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Biomedical subjects

K A Polse

Publications and source records attributed to K A Polse.

At least 19 recordsLinked to original sources
PubMed1992

Stromal acidosis affects corneal hydration control.

An estimate of overall corneal hydration control can be obtained by measuring the rate of thickness recovery following induced corneal swelling; it is expressed as the percent recovery per hour (PRPH). This recovery is nearly, but not exactly, exponential, because there appears to be an initial slower recovery phase lasting about 30-40 minutes. This 30-40 minute period of slower recovery corresponds to the time when corneal pH is reduced secondary to the contact lens-induced swelling, suggesting the possibility that stromal acidosis may retard the corneal deswelling process. In this study, we explored the effects of corneal acidosis on hydration control by monitoring corneal recovery under normal and reduced pH conditions. Corneal pH was controlled by having subjects were goggles and exposing their eyes to air (normal pH) or a gas mixture providing 21% O2 and 7% CO2 (low pH). Relative corneal pH levels were monitored by measuring fluorescence intensity (FI) ratios, which showed that the average (+/- standard deviation) FI ratio was significantly lower under 7% CO2 (0.838 +/- .024) vs air (0.985 +/- .025; P = 0.0001), corresponding to approximate pH values of 7.25 vs 7.50. Under these reduced pH conditions, open-eye steady-state (OESS) corneal thickness was not substantially affected. For 10 subjects, mean (+/- SD) corneal thickness decreased 0.93 +/- 3.7 microns vs 1.10 +/- 4.50 microns after exposures to 60 minutes of 7% CO2 and 40 minutes of air (P greater than or equal to 0.45), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMed1991

Clinical assessment of corneal hydration control in Fuchs' dystrophy.

The diagnosis and monitoring of Fuchs' disease is typically based on information obtained from patient symptoms and a slitlamp examination. Although this clinical information provides a basis for diagnosis, it does not give a quantitative method for charting the progression of the disease systematically or a reliable basis for predicting the cornea's capacity to remain transparent after stress (e.g., cataract extraction). However, it is possible to quantify overall corneal hydration control by inducing corneal swelling and then monitoring the deswelling rate expressed as percent recovery per hour (PRPH). We have tested subjects with Fuchs' dystrophy and found that the PRPH provides a reasonable estimate of corneal hydration control. Unfortunately, the PRPH procedure involves considerable time and technical assistance and therefore is not convenient for clinical practice. In this report, we document the results of an initial effort to explore the relations between PRPH and six clinical measures consisting of five biomicroscopic indices and a subjective synthesis of clinical information called the probability of decompensation (POD) based on these indices. PRPH was significantly related to striae (p less than 0.001), stromal haze (p = 0.025), microcysts (p less than 0.001), and the POD (p less than 0.001) and not significantly related to guttae (p = 0.252) or Descemet's folds (p = 0.185). An empirically weighted predictor of PRPH was constructed from a statistical analysis of five slitlamp assessments and age. This approach for synthesizing clinical information produced a result at least as good as that obtained from the POD summary. These results show an important link between a quantitative laboratory assessment of corneal function and a clinical evaluation of corneal status and suggest that with continued refinement, clinical assessment may provide more quantitative information on Fuch's dystrophy and other diseases that affect corneal status.

Adult↗
PubMed1991

Corneal response to different oxygen levels during extended wear.

In this study we explored the relationship between hypoxic exposure level and corneal response by assuming that the partial pressure of oxygen (PO2) under a contact lens during eye closure is directly related to oxygen transmissibility (Dk/L). To study this relationship, we monitored a group of subjects who wore RGP lenses of various Dk/L values on an extended wear basis. The results revealed that as Dk/L increases, there is a substantial decrease in overnight corneal edema and epithelial microcysts. However, other responses seemingly related to purely mechanical properties (e.g., lens adherence, corneal topographical changes, and 3-9 limbal superficial punctate keratitis) appear to be independent of Dk/L. Results also suggest that sufficient PO2 levels under a contact lens can minimize endothelial morphological changes associated with hypoxia. We conclude that metabolically driven complications accompanying RGP extended wear can be substantially eliminated with lenses having Dk/L values of 80 x 10(-9) (cm x mL O2)/(sec x mL x mm Hg) or greater.

Adult↗
PubMed1990

Humidity effects on corneal hydration.

Overall corneal hydration control expressed as the percent recovery per hour (PRPH) can be assessed with an exponential model that uses data derived from two kinds of corneal thickness measurements; one from monitoring recovery after inducing corneal swelling, and the other from measurements made after the eye has been open long enough to reach its open-eye steady-state (OESS) corneal thickness. Up to now these thickness measurements have been made without controlling the ambient humidity. It is possible that changes in relative humidity may effect tear film osmolarity sufficiently to change the state of corneal hydration. To evaluate the effects of humidity on hydration control, the OESS and PRPH were determined under several humidity levels. For both the OESS and the PRPH, two substudies were conducted. For the OESS, substudy 1 consisted of measuring corneal thickness when humidity was changed from 30% (ambient) to 52 or 97% controlled humidity. This resulted in mean +/- standard deviation (SD) changes in OESS thickness amounting to -0.33 +/- 3.5 microns and 2.6 +/- 3.4 microns, respectively, with a differential change of 2.94 +/- 3.04 microns (95% confidence interval [CI] from 0.77 to 5.11 microns). Corresponding results for substudy 2 connected with changes from 43% (ambient) to 12 or 97% controlled humidity were -2.4 +/- 2.7 microns and -0.3 +/- 1.9 microns, respectively, with a differential change of 2.1 +/- 1.8 microns (95% CI from 0.9 to 3.4 microns).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Hypoxic effects on corneal morphology and function.

Normal corneal metabolism depends on a critical level of oxygen, below which a series of acute corneal responses occur, including an increase in stromal lactate, a reduction in intercellular pH, and an increase in corneal hydration. These acute responses are reversible when normal oxygen is restored; however, it has been shown that chronic exposure to low oxygen levels can result in permanent morphologic changes in the corneal endothelium. Clinicians have expressed concern that these observed structural changes may also be accompanied by alterations in corneal physiology. Whether such effects occur is not known, since it has been difficult to assess human corneal function accurately. Recently, we have developed an in vivo test, able to measure overall corneal hydration control, that can be used to study the effects of hypoxia on corneal function. This test provides information on several characteristics of hydration control, one of which is the percent corneal thickness recovery per hour (PRPH) after inducing corneal swelling. In this study, we assumed that corneal hypoxia accompanies both extended and polymethylmethacrylate (PMMA) contact lens wear and that the dose received is related to the years of past lens wear. Using this paradigm, we explored the relationship of hypoxic dose to an endothelial polymegethism index (EPI), endothelial cell density (ECD), and PRPH in 36 subjects with varying contact lens wearing histories. Based on multiple regression analysis, the relative change (expressed as percent per year) associated with hypoxic dose (adjusted for age and gender) was found to be dose-dependent and corresponded to estimated changes of 1.70%/yr, -0.25%/yr, and -1.26%/yr, with 95% confidence limits of (-0.3, 3.7), (-1.4, 0.9), and (-2.6, 0.06) for EPI, ECD, and PRPH, respectively. These preliminary data suggest that hypoxic exposure alters endothelial morphology and reduces corneal function; however, it is important to indicate that this was a exploratory investigation with several limitations, and that therefore these results should be viewed as preliminary until more definitive studies are completed.

Adolescent↗
PubMed1989

Corneal hydration control in Fuchs' dystrophy.

Corneal hydration control was tested in 22 patients with Fuchs' dystrophy, and eight subjects of similar age without the disease, by measuring the corneal thickness recovery from swelling induced by hypoxia or following overnight sleep. Measurement precision was enhanced by using a modified optical pachometer and conducting two test procedures which were analyzed by a coupled exponential model. We have identified three parameters of the recovery from corneal swelling which may be used to describe hydration control: percent recovery per hour (PRPH) (mean 25.4% for Fuchs' and 34.2% for normals), time for 95% of corneal thickness recovery (mean 10.2 hr for Fuchs' and 7.1 hr for normals), and the open-eye steady-state thickness (mean 562 microns for Fuchs' and 537 microns for normals.) A PRPH of 17.1%/hr was identified as the minimum below which the cornea could not regain its open-eye steady state during the entire day and approaches decompensation. Our test procedure quantifies the corneal hydration control mechanism and may provide a test of endothelial function which can be used to monitor the progression of Fuchs' disease and guide decisions related to corneal surgery.

Aged↗
PubMed1989

Age differences in corneal hydration control.

Dynamic changes in corneal thickness were measured in eight young and eight older normal subjects (mean ages 24.4 +/- 4.3 years and 71.9 +/- 7.3 years, respectively) to provide data for quantitative assessment of corneal hydration control and thereby provide information for studying age differences in this important aspect of corneal function. For each subject, pachometry data were obtained by (A) monitoring corneal recovery following hypoxic stress, and by either (B1) measuring recovery after sleep or (B2) by measuring corneal thickness in the late afternoon. The combined data from A and B1 or A and B2 were analyzed through an exponential model to provide information on the: (1) percent recovery per hour (PRPH) following induced corneal hydration; (2) open-eye steady-state (OESS) corneal thickness; (3) residual corneal swelling just before the hypoxic stress test; (4) amount of corneal edema induced by hypoxic stress; and (5) time to reach 95% recovery back to the OESS thickness level (T95%). The results show that between the two age groups, there are substantial differences in some characteristics of corneal hydration while other aspects are similar. For example, the mean PRPH values (58.9 +/- 7.8% and 34.2 +/- 6.4%/hr) were significantly higher in the younger subjects (P = 0.0002) and the mean time for 95% recovery to OESS thickness (207 +/- 42 min and 452 +/- 117 min) was significantly lower in the younger vs. the older group (P = 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Ocular effects of hard gas-permeable-lens extended wear.

Thirty-five myopic subjects were fitted with rigid gas-permeable lenses for 6 months of extended wear (EW). These lenses had an average oxygen transmissibility of 37 x 10(-9) (cm x ml x O2)/(s x ml x mm Hg). For six monthly morning visits subjects reported with one eye patched; corneal thickness, corneal curvature, refractive error, endothelial photomicroscopy, and slitlamp examinations were done on both eyes. The average morning corneal swelling was 5.9 +/- 3.3%. Corneal curvature showed 0.24 +/- 0.44 D flattening in the steep meridian and 0.20 D steepening in the flat meridian. Spectacle refraction and corrected visual acuity changes were small in the spherical and cylindrical components. Complications that were important clinically included 10% lens adherence syndrome, 20% superficial limbal keratitis, 6.5% epithelial microcysts, and some increase in endothelial polymegathism. No infections, red eye responses, or infiltrative keratitis were observed during the 6-month follow-up period. These results suggest that hard-lens EW is feasible and that lenses with this Dk/L value will meet oxygen requirements for many patients; however, some patients will require lenses of higher oxygen transmissibility to avoid undesirable complications.

Cell Count↗
PubMed1988

Rigid contact lens adherence: incidence, severity and recovery.

The incidence of rigid lens adherence in one eye of 25 subjects was compared to the results for the fellow eye wearing a soft lens of nearly equal permeability in an in-laboratory overnight study. A 48% incidence of adherence was found for both extended wear modalities, which demonstrates the high frequency of this problem. Adherence of both rigid and soft lenses caused epithelial breakdown and corneal distortion, but these sequelae were generally more severe with rigid lenses. Recovery data on nine subjects whose rigid lenses adhered show that positive signs of adherence often disappear within 1 hour, demonstrating the need for early morning examinations. Practical considerations for the detection of rigid lens adherence and the possible consequences of failure to diagnose this condition are discussed.

Adhesiveness↗
PubMed1987

Effect of rigid contact lens oxygen transmissibility on stromal pH in the living human eye.

Corneal stromal pH was measured fluorometrically in nine human subjects after 1.5 hours of eye closure while wearing hard gas permeable contact lenses. Six lens types providing a wide range in oxygen transmissibilities (Dk/L)O2 from 0.15 to 55.0 X 10(-9) (cm ml O2/seconds of ml mmHg) were used. Stromal pH upon opening the eyes was directly related to (Dk/L)O2 and ranged from 7.01 to 7.26. These pH values were all significantly lower than the control (no lens), which had a pH of 7.38 (P less than 0.005). After eye opening (lens still on) stromal pH increased and reached a new steady-state (range, 7.11-7.45) in approximately 30 minutes; however, these pH levels were still below the control (no lens) (pH 7.54; P less than 0.005). The rate of pH change after eye opening also increased directly with (Dk/L)O2. The authors conclude that the lenses presently available provide insufficient gas exchange to prevent alteration of corneal pH and suggest that the measurement of stromal pH may provide a sensitive index for evaluating the metabolic effects of contract lens wear.

Acid-Base Equilibrium↗
PubMed1987

Corneal acidosis during contact lens wear: effects of hypoxia and CO2.

The effects of tear-film hypoxia and contact lens wear on human in vivo stromal pH was tested using a non-invasive fluorometric technique. Hypoxia was produced by exposing the normal open eye to 100% nitrogen gas passed through tight-fitting goggles. Stromal pH dropped from 7.53 +/- 0.02 to 7.34 +/- 0.03 (n = 12, +/- SD) within 90 min of nitrogen gas exposure, t1/2 = 20 min. After removing the goggles, stromal pH returned to baseline in 35 min, t1/2 = 10 min. Wearing a thick hydrogel contact lens which caused a tear PO2 less than or equal to 2 mm Hg with the eyes open, reduced stromal pH from 7.55 +/- 0.02 to 7.15 +/- 0.04 (n = 12, +/- SD) in 80 min, t1/2 = 9.5 min. After removing the lens, baseline pH was reached in 40 min, t1/2 = 4.5 min. The stromal pH differences between hypoxia (N2 only) and contact lens wear were not due to differences in tear temperature between the two procedures (contact lens wear 32 +/- 1.5 degrees C, goggles 33 +/- 1.0 degrees C). However exposing the eye to 95% nitrogen-5% carbon dioxide reduced stromal pH to 7.16 +/- 0.05 (n = 7, +/- SD) in 80 min, t1/2 = 8 min, which was similar to that produced during contact lens wear. These experiments show that contact lens wear causes corneal acidosis by: (1) the production of protons from hypoxic metabolism, and (2) the accumulation of carbon dioxide behind the lens due to low lens CO2 transmissibility.

Acidosis↗
PubMed1987

The effect of rigid gas permeable lenses on corneal sensitivity.

Long term wear of hard (PMMA) contact lenses decreases corneal sensitivity. Clinicians have noted that in some patients who are refitted with rigid gas permeable (RGP) lenses, there is often an increase in lens awareness. To document this symptom, we monitored changes in corneal sensitivity of long term PMMA wearers who were refitted with RGP lenses. Corneal sensitivity measurements were conducted over a 6-month period. During this time, corneal touch threshold decreased to normal levels within a few weeks after refitting with RGP lenses. These results suggest an oxygen dependency factor in the control of corneal sensitivity accompanying contact lens wear.

Adult↗
PubMed1987

Measurement of in vivo human corneal stromal pH: open and closed eyes.

The pH sensitive fluorescent properties of fluorescein were utilized to noninvasively measure human in vivo stromal pH in the normal open eye and following eye closure. Stromal pH after either 20 or 90 min of eye closure was 7.39 +/- 0.01 (n = 12, +/- SEM) and returned to 7.54 within 10-15 min of opening the eye, t1/2 = 3 min. Eye closure was simulated by exposing the eye to a gas mixture of 7.1% O2, 6.7% CO2, balance N2, which was passed through tight-fitting goggles. This gas mixture resulted in a steady-state stromal pH of 7.29 +/- 0.02 within 10-15 min, t1/2 = 2.2 min. The time course of the return of stromal pH to open eye levels after removal of the goggles, t1/2 = 2.3 min, was similar to that after eye opening. The extent of the pH change however, was 0.1 pH units greater with the test gas. Exposure of the eyes to 5% CO2 (CO2 concentration of blood) and balance air, produced a stromal pH of 7.38 + 0.01 (n = 6, +/- SEM), which closely matches that following eye closure suggesting that conjunctival [CO2] is 5% and is the major component controlling stromal pH when the eyes are closed.

Adult↗
PubMed1986

Influence of wearing schedule on extended-wear complications.

The effect of wearing schedule on extended-wear (EW) success was evaluated over a nine-month period by assigning 36 subjects to 5 different wearing schedules (removal every 4, 7, 14, or 28 days, or daily wear [DW]). All but one EW patient required interruption of extended wear at least once; half of the DW patients completed the study without interruption. The most prevalent (100%) complication in the EW group was epithelial microcysts; 54% had to discontinue EW for 67 +/- 30 days while severe microcysts subsided. Evidence is given for a hypoxic etiology of microcysts. Other EW complications included: persistent punctate keratitis, infiltrative keratitis, infection, and idiopathic red eye. Neither the level of overnight corneal swelling nor the period between removals influenced the incidence or severity of complications. Data is given on the recovery of corneal parameters after EW is discontinued.

Adult↗
PubMed1979

Tear flow under hydrogel contact lenses.

The tear replenishment rate under three different hydrogel lenses was determined with a slit lamp modified to serve as a fluorophotometer. Fractional tear volume replenishment rates under these lenses averaged 0.011 per blink, which is significantly lower than the 0.10 to 0.20 per blink reported for rigid lenses. These data suggest that the amount of oxygen delivered to the cornea by tear pumping for gel lenses is relatively small and that oxygen received by the cornea covered by a gel lens comes principally by diffusion through the material.

Contact Lenses, Hydrophilic↗
PubMed1979

Oxygen tension under a contact lens.

Corneal thickness changes were measured on human subjects who wore gel lenses that varied in center thickness. Using these measurements and the results of an earlier study in which changes in corneal thickness were monitored on human corneas exposed to oxygen tensions below that in air, we showed that the oxygen tension under most contact lenses varies from 0 to 25 mm Hg which produces a corresponding oxygen flux into the cornea of 0 to 6 microliter cm2 hr. A critical oxygen tension and flux under the lens was found to be 10 mm Hg and 2 microliter cm2 hr, respectively, below which corneal swelling occurs. To maintain these critical levels of tension and flux, the minimum oxygen transmissibility of a stationary lens on the cornea was determined to be 5 X 10(-9) and 15 X 10(-9) (cm X ml O2)/(sec X ml X mm Hg) for the open and closed eye conditions, respectively.

Adult↗