nearby flanking features, which exerts a significant impact in many clinical tests of visual acuity. Our results indicate that the magnitude of interaction depends either on the flanker contrast energy (i.e., the product of flanker contrast and width) or the flanker contrast alone, depending on the contrast energy of the flankers. PURPOSE: The discrimination of acuity targets is impaired by the presence of nearby flanking contours, a phenomenon known as contour interaction. METHODS: In this study, we measured percent correct identification for threshold size, high-contrast Sloan letters at the fovea and at 5° in the inferior visual field for different combinations of flanking-bar width, and Weber contrast corresponding to specific fixed values of contrast energy (width × contrast, in %-min arc). RESULTS: For flanking bars with low-contrast energy, contour interaction exhibited no systematic dependence on the flanking-bar width. However, when the flanking bars had higher contrast energy, narrower high-contrast bars produced significantly greater contour interaction than wider bars of lower contrast. CONCLUSIONS: The results are consistent with the interpretation that contour interaction depends primarily on the contrast energy of flanking contours when their contrast energy is low. As the contrast energy of the flanking contours increases, the magnitude of contour interaction depends on the flanker contrast. For high-contrast flanking contours, the magnitude of contour interaction saturates when the width of the flanking contours is approximately 20% of letter size.

Contour interaction under photopic and scotopic conditions.

In the present study, we asked whether contour interaction undergoes significant changes for different luminance levels in the central and peripheral visual field. This study included nine normal observers at two laboratories (five at Palacky University Olomouc, Czech Republic and four at the University of Houston, USA). Observers viewed a randomly selected Sloan letter surrounded by four equally spaced bars for several separations measured edge-to-edge in min arc. Stimuli were viewed foveally under photopic and mesopic luminances and between 5° and 12° peripherally for four different background luminances of the display monitors, corresponding to photopic, mesopic, scotopic, and dim scotopic levels. The extent of the contour interaction in the fovea is approximately 20 times smaller than in the periphery. Whereas the magnitude of foveal contour interaction markedly decreases with decreasing luminance, no consistent luminance-induced change occurs in peripheral contour interaction. The extent of contour interaction does not scale with the size of the target letter, either in the fovea or peripherally. The results support a neural origin of contour interaction consistent with the properties of center-surround antagonism.

Mesopic visual acuity is less crowded.

PURPOSE: The decrease in visual acuity under low luminance conditions is well known. Recent laboratory evidence showed that crowding under low luminance (mesopic) light levels is less robust than under photopic conditions. The present study examines whether such differences in crowding influence clinical measurements of mesopic visual acuity, including test-retest repeatability. METHODS: Twenty adult subjects with normal or corrected to normal visual acuity were recruited for the study. Monocular visual acuity was measured under photopic (228 cd/m2) and mesopic (0.164 cd/m2) luminance conditions using a letter chart, similar in principle to the ETDRS logMAR chart, presented on a computer monitor. Three rows of five letters, each row differing in size by 0.05 logMAR from largest to smallest were displayed at the center of the monitor. The level of crowding was varied by varying the separation between horizontally adjacent letters from 100% optotype size to 50, 20, and 10% optotype size. Inter-row spacing was proportional to optotype size. Observers read the letters on the middle row only. Measurements continued by reducing the size of the letters, until three or more errors on the middle row were made. Each correctly identified letter contributed 0.01 to the recorded logMAR score. All measurements were repeated for each subject on two separate days. RESULTS: Visual acuity (logMAR) was significantly better under photopic than mesopic luminance conditions with a mean difference of 0.48 logMAR. Visual acuity also decreased with decreasing letter separation (i.e. increase in crowding). However, the decrease in visual acuity for the smallest letter separation was less under the mesopic luminance condition, even after accounting for the increased size of threshold acuity letters. Test-retest repeatability for mesopic and photopic conditions was not significantly different. CONCLUSIONS: Crowding under mesopic luminance conditions has less impact on visual acuity than under photopic luminance.

Intraocular Pressure Response to Maximal Exercise Test during Recovery.

SIGNIFICANCE: The main aim of this study was to determine the intraocular pressure (IOP) response to maximal incremental running test during 30 minutes of recovery. Exhaustive exercise induced a highly individually variable IOP response, which was related to its initial value and the initial heart rate. PURPOSE: The purpose of the study was to analyzed the IOP response to a maximal incremental running test in healthy women during a 30-minute recovery period. Secondarily, the study attempted to determine if the IOP was dependent on its baseline, maximal oxygen uptake, initial heart rate, and autonomic nervous system regulation. METHODS: Twenty-four healthy women between the ages of 19 and 30 years were recruited for the study. Initial IOP (baseline), heart rate, and autonomic nervous system regulation were measured after 30 minutes of rest. Each subject then underwent an incremental running test on a treadmill to reach the maximal physical activity and to determine physical fitness based on maximal oxygen uptake. Intraocular pressure and autonomic nervous system activity were measured immediately after completion of the physical activity during a 30-minute recovery period in the supine position. RESULTS: The IOP variability increased markedly after the exercise up to 1.7-fold of the resting state. The IOP before and after exercise did not differ significantly; however, the lower baseline revealed a significant increase in comparison with the higher baseline. The time course of the IOP changes was significantly influenced by the initial heart rate. All other effects, interactions, and correlations were insignificant. CONCLUSIONS: The IOP response after maximal exercise was highly dependent on the individual. The IOP seems to be slightly increasing with a significant dependence on its resting baseline and initial heart rate.

Intraocular Pressure Response to Short-Term Extreme Normobaric Hypoxia Exposure.

Purpose: The purpose of the study was to determine the intraocular pressure response to normobaric hypoxia and the consequent recovery under additional well-controlled ambient conditions. Second, the study attempted to determine if the intraocular pressure changes were dependent on its baseline, initial heart rate, sex and arterial oxygen saturation. Methods: Thirty-eight visually healthy volunteers (23 women and 15 men) of an average age 25.2 ± 3.8 years from 49 recruited participants met the inclusion criteria and performed the complete test. Initial intraocular pressure (baseline), heart rate, and arterial oxygen saturation were measured after 7 min of rest under normal ambient conditions at an altitude 250 m above sea level. Each subject then underwent a 10 min normobaric hypoxic exposure and a subsequent 7 min recovery under normoxic conditions. Within hypoxic period, subjects were challenged to breathe hypoxic gas mixture with fraction of inspired oxygen of 9.6% (~6.200 m above sea level). Intraocular pressure and arterial oxygen saturation were re-measured at 4 and 10 min during the hypoxia and at 7 min after hypoxia termination. Results: Intraocular pressure increased in 1.2 mmHg ± 1.9 mmHg and 0.9 mmHg ± 2.3 mmHg at 4 and 10 min during the hypoxic period and returned approximately to the baseline at 7 min of recovery. The influence of sex was not statistically significant. The arterial oxygen saturation decreased in 14.9 ± 4.2% at min 4 and 18.4 ± 5.8% at min 10 during hypoxia and returned to the resting value at 7 min of recovery. The decrease was slightly higher in the case of women if compared with men. The hypoxia induced changes in intraocular pressure were significantly correlated with the arterial oxygen saturation changes, whereas the relationship with intraocular pressure baseline and initial heart rate were insignificant. Conclusion: There was a significant increase in intraocular pressure as a response to short-term normobaric hypoxia, which returned to the baseline in 7 min after hypoxia. The increase was dependent on the induced oxygen desaturation.

Intraocular Pressure Response to Moderate Exercise during 30-Min Recovery.

PURPOSE: The aim of the study was to evaluate intraocular pressure (IOP) before and after moderate exercise in normal healthy individuals with defined physical exertion. The second aim of this investigation was to determine the correlation between resting IOP (IOPr) and its change induced by exercise as well as the relationship between resting heart rate (HRr) and changes in IOP after exercise. METHODS: Forty-one healthy volunteers between the ages of 19 and 25 years were recruited for the study. First, the resting (reference) values IOPr and HRr were measured after 30 min of resting time. Volunteers consequently performed 30 min of exercise on a bicycle ergometer. Intraocular pressure was remeasured immediately after the end of exercise (the relevant IOP change was denoted as ΔIOP0) and subsequently repeated 5, 10, 20, and 30 min after exercise. RESULTS: A significant decrease in IOP compared with the resting value (post hoc Tukey honest significant difference test) was found immediately after exercise (p = 2 × 10) and 5 and 10 min after exercise (p = 2 × 10 and p = 3 × 10). Significant relationships were found between the change in IOP (ΔIOP0) and baseline IOP (IOPr) and between the baseline resting heart rate (HRr) and the change in IOP (ΔIOP0). CONCLUSIONS: There was a significant IOP-lowering effect, which was persistent for 10 min after 30 min of exercise. The IOP change was dependent on the initial IOP reading and initial HR.

The importance of angle kappa evaluation for implantation of diffractive multifocal intra-ocular lenses using pseudophakic eye model.

PURPOSE: To determine the critical value of the angle kappa in connection with a higher risk of photic phenomena for the AcrySof ReSTOR and Tecnis multifocal intra-ocular lens (MIOL) on a standardized pseudophakic eye model. To analyse the impact of biometric value changes on the critical angle kappa. METHODS: Geometrical optic rules applied to a suitable optical model of the pseudophakic eye were used to calculate the critical value of the angle kappa for the Tecnis and three types of the AcrySof ReSTOR MIOLs. The angle kappa was defined as critical if the incident ray passed through the first ring's edge area. The influence of different positive optical corneal power (K), effective lens position (ELP) and axial length (AL) on the critical angle kappa (κc) was investigated. The dependence of κc on one of the parameters was studied for standardized values of the remaining parameters. RESULTS: The highest value of the critical angle kappa was evaluated for the Tecnis MIOL. The increase in ELP and K caused an increase in κc under the given conditions. On the contrary, an increase in AL led to lower values of κc. CONCLUSION: We demonstrated the dependence of the critical angle kappa on the central part of the MIOL and on biometric parameters of the eye, especially on the effective lens position. According to these results, we conclude that shallow anterior chamber depth in connection with a higher angle kappa is an important risk factor for pronounced photic phenomena after implantation of a diffractive MIOL.

Comparison of reliability of the eye optic disc cup and pallor areas in glaucoma diagnostics.

The aim of this paper is to compare the glaucoma diagnostic reliability of two optic disc parameters: the relative cup area size determined by the Heidelberg retina tomography and the relative pallor area size determined by the proposed algorithm of the optic disc image analysis. Both parameters were measured for 240 normal healthy eyes and 240 glaucomatous eyes. The diagnostic reliability of studied parameters were compared using normalized distance d of their statistical distributions obtained for normal healthy and glaucomatous eyes and by comparison of area sizes under their ROC (Receiver Operating Characteristic) curves. The normalized distances were 2.19 or 1.73 and the area sizes under ROC curves were 0.95 or 0.89 for relative cup or pallor area size. Both considered relative parameters are significantly influenced by the glaucoma and can be used in its diagnostics. The designed pallor analysis is less diagnostic reliable than the analysis of the cup.

Contour interaction for foveal acuity targets at different luminances.

Single-letter visual acuity is impaired by nearby flanking stimuli, a phenomenon known as contour interaction. We showed previously that when foveal acuity is degraded by a reduction of letter contrast, both the magnitude and angular spatial extent of foveal contour interaction remain unchanged. In this study, we asked whether contour interaction also remains unchanged when foveal visual acuity is degraded by a reduction of the target's background luminance. Percent correct letter identification was measured for isolated, near-threshold black Sloan letters and for letters surrounded by 4 flanking bars in 10 normal observers, 5 at Anglia Ruskin University, UK (ARU) and 5 at Palacky University, Czech Republic (PU). A stepwise reduction in the background luminance over 3 log units resulted in an approximately threefold increase in the near-threshold letter size. At each background luminance, black flanking bars with a width equal to 1 letter stroke were presented at separations between approximately 0.45 and 4.5 min arc (ARU) or 0.32 and 3.2 min arc (PU). The results indicate that the angular extent of contour interaction remains unchanged at approximately 4 min arc at all background luminances. On the other hand, the magnitude of contour interaction decreases systematically as luminance is reduced, from approximately a 50% reduction to a 30% reduction in percent correct. The constant angular extent and decreasing magnitude of contour interaction with a reduction of background luminance suggest foveal contour interaction is mediated by luminance-dependent lateral inhibition within a fixed angular region.