Efficacy of two silicone-hydrogel contact lenses for bandage use after photorefractive keratectomy.

PURPOSE: To evaluate the efficacy of two silicone hydrogel (SiH) contact lenses, approved for continuous wear for one week, following photorefractive keratectomy (PRK). METHODS: Forty seven myopic patients (94 eyes) undergone bilateral PRK were enrolled in this prospective, double-masked, comparative study. One eye of each patient was fitted with a Lotrafilcon B lens (Ciba Vision, Duluth, US; 30-day recommended replacement) whereas the fellow eye was fitted with an Asmofilcon A lens (Menicon, Nagoya, Japan; 14-day recommended replacement). Epithelial defect size was assessed using slit lamp biomicroscopy on the day of surgery and at days 1-4 post-operatively. Uncorrected and best-corrected visual acuity and retinal straylight (C-Quant, Oculus Optigerate, Germany) were evaluated pre-operatively and one month post-operatively. RESULTS: Average epithelial defect size for Asmofilcon A and Lotrafilcon B was 25.5±11.0mm(2) vs. 27.1±9.9mm(2) at day 1 (p=0.007) and 6.3±7.0mm(2) vs. 9.2±9.5mm(2) at day 2 (p=0.012) post-operatively. Re-epithelialization at day 3 was completed in 87.2% of the eyes fitted with Asmofilcon A lenses, compared to 74.5% with Lotrafilcon B lenses (p=0.012). At the 3rd post-operative day 29.8% of re-epithelialized eyes showed irregular suture with Lotrafilcon B, compared to 12.8% eyes with Asmofilcon A lenses (p<0.001). Finally, no statistically significant differences were found post-operatively between the two lenses retinal straylight (p=0.98) and best-corrected visual acuity (p=0.68). CONCLUSIONS: SiH lenses can be used as an effective bandage after PRK due to the limited time requested for achieving complete corneal re-epithelialization. Faster and smoother epithelial healing is provided with Asmofilcon A over Lotrafilcon B lenses.

Threat and anxiety affect visual contrast perception.

Threat cues activate the visual cortex and are detected faster than neutral cues as evidenced by functional brain imaging during viewing of visual threat and neutral stimuli. The functional visual processes underlying these phenomena have not been determined. Pattern visual evoked potentials were elicited in a baseline and a verbal threat condition with two stimulus contrasts in subjects with high and low trait anxiety. Threat reduced the latency of the early P100 wave in the low but not the high anxious group. The reduction was greater with increasing stimulus contrasts. The dependence of the P100 latency on trait anxiety is reminiscent of the Yerkes-Dodson inverted U-shape curve, which relates anxiety to behavioural responses. These results show that threat affects perceptual processes and suggest that data based on the effects of threat in visual search studies should be reappraised to include acceleration of contrast perception.

Summation characteristics of the detection of compound gratings.

Many classical experiments have shown that two superimposed gratings are more easily detected than a single grating, in keeping with probability theory. Here we test the rules for the detection of 2-component compound gratings by extending the range of parameters used in previous experiments. Two complementary methods of deriving summation indices are described. Data are presented so that the conditions for the transition from probability to neural summation are easily identified. True probability summation occurs only when grating contrasts are carefully perceptually equalised and spatial frequency differs by more than a factor of 2. A wide range of contrast ratios of the component gratings were explored such that gratings were at different contrasts, relative to respective thresholds. We find clear evidence of suppressive interactions when the compound gratings are composed of a close to threshold low frequency component and a below-threshold higher spatial frequency component.

Comparison of the ocular wavefront aberration between pharmacologically-induced and stimulus-driven accommodation.

PURPOSE: To compare the ocular wavefront aberration between pharmacologically- and stimulus-driven accommodation in phakic eyes of young subjects. METHODS: The aberration structure of the tested eye when accommodating was measured using the Complete Ophthalmic Analysis System (COAS; AMO WaveFront Sciences, Albuquerque, NM, USA). It was used in conjunction with a purposely-modified Badal optometer to allow blur-driven accommodation to be stimulated by a high contrast letter E with a vergence range between +0.84 D and -8.00 D. Pharmacological accommodation was induced with one drop of pilocarpine 4%. Data from six subjects (age range: 23-36 years) with dark irides were collected. RESULTS: No correlation was found between the maximal levels of accommodative response achieved with an 8 D blur-driven stimulus and pharmacological stimulation. Pharmacological accommodation varied considerably among subjects: maximum accommodation, achieved within 38-85 min following application of pilocarpine, ranged from 2.7 D to 10.0 D. Furthermore, although the changes of spherical aberration and coma as a function of accommodation were indistinguishable between the two methods for low levels of response, a characteristic break in the pattern of aberration occurred at higher levels of pilocarpine-induced accommodation. This probably resulted from differences in the time course of biometric changes occurring with the two methods. CONCLUSION: Measuring the pilocarpine-induced accommodative response at only one time point after its application may lead to misleading results. The considerable inter-individual differences in the time course of drug-induced accommodative response and its magnitude may lead to overestimation or underestimation of the corresponding amplitude of normal, blur-driven accommodation. Stimulating accommodation by topical application of pilocarpine is inappropriate for evaluating the efficacy of 'accommodating' IOLs.

The value of contrast sensitivity in diagnosing central serous chorioretinopathy.

A 39-year-old hyperopic male was referred for laser refractive treatment. In the course of the pre-operative evaluation he complained of a recent deterioration of vision. The suspicion of unilateral central serous chorioretinopathy (CSCR) was confirmed by contrast sensitivity testing and by ocular fundus examination. Contrast sensitivity (CS) for six spatial frequencies (1, 2, 4, 8, 12 and 16 c/deg) was evaluated using Gabor patches of gratings projected on a high-resolution display by means of a stimulus generator card. Although VA remained unaltered, the pattern of contrast sensitivity function varied at different stages of CSCR: during the acute stage, performance at all spatial frequencies was depressed, while at two-month follow up, intermediate and high spatial frequencies were mainly affected. It is concluded that the level of visual deficit in CSCR cannot be evaluated by measuring visual acuity. History and contrast sensitivity can play a central role in setting the correct diagnosis and characterising its stage.

The dazzle reflex: electrophysiological signals from ocular muscles reveal strong binocular summation effects.

Under dark adapted or dim conditions the mammalian visual system is carefully programmed to respond rapidly to the sudden onset of bright lights. This response, called the dazzle reflex, is controlled from sub-cortical structures of the brain. It is known anecdotally that exposure to a bright light when dark adapted induces an instinctive closure of one eye to reduce the pain associated with dazzle. This binocular summation of the dazzle response has not previously been reported. The dazzle reflex can be measured in human subjects by recording the electrical activity from surface electrodes located near the muscles around the eye. In this paper we report an investigation of the apparent binocular summation of the dazzle reflex using this technique. The data reveal a clear difference between monocular and binocular stimulation, with the binocular response being much larger than the monocular response. Furthermore this monocular/binocular difference arises only if the stimulus duration is longer than approximately 1 s. These observations are interpreted in terms of the known physiology of blink mechanisms.

Road traffic casualties: understanding the night-time death toll.

A disproportionate number of fatal injuries occur after dark. The paper presents some statistics of road traffic injuries in a novel way which suggests that low luminance plays a major role in this effect. A sound physiological explanation for this is advanced based on the poor temporal characteristics of rod photoreceptors. It is argued that processing information based on low luminance, low contrast targets is much slower than that for high contrast bright targets. To test the idea, simple visual reaction times were measured under typical low visibility conditions encountered on non-lit roads and were found to be substantially longer than under optimal conditions. It is shown that longer reaction times translate into significantly increased stopping distances. This important point has received insufficient attention in the road safety literature, by the Highways Agency, the police, injury prevention officials, and the UK Highway Code.

Effect of foveal tritanopia on reaction times to chromatic stimuli.

To investigate the effect of foveal inhomogeneities on sensitivity to chromatic stimuli, we measured simple reaction times (RTs) and detection thresholds to temporally and spatially blurred isoluminant stimuli at retinal eccentricities from 0 deg to 8 deg. Three color-normal subjects participated. Contrast gain was derived from the slope of the RT versus contrast function. With a Gaussian spatial distribution (S.D. = 0.5 deg) and modulation between white (CIE x, y, L = 0.31, 0.316, 12.5 cd x m(-2)) and blue (MBDKL 90 deg), gain was maximal at about 2-deg eccentricity and declined by approximately 1 log unit towards the center and the periphery. The red (0 deg) and green (180 deg) cardinal axes showed maximum gain in the center, whilst the yellow (270 deg) data were intermediate. Although the spatial extent of the Gaussian spot was much larger than the S-cone free zone, we wished to determine whether foveal tritanopia was responsible for the marked drop in sensitivity to the 90-deg stimulus. To align the color vector along a tritan line, we used a smaller disk (0.3 deg) with a blurred edge and measured detection threshold, rotating the vector until minimum central sensitivity was obtained. Other workers have used transient tritanopia or minimally distinct border to similar effect. By repeating this at different locations in color space, a group of vectors were obtained. These converged near to the S-cone co-punctal point, evidence that they lay along tritan confusion lines. These threshold findings were then confirmed using the RT-derived contrast gain function. The tritan vectors were less pronounced as stimulus size increased. With the vector optimized to produce foveal tritanopia, the RT gain versus eccentricity functions for the 90-deg and 270-deg stimuli both fell markedly in the center and periphery, and sensitivity peaked at about 3-deg eccentricity. There are some similarities between these findings and the underlying photoreceptor distributions. As a result, there is a greater difference in gain between red-green and blue-yellow systems in the center than in the near periphery. We conclude that the RT versus contrast function is a sensitive index of foveal opponency.

Contrast coding and magno/parvo segregation revealed in reaction time studies.

Reaction times (RTs) are obtained for a wide range of contrasts of vertical sinusoidal gratings. The data are plotted as a function of the reciprocal of contrast. In some conditions, a single linear function accounts for the data. In others a clear bi-linear function is obtained. The low and high contrast regions of the function are interpreted as representing magno and parvo activity, respectively. RT-based supra-threshold sensitivity functions are obtained for different luminances, stimulus durations and eccentricities and these are compared with conventional threshold-based sensitivities to establish the extent to which RTs and contrast sensitivity are constrained by the same sensory processes.

Reaction times as an index of visual conspicuity when driving at night.

Conspicuity refers to the visibility of objects that are either close to threshold or viewed in a cluttered environment. Conventional, threshold-based tests of vision are unlikely to be related to target visibility, because visual systems behave differently under supra-threshold and close-to-threshold conditions, or when low luminance levels are used. In these experiments, Reaction Times (RTs) are tested under a wide range of contrasts, luminances and spatial frequencies commonly encountered in the real world. We show that RTs are closely related to sensitivity and can therefore provide a method of measuring supra-threshold visual performance. The data are interpreted in terms of visual performance when driving, where a reduction in target visibility leads to increases in processing time.

Raised visual detection thresholds depend on the level of complexity of cognitive foveal loading.

The objective of the study was to measure the interactions between visual thresholds for a simple light (the secondary task) presented peripherally and a simultaneously performed cognitive task (the primary task) presented foveally The primary task was highly visible but varied according to its cognitive complexity. Interactions between the tasks were determined by measuring detection thresholds for the peripheral task and accuracy of performance of the foveal task. Effects were measured for 5, 10, 20, and 30 deg eccentricity of the peripherally presented light and for three levels of cognitive complexity. Mesopic conditions (0.5 lx) were used. As expected, the concurrent presentation of the foveal cognitive task reduced peripheral sensitivity. Moreover, performance of the foveal task was adversely affected when conducting the peripheral task. Performance on both tasks was reduced as the level of complexity of the cognitive task increased. There were qualitative differences in task interactions between the central 10 deg and at greater eccentricities. Within 10 deg there was a disproportionate effect of eccentricity, previously interpreted as the 'tunnel-vision' model of visual field narrowing. Interactions outside 10 deg were less affected by eccentricity. These results are discussed in terms of the known neurophysiological characteristics of the primary visual pathway.

Neurophysiological interpretation of human visual reaction times: effect of contrast, spatial frequency and luminance.

Neurophysiological studies have demonstrated that in primates Magno and Parvo neurons have distinct contrast gain properties. Reaction Times (RTs) can be used to study supra-threshold contrast coding in humans over the same range of stimulus parameters. RTs to achromatic sinusoidal gratings were measured for a range of spatial frequencies (0.49-17.7 c/degree), stimulus luminances (0.005-20 cd/m2) and contrasts (from threshold to 0.5). The stimuli subtended an angle of 7.2 degrees at a viewing distance of 114 cm. RTs exhibit a linear relationship when plotted against the reciprocal of suprathreshold contrast. The slope of these functions reveals how contrast is linked to RT and can, therefore, be referred to as the RT-contrast factor with units of msec x contrast. A general equation is derived which accounts for all stimulus combinations. RT-based contrast functions resemble closely those obtained neurophysiologically for Magno (M) and Parvo (P) cells. Furthermore, the RT equivalent of contrast gain exhibits qualitatively similar gain characteristics to these neurons for a wide range of luminances and spatial frequencies. Our data support the notion that the sensory component of RTs is limited by the properties of pre-cortical neurons.

On-eye power characteristics of soft contact lenses.

BACKGROUND: The power of a soft contact lens on the eye is a function of its off-eye power, the manner in which the lens flexes on the eye, lens hydration changes, and the corneal topography. METHODS: In the present study, we used a high illumination keratometer, which allowed us to obtain front and back surface keratometric readings when the lenses were in position on the eye. The on-eye power of the lens could then be calculated from these readings, with the assumption that the center thickness and refractive index of the lens corresponded to those in vitro. RESULTS: The estimates of the on-eye powers agreed closely with the results indicated by over-refraction. Moreover, comparison of in vitro with in vivo power estimates indicated that the positive lenses lost power on-eye, whereas the negative ones maintained their power. CONCLUSIONS: The present study confirms the results of earlier workers, who suggested that soft lenses drape to fit the cornea. Our findings appeared to be in agreement with the predictions of most of the models developed in the past.