SmartEye: Developing a Novel Eye Tracking System for Quantitative Assessment of Oculomotor Abnormalities

Eye movements are a continuous and ubiquitous part of sensory perception. To properly generate highly accurate and co-ordinate ocular movements, a vast network of brain areas are engaged, from low-level visual processing to motor control of gaze orientation. This renders oculomotor system vulnerable to various neurological disorders with unique clinical patterns. Therefore, oculomotor examination can serve as an early and sensitive indicator for various neurological conditions. A simple-to-use, clinically valid system for objectively assessing the oculomotor function can thus bring a paradigm shift in diagnosis and treatment of brain disorders. In principal accordance, this paper presents a gaze assessment tool, called SmartEye, which is based on eye fixation, smooth pursuit, and blinking in response to both static and dynamic visual stimuli. The gaze related indices were evaluated in real-time by SmartEye and these were mapped to the reported pathological state in chronic ( > 3 months) patients with stroke. Our preliminary feasibility study with eight pairs of chronic ( > 3 months) stroke survivors and healthy individuals revealed that gaze related indices in response to both static and dynamic visual stimuli may serve as potential quantitative biomarkers for stroke assessment.

Inter-device reproducibility of the scanning laser polarimeter with variable cornea compensation

OBJECTIVE

To evaluate the interdevice reproducibility of retinal nerve fibre layer (RNFL) thickness measurements obtained with the commercially available GDx-VCC, a scanning laser polarimeter with variable (individualized) corneal compensation.

METHODS

A prospective instrument validation study in which 13 GDx-VCC devices were tested. One eye each, from three normal subjects were used to test each of the devices, on the same day, by an experienced operator. Variability and reproducibility for each of five GDx parameters were calculated.

RESULTS

For each of five tested GDx parameters, the coefficient of variation and 95% confidence interval range (microm), for the 13 devices, respectively, were: TSNIT avg: 5.1%, 3.84 microm; Superior avg: 5.3%, 4.82 microm; Inferior avg: 6.1%, 5.50 microm; TSNIT standard deviation: 8.6%, 2.92 microm; and nerve fibre indicator (NFI): N/A, 5.69. Item reliability (Cronbach's alpha) for the five GDx parameters are: TSNIT-Avg: 0.97, Sup-Avg: 1.00, Inf-Avg: 0.84, TSNIT-SD: 0.99, NFI: 0.99.

CONCLUSIONS

With the commercially available GDx-VCC, our results indicate that RNFL measurements appear reproducible across devices.

New Instruments for Dry Eye Diagnosis

Several non-invasive techniques for dry eye diagnosis have been developed in the past decade. These include quantitative assessment of tear volume, tear film stability, tear dynamics, and integrity of ocular surface epithelium. A combination of meniscometry and interferometry is useful for proving focal dry eye, by confirming whether or not tears at the meniscus have an effect on the ocular surface. Interferometer is also useful to evaluate tear dynamics on soft contact lenses. Fluorophotometry is useful for assessing the severity of dry eye from the view point of corneal epithelial barrier function and measuring the tear turnover rate. Both video-meibography and meibometry are useful for screening meibomian gland dysfunction. The advances in these techniques accumulate knowledge regarding pathophysiology of dry eye and allow precise diagnosis of dry eye. More targeted treatment will become feasible based on the clearer pathophysiology.

Parallax-free exophthalmometry: a comprehensive review of the literature on clinical exophthalmometry and the introduction of the first parallax-free exophthalmometer

PURPOSE

To present the first parallax-free exophthalmometer design.

BACKGROUND

Exophthalmometry is an important clinical tool. We provide a historic overview of clinical exophthalmometer designs, and we review current problems encountered in exophthalmometry.

METHODS

We present a new and parallax-free exophthalmometer design that we have evaluated in 49 patients visiting our orbital clinic.

RESULTS

The mean age of the patients was 49.8 years and 72% were female. The Pearson interobserver variation was 0.97, and 94% of the Hertel values measured by the two observers were within the limits (1.6 mm) of agreement.

CONCLUSION

This meter appears to be a reliable instrument for exophthalmometry. It is the first instrument that allows for a complete parallax-free measurement.

Assessment of pupil size under different light intensities using the Procyon pupillometer

PURPOSE

To study the relationship between pupil size and light intensity using the Procyon pupillometer.

SETTING

University based clinic.

METHODS

In this retrospective study, 20 consecutive patients had pupil size assessment with the Procyon pupillometer under 3 different light conditions--4, 0.4, and 0.04 lux. Correlation was established using the log unit of the light intensity and pupil size.

RESULTS

The correlation coefficient for the association between pupil size and log unit of light intensity in all eyes was significant (P<.001). The mean correlation coefficient for the association between pupil size and log unit of light intensity in all patients was 0.968 +/- 0.089 (SD) in the right eye and 0.970 +/- 0.031 in the left eye.

CONCLUSION

The linear relationship between the pupil size and the log unit of the light intensity showed a tight correlation in all cases. These results can be useful in the comparing pupil size with pupillometers that work under different light conditions.

The effect of alpha antagonists on pupil dynamics: implications for the diagnosis of intraoperative floppy iris syndrome

PURPOSE

To assess pupil dynamics quantitatively in relation to the use of α1-adrenoceptor antagonists, which contribute to the features of intraoperative floppy iris syndrome, using a new, hand-held, digital pupillometer.

DESIGN

Prospective case-control study.

METHODS

We studied 15 and 25 patients administered tamsulosin and alfuzosin, respectively, as well as 25 control patients. Resting pupil diameter and subsequent contraction, latency, constriction velocity, and dilation velocity were recorded using an electronic pupillometer. All pupil measurements were performed before and after pharmacologic dilation.

RESULTS

In predilation pupillary measurements, we detected a significant decrease in maximum pupillary diameter by 0.50±0.19 mm (P=.011) and in the mean percentage of diameter reduction after stimulation (5.23±2.42%, P=.035) in the tamsulosin group. Alfuzosin also induced a significant decrease in maximum pupillary diameter (0.49±0.17 mm, P=.005). Constriction velocity was significantly reduced by 0.70±0.20 m/s (P=.001) in the tamsulosin group and by 0.54±0.18 m/s (P=.004) in the alfuzosin group. In terms of postdilation measurements, maximum and minimum pupil diameters were reduced significantly only in the tamsulosin group (by 1.09±0.31 mm [P=.001] and by 0.89±0.36 mm [P=.016], respectively).

CONCLUSIONS

We describe a reliable, accurate, and rapid method to acquire quantitative pupil measurements and identify the tendency for intraoperative floppy iris syndrome before cataract surgery after the use of alfuzosin and tamsulosin. This investigation also analyzed the similarities and differences induced by the 2 drugs in predilation and postdilation pupil dynamics, demonstrating that tamsulosin is more potent than alfuzosin in inducing intraoperative floppy iris syndrome.

Requirements for discrete actuator and segmented wavefront correctors for aberration compensation in two large populations of human eyes

Numerous types of wavefront correctors have been employed in adaptive optics (AO) systems for correcting the ocular wavefront aberration. While all have improved image quality, none have yielded diffraction-limited imaging for large pupils (>/=6 mm), where the aberrations are most severe and the benefit of AO the greatest. To this end, we modeled the performance of discrete actuator, segmented piston-only, and segmented piston/tip/tilt wavefront correctors in conjunction with wavefront aberrations measured on normal human eyes in two large populations. The wavefront error was found to be as large as 53 microm, depending heavily on the pupil diameter (2-7.5 mm) and the particular refractive state. The required actuator number for diffraction-limited imaging was determined for three pupil sizes (4.5, 6, and 7.5 mm), three second-order aberration states, and four imaging wavelengths (0.4, 0.6, 0.8, and 1.0 microm). The number across the pupil varied from only a few actuators in the discrete case to greater than 100 for the piston-only corrector. The results presented will help guide the development of wavefront correctors for the next generation of ophthalmic instrumentation.

Precision of NIDEK OPD-Scan Measurements

PURPOSE

To evaluate the repeatability of wavefront measurements using the NIDEK OPD-Scan.

METHODS

A total of 179 eyes from 90 healthy volunteers (57 women and 33 men) with no corneal or lenticular pathology and normal visual acuity were enrolled in this study. Mean patient age was 39 years (range: 17 to 85 years). All patients underwent four consecutive measurements by one examiner with the NIDEK OPD-Scan. Total, corneal, and internal wavefront errors were measured and calculated with the device, using slit retinoscopy. Repeatability of the measurements was evaluated for spherical aberration, coma, and trefoil.

RESULTS

The repeatability test revealed a good result for all three higher order aberrations evaluated. The best repeatability values were found for total aberrations, followed by internal and corneal aberrations.

CONCLUSIONS

The NIDEK OPD-Scan has good precision in the wavefront measurement of total, corneal, and internal optical aberrations.

The Reliability of Central Corneal Thickness Measurements by Ultrasound and by Orbscan System in Schoolchildren

PURPOSE

To compare the central corneal thickness measurements obtained by ultrasound (US) pachymetry and the Orbscan II system in healthy schoolchildren.

METHODS

A total of 356 schoolchildren aged 7 to 12 years underwent central cornal thickness (CCT) measurement with Orbscan II and ultrasonic pachymetry. All eyes were examined first with the Orbscan II and then by US pachymetry. The mean of the difference, standard deviation (SD), and 95% limits of agreement, with and without applying the acoustic correction factor, were determined. The differences between the devices in measuring mean CCT were calculated with paired-sample t test. Pearson correlation test was used to determine the correlation between variables. p < 0.05 was considered to be statistically significant. Linear regression analysis was used to quantify the correlation between the two methods.

RESULTS

Orbscan II measurements were significantly higher than US pachymetry measurements without applying the manufacturer-recommended acoustic correction factor (0.92) correction (580.39 +/- 37 microm and 562.95 +/- 32 microm, respectively) (p < 0.0001). When this acoustic correction factor was applied, the Orbscan II measurements demonstrated significantly lower results when compared with those of US pachymetry (533.96 +/- 34 microm and 562.95 +/- 32 microm, respectively) (p < 0.0001). The linear regression analysis lines showed approximately 45-degree slope indicating a strong correlation between these methods (US pachymetry = 145.71 + 0.72 x Orbscan II value without acoustic correction factor (microm), r = 0.89, p < 0.0001). There was a high degree of variability in differences between the 2 devices in individual subjects. The range was between 25 to -55 microm without the acoustic correction factor and 67 to -5 microm with the acoustic correction factor.

CONCLUSIONS

Although US pachymetry and Orbscan II demonstrated a strong linear correlation, there was a high degree of variability in differences between the two devices in individual subjects who participated.

Comparison of Aberrometer and Autorefractor Measures of Refractive Error in Children

PURPOSE

The purpose of this study was to evaluate and compare the Complete Ophthalmic Analysis System (COAS) G200 Aberrometer (Wavefront Sciences Inc., Albuquerque, NM) and Canon RK-F1 Autorefractor (Canon Inc., Tokyo, Japan) for measuring refractive errors in young children.

METHODS

The Sydney Myopia Study is a population-based study of refractive error and eye health in young Australian children. Cycloplegic refractions were performed on 1504 school year 1 students (mostly 6 years old) and 890 school year 7 (mostly 12 years old) students using both the COAS G200 Aberrometer and Canon RK-F1 autorefractor. Refractive data were analyzed using power vectors. Mean differences and 95% limits of agreement were determined for refractive components between the two instruments.

RESULTS

The mean age +/- standard deviation was 6.7 +/- 0.4 years (range, 5.5-9.1 years) and 12.6 +/- 0.5 years (range, 11.1-14.4 years) for the year 1 and year 7 students, respectively. Mean paired differences for the M component (spherical equivalent) between the COAS G200 and Canon RK-F1 were <0.25 D in both age groups and were statistically significant in the year 1 group only (p < 0.001). Small significant differences were found in the astigmatic components (J0 and J45) in both groups. A smaller coefficient of agreement for the M component was found in the older group (0.54 D), whereas the coefficients of agreement of the astigmatic components (J0 and J45) were similar for both groups.

CONCLUSIONS

The COAS G200 aberrometer was an easy-to-use instrument for the measurement of refractive error in children. In addition to being able to measure higher and lower order aberrations, the COAS G200 provides refractive error measurements comparable to those of an autorefractor.

Comparison Between Newly Developed Scanning Peripheral Anterior Chamber Depth Analyzer and Conventional Methods of Evaluating Anterior Chamber Configuration

PURPOSE

To compare the newly developed scanning peripheral anterior chamber depth analyzer (SPAC) with the Van Herick technique, the Shaffer grading system, and ultrasound biomicroscopy (UBM), in terms of accuracy of measurement of peripheral anterior chamber depth (ACD).

METHODS

The subjects were well-controlled glaucoma patients who were being treated at the University of Yamanashi Hospital. Ten eyes from each of the 4 groups classified as Shaffer grades 1 to 4 were evaluated by SPAC, the Van Herick technique, and UBM. All measurements were performed independently on the temporal side in a masked fashion. SPAC evaluated ACD consecutively from the pupil center to the limbus at 0.4 mm intervals. UBM measurements were carried out at a depth of 500 mum (angle-opening distance 500) from the scleral spur. A dummy eye was used for evaluating SPAC measurement accuracy.

RESULTS

The results of SPAC measurement were well correlated with those of the Van Herick technique and the Shaffer grading system. The SPAC measurement results were also significantly correlated with angle-opening distance 500. The correlation coefficients at distances of 2, 4, 4.8, and 5.6 mm from the pupil center were r=0.68, 0.69, 0.69, and 0.61, respectively, and the P values of all the correlations were less than 0.0001. Study of the dummy eye revealed that SPAC has high accuracy for measuring ACD and that the coefficient variances were less than 1.0% at all measured points.

CONCLUSIONS

The results of SPAC measurement correlate well with those of the conventional methods.

A 15-MHz 1-3 Piezocomposite Concave Array Transducer for Ophthalmic Imaging

Because of the spherical shape of the human eye, the anterior segments of the eye, particularly the cornea and the lens, create high levels of refraction and reflection of ultrasound which negatively affect the performance of linear and convex arrays. To minimize the ultrasound energy loss, a 15-MHz concave array transducer was designed, fabricated, and characterized; its footprint is able to mesh well with the shape of the cornea. The concave array has a curvature with a radius of 15 mm and 128 elements with a 1.44- pitch. Its elevational focus and view angle are 30 mm and 72.3°, respectively, thus allowing the imaging area to cover the retinal region of interest in the posterior segment. As an active layer, a 1-3 piezocomposite was designed and fabricated in response to the bidirectional (i.e., azimuthal and elevational) curvature of the concave array and the high coupling coefficient. From the performance evaluation, it was found that the completed concave array is able to provide a center frequency of 15.95 MHz and a -6-dB fractional bandwidth of 67.8% after electrical tuning has been conducted. The crosstalk level was measured to be less than -25 dB. It was verified that the concave array is robust to the refraction and reflection from the cornea through pulse-echo testing using a custom-made eye-mimicking phantom. Furthermore, images of both the wire-target phantom and the ex vivo porcine eye were acquired by the finished concave array, which was connected to a commercial ultrasound scanner equipped with a research package. The evaluation results demonstrated that the developed concave array transducer is a possible alternative to conventional arrays for effectively imaging the posterior segment of the eye.

Takagi Glare Tester CGT-1000 for Contrast Sensitivity and Glare Testing in Normal Individuals and Cataract Patients

PURPOSE

To investigate the sensitivity and repeatability of the Takagi Contrast Glare Tester CGT-1000 in normal individuals and those with cataracts.

METHODS

A prospective observational study was performed. The Takagi Contrast Glare Tester measures contrast sensitivity (CS) at 6 target sizes and 13 contrast levels (2.00 to 0.34 logCS). Testing follows a method of descending limits paradigm with a single reversal determining threshold. The CGT-1000 was administered with and without glare in 95 eyes of 61 cataract patients and 13 controls. The percentage floor (unable to see the highest contrast) and ceiling (able to see the lowest contrast) effects and correlations between CS and cataract grades were determined. The repeatability was evaluated using Bland-Altman limits of agreement and expressed as the coefficient of repeatability (COR). Factor analysis was used to test for redundancy within the 6 spatial frequencies.

RESULTS

In normal individuals, a high rate of ceiling effect varying with target size was noted--for 6.3 degrees, 4.0 degrees, 2.5 degrees, 1.6 degrees, 1.0 degrees, 0.7 degrees, ceiling effects were 68%, 58%, 18%, 11%, 4%, 2%, respectively, for no glare, and 47%, 42%, 8%, 2%, 2%, 2%, respectively, with glare. In cataract patients, floor effects were noted--3%, 0%, 3%, 7%, 19%, 62%, respectively, for no glare, and 3%, 3%, 6%, 14%, 44%, 79%, respectively, with glare. Correlations with cataract grades ranged from 0.10 to 0.61, being best for nuclear cataract. Repeatabilities expressed as COR were +/- 0.11, +/- 0.14, +/- 0.28, +/- 0.38, +/- 0.38, +/- 0.47 logCS, respectively. All spatial frequencies loaded heavily on one factor, indicating no gain in information from testing multiple target sizes.

CONCLUSIONS

Sensitivity to the presence of cataract was good, but ceiling effects in normal individuals and floor effects in cataract patients limit accuracy. Repeatability was poor, but could be improved by testing less spatial frequencies more rigorously.

Comparison of Measurement of Pupil Sizes Among the Colvard Pupillometer, Procyon Pupillometer, and NIDEK OPD-Scan

PURPOSE

To compare pupil sizes measured with the Colvard pupillometer, Procyon pupillometer, and NIDEK OPD-Scan.

METHODS

Pupil diameter was measured in 90 consecutive eyes from 55 patients under mesopic and scotopic light conditions with all three instruments.

RESULTS

The mean scotopic pupil diameter was 6.3+/-0.98 mm with the Colvard pupillometer and 6.45+/-1.01 mm with the Procyon pupillometer. The mean mesopic pupillometer was 5.58+/-1.01 mm with the Procyon pupillometer and 6.26-0.99 mm with the

CONCLUSIONS

The mesopic pupil diameter measured with the NIDEK OPD-Scan is more consistent with the scotopic pupil diameter measured with the Procyon and Colvard pupillometers than the mesopic pupil diameter measured with the Procyon pupillometer.

Corneal mechanical sensitivity measurement using a staircase technique

PURPOSE

To determine the repeatability of an unequal staircase technique (Garcia-Perez Staircase, GPS) to measure corneal mechanical threshold using the CRCERT-belmonte Aesthesiometer, and to compare this with a previously-reported psychophysical method (method of constant stimuli, MOCS).

METHODS

The GPS, utilising unequal ascending and descending steps, was used to obtain a threshold measurement from the mean of six response reversals. repeatability was determined for the GPS and MOCS methods (N = 14), and threshold results obtained with each method were compared (N = 10).

RESULTS

The GPS (65.0 +/- 16.9 mL min(-1); CoR +/- 18.3 mL min(-1)) method was more repeatable than the MOCS (64.0 +/- 15.7 mL min(-1); CoR +/- 37.3 mL min(-1)) and the absolute values obtained with the two methods were not significantly different.

CONCLUSIONS

Although each method gave equivalent threshold results, the GPS method was more repeatable and quicker to apply and hence should reduce the influence of patient fatigue and help to minimise possible carry-over effects.

The precision of ophthalmic biometry using calipers

OBJECTIVE

The purpose of the study is to determine the precision of whole globe and cornea measurements acquired using calipers, and to quantify the intraoperator and interoperator variance.

DESIGN

Experimental study.

PARTICIPANTS

Ten human donor eyes.

METHODS

Ten human eyes (donor age, 16-54 years) were obtained between 18.5 and 66.5 hours postmortem. The horizontal and vertical diameters and the anteroposterior length of the globe were measured using a digital Vernier caliper. The horizontal and vertical diameters of the cornea were measured using both a digital Vernier caliper and a Castroviejo caliper. The measurements were performed by 3 operators with 5 repeat measurements for each dimension.

RESULTS

No significant differences were observed between measurements of globe anteroposterior length, horizontal diameter, and vertical diameter. Horizontal corneal diameter was greater than vertical diameter with all instruments and all operators. Variability of either instrument did not change with measurement object scale, and was similar across all operators. No significant differences were observed between the variabilities of the 2 devices. The mean intraoperator SD was 0.127 ± 0.023 mm with the digital caliper and 0.094 ± 0.056 mm with the Castroviejo caliper.

CONCLUSIONS

The precision of commercially available calipers in ophthalmic biometry measurements is limited to approximately 0.1 mm.

Nerve fibre layer analysis with GDx with a variable corneal compensator in patients with multiple sclerosis

PURPOSE

To evaluate the ability of GDx with variable corneal compensator (VCC) compared to visual-evoked potentials (VEPs) and standard automated perimetry (SAP) in the detection of early optic nerve damage in patients with multiple sclerosis (MS).

METHODS

46 eyes of 23 MS patients were included. Ten of them had a history of acute retrobulbar optic neuritis. A control group of 20 normal subjects was also included. All subjects underwent a complete ophthalmological examination and testing with SAP, GDx VCC and VEPs.

RESULTS

19 eyes (41.3%) were abnormal with GDx VCC compared to 38 eyes (82.6%) with SAP and 31 (64.4%) with VEPs. In the optic neuritis group, 9 eyes (69.2%) had optic nerve pallor; SAP was abnormal in 8 of these eyes (61.5%) while VEPs and GDx VCC were abnormal in 6 eyes (46.1%). 2/20 eyes (10.0%) in the control group gave a false-positive abnormal result with SAP. GDx VCC and VEP were normal for all the eyes in the control group.

CONCLUSIONS

GDx VCC is less able to detect early defects in MS patients compared to the currently used standard techniques of SAP and VEPs.

Pupil measurement using the Colvard pupillometer and a standard pupil card with a cobalt blue filter penlight

PURPOSE

To compare scotopic pupil measurements obtained with a Colvard pupillometer with measurements taken with a printed pupil gauge and penlight with a cobalt blue filter attachment in mesopic and scotopic luminance.

SETTING

The Illinois Eye Institute, Chicago, Illinois, USA.

METHODS

Pupil measurements were taken of both eyes of 38 patients (76 eyes). Any subject presenting with anterior segment disease, fixed or dilated pupils, iris abnormalities, or a history of eye disease or eye trauma was excluded. At a mesopic luminance of 2.11 foot-candles, pupil measurements were taken with a Bernell pupil card and penlight with a cobalt blue filter attachment. At a scotopic luminance of less than 2.00 foot-candles, pupil measurements were taken with the Bernell card system and the Colvard pupillometer.

RESULTS

In mesopic luminance, the mean pupil diameter was 5.17 mm (range 3.0 to 7.5 mm) with the Bernell card method. The mean difference between the Colvard in scotopic luminance and the Bernell card system in mesopic luminance was -0.04 mm (P = .0831). In scotopic luminance, the mean pupil diameter was 6.32 mm (range 4.0 to 8.0 mm) with the Bernell card method and 5.13 mm (range 3.0 to 7.5 mm) with the Colvard pupillometer, with a mean difference of -1.18 mm (P<.0001). The limits of agreement between the mesopic Bernell card system and the Colvard pupillometer were small (-0.32 to 0.24), whereas the limits of agreement between the scotopic measurements of both techniques were large (-2.18 to -0.18).

CONCLUSIONS

Under both illuminance conditions, the Bernell card system with the cobalt filter measured a larger pupil size than the Colvard pupillometer. The measurement differences between the techniques were most pronounced at the lower illumination. The limits of agreement were larger under the lower illumination, indicating more variation between techniques. This study suggests that the Bernell card system with cobalt illumination provides a generous measurement of the pupil size compared with the Colvard pupillometer, which makes it an appropriate and cost-effective screening tool for refractive surgery evaluation.

Intersession reproducibility of retinal nerve fiber layer thickness measurements by GDx-VCC in healthy and glaucomatous eyes

BACKGROUND

To assess intersession reproducibility of retinal nerve fiber layer (RNFL) thickness measurements on scanning laser polarimetry with variable corneal compensation (GDx-VCC) in a sample of healthy subjects and glaucoma patients.

METHODS

One eye each from 29 healthy and 29 glaucomatous subjects was selected and underwent RNFL scanning by the same operator at baseline and 1 week later. Glaucoma diagnosis relied on the presence of a reproducible defect on automated perimetry. GDx-VCC parameters considered were those available on page 1 of the printout [TSNIT average and standard deviation (SD), superior and inferior average (SA, IA), Nerve Fiber Indicator]. Reproducibility was assessed by calculating coefficient of variation and intraclass correlation coefficient separately for the two groups and for each parameter. The percentage of eyes with an intersession difference in thickness parameters of more than 5% was also calculated.

RESULTS

Coefficient of variation was <6% for TSNIT average, SA and IA in both groups. Corresponding values for TSNIT SD in healthy subjects and in glaucoma patients were 13.7 and 11.4%, respectively, whereas for Nerve Fiber Indicator they were 82.9 and 13.3%. Intraclass correlation coefficient ranged from 0.794 to 0.907 in healthy subjects and from 0.924 to 0.972 in glaucoma patients. In healthy subjects, TSNIT average, SA and IA intersession difference was 5% or less in 55-69% of eyes, whereas the value for TSNIT SD was 34.5%. Corresponding values in glaucomatous eyes ranged from 69 to 79.3% for TSNIT average, SA and IA and was 37.9% for TSNIT SD.

CONCLUSIONS

Intersession reproducibility of RNFL thickness measurements on GDx-VCC is high, both in healthy and in glaucomatous eyes. In a few cases, however, intersession variation may be larger than 10%. Caution is necessary while interpreting these changes during follow-up, in order to separate physiological variability from real RNFL thickness variations.

Corneal thickness mapping by 3D swept-source anterior segment optical coherence tomography

PURPOSE

To assess accuracy and repeatability of central corneal thickness (CCT) measurements obtained by swept-source anterior segment optical coherence tomography (AS-OCT), spectral-domain retinal OCT with corneal module and ultrasound pachymetry (USP), and to assess repeatability of pachymetric mapping with AS-OCT.

METHODS

50 healthy volunteers were recruited. A single, experienced operator analysed the right eye of each participant twice in the same session with AS-OCT ('corneal map' routine), retinal OCT and USP. CCT measurements were compared using repeated-measures analysis of variance, Bonferroni test, Pearson correlation and Bland-Altman plots. Repeatability of thickness maps and CCT measurements were assessed using Alpha of Cronbach, intraclass correlation coefficient (ICC) and coefficient of repeatability.

RESULTS

Mean CCT±SD was 540±28.9 μm for AS-OCT, 544±29.5 μm for retinal OCT and 549.3±31.7 μm for USP; the differences were statistically significant (p<0.01). CCT measurements obtained with the three instruments were highly correlated: r was 0.965 for AS-OCT/USP, 0.962 for retinal OCT/USP and 0.984 for AS-OCT/retinal OCT comparison. The repeatability of CCT measurements was higher for AS-OCT than for the other devices (p<0.001). Repeatability of pachymetric maps was excellent (ICC=0.999).

CONCLUSIONS

Pachymetric maps by swept-source AS-OCT showed excellent repeatability. CCT measurements obtained by AS-OCT, USP and retinal OCT were highly correlated although not identical.

Comparison of EyeCam and anterior segment optical coherence tomography in detecting angle closure

PURPOSE

To compare the diagnostic performance of EyeCam (Clarity Medical Systems, Pleasanton, CA, USA) and anterior segment optical coherence tomography (ASOCT, Visante; Carl Zeiss Meditec, Dublin, CA, USA) in detecting angle closure, using gonioscopy as the reference standard.

METHODS

Ninety-eight phakic patients, recruited from a glaucoma clinic, underwent gonioscopy by a single examiner, and EyeCam and ASOCT imaging by another examiner. Another observer, masked to gonioscopy findings, graded EyeCam and ASOCT images. For both gonioscopy and EyeCam, a closed angle in a particular quadrant was defined if the posterior trabecular meshwork was not visible. For ASOCT, angle closure was defined by any contact between the iris and angle anterior to the scleral spur. An eye was diagnosed as having angle closure if ≥2 quadrants were closed. Agreement and area under the receiver operating characteristic curves (AUC) were evaluated.

RESULTS

The majority of subjects were Chinese (69/98, 70.4%) with a mean age of 60.6 years. Angle closure was diagnosed in 39/98 (39.8%) eyes with gonioscopy, 40/98 (40.8%) with EyeCam and 56/97 (57.7%) with ASOCT. The agreement (kappa statistic) for angle closure diagnosis for gonioscopy versus EyeCam was 0.89; gonioscopy versus ASOCT and EyeCam versus ASOCT were both 0.56. The AUC for detecting eyes with gonioscopic angle closure with EyeCam was 0.978 (95% CI: 0.93-1.0) and 0.847 (95% CI: 0.76-0.92, p < 0.01) for ASOCT.

CONCLUSION

The diagnostic performance of EyeCam was better than ASOCT in detecting angle closure when gonioscopic grading was used as the reference standard. The agreement between the two imaging modalities was moderate.

Comparison of monochromatic ocular aberrations measured with an objective cross-cylinder aberroscope and a Shack-Hartmann aberrometer

Repeated measures of wavefront aberrations were taken along the line-of-sight of seven eyes using two instruments: an objective, cross-cylinder aberroscope (OA) and a Shack-Hartmann (SH) aberrometer. Both instruments were implemented on the same optical table to facilitate interleaved measurements on the same eyes under similar experimental conditions. Variability of repeated measures of individual coefficients tended to be much greater for OA data than for SH data. Although Zernike coefficients obtained from a single measurement were generally larger when measured with the OA than with the SH, the averages across five trials were often smaller for the OA. The Zernike coefficients obtained from the two instruments were not significantly correlated. Radial modulation-transfer functions and point-spread functions derived from the two sets of measurements were similar for some subjects, but not all. When average Zernike coefficients were used to determine optical quality, the OA indicated superior optics in some eyes, but the reverse trend was true if Zernike coefficients from individual trials were used. Possible reasons for discrepancies between the OA and SH measurements include difference in sampling density, quality of data images, alignment errors, and temporal fluctuations. Multivariate statistical analysis indicated that the SH aberrometer discriminated between subjects much better than did the objective aberroscope.

Validity and Reliability of a Novel Handheld Osmolarity System for Measurement of a National Institute of Standards Traceable Solution

PURPOSE

To evaluate the validity and reliability of a novel handheld osmolarity system (I-PEN Osmolarity System; I-MED Pharma Inc, Dollard-des-Ormeaux, Quebec, Canada) for measurement of the osmolarity of a National Institute of Standards and Technology (NIST) traceable solution at a variety of ambient temperatures.

METHODS

A total of 65 measurements of an NIST solution with a verified osmolarity of 290 ± 2 mOsmol/L were taken using 3 separate handheld osmolarity systems, 65 unique single-use sensors (SUSs) from 3 different lots, and 2 adaptors. Mean values were calculated using the device, SUS, and adaptor. Measurements were taken using a handheld osmolarity system, an adaptor, and 56 individual SUSs at 6 different ambient temperatures ranging from 17.7 to 26.5°C.

RESULTS

Overall, the mean osmolarity measured was 294.06 mOsmol/L (SD ±2.29; percent coefficient of variation 0.78), ranging from 286.60 to 298.18 mOsmol/L. This fell within a prespecified acceptable variability of ±4 mOsmol/L (SD ±7). Mean values did not vary across devices, adaptors, or single-use sensors used. Mean osmolarity measurements increased with rising ambient temperatures, with an R = 0.88. The temperature correction factor was calculated to be 2.01 mOsmol/L per °C.

CONCLUSIONS

The osmolarity system reliably and accurately measured the osmolarity of an NIST solution in a laboratory setting, using an adaptor to correct for differences in resistance between a laboratory NIST solution measurement and direct measurements on the palpebral conjunctiva of the eyelid. The handheld osmolarity system represents a rapid and accurate instrument for measurement of tear osmolarity in a simulated testing setting.