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Biomedical subjects

N A Brennan

Publications and source records attributed to N A Brennan.

At least 19 recordsLinked to original sources

The duration of normal visual exposure necessary to prevent form deprivation myopia in chicks.

The aim of this study was to determine the minimum daily period of exposure to normal visual stimulation required to prevent occlusion induced myopia in chicks. Chicks were treated with monocular translucent occlusion in a 12 hr light/12 hr dark cycle. Occluders were removed for 0 (constant occlusion), 15, 20, 30, 40, 60, 75, 90, 120, 150, 240 or 720 (no occlusion) minutes each day for either 2 or 3 weeks. Fellow eyes and the eyes of normal chicks (bilaterally unoccluded) were used as controls. Occlusion-induced myopia and axial elongation were found to decrease significantly (P < 0.01) with increasing daily exposure to normal visual stimulation. Application of a time series equation to the data estimates that 30 and 130 min of normal visual exposure per day reduces myopia by 50 and 95% respectively. This study demonstrated that the regulation of ocular growth is affected strongly by short periods of normal visual stimulation in the presence of long periods of abnormal stimulation.

Animals

Soft lens movement: effects of humidity and hypertonic saline on lens settling.

Hydrogel contact lenses require a settling period before lens fit stabilizes, but the process underlying the initial reduction in lens mobility is poorly understood. Explanations for this phenomenon include base curve steeping with dehydration, expulsion of postlens tear fluid, and osmotic flow of hypotonic tears into the cornea. We conducted two randomized, single-masked interocular comparisons for ten subjects wearing HEMA lenses for 1 h. We investigated potential mechanisms of dehydration-dependent lens tightening, by limiting dehydration in one eye using a high humidity environment (experiment 1), and of a hypotonic lacrimation-dependent decrease in lens movement, by presoaking lenses in isotonic (0.9%) or hypertonic (1.5%) saline (experiment 2). Lens mobility profiles were not significantly affected by modification of environment; lenses in both normal and high humidity environments displayed a significant reduction in lens movement during the first 15 min of wear (ANOVA, p = 0.0001), and no change in lens mobility thereafter. Lens mobility profiles were identical for lenses presoaked in isotonic and hypertonic saline, with initial lens movement being significantly greater than for subsequent measurements (ANOVA, p < 0.05). These studies find no evidence to support dehydration-dependent steepening of base curve, or osmotic-dependent binding from hypotonic lacrimation as mechanisms for the initial postinsertion decrease in lens movement.

Adult

Soft lens movement: temporal characteristics.

The time-course of on-eye hydrogel lens movement has not been carefully scrutinized, despite the importance of lens movement in optimizing lens fit and corneal physiology. We conducted a study to define the time-course of soft lens movement using 26 subjects. Video slitlamp recordings were made of lens movement at 5-min intervals for 30-min wear and after 8-h wear of 38 or 67% water content lenses (N = 14 and 12, respectively). Lens mobility profiles were statistically indistinguishable for high and low water content lenses, and for experienced and neophyte lens wearers. Lens movement displayed biphasic temporal characteristics, decreasing significantly over the first 25 min from a median of 0.6 to 0.3 mm (Wilcoxon matched-pairs signed-rank test, p = 0.002), then increasing significantly to 0.5 mm after 8 h of wear (p = 0.03). Although some subjects exhibited little alteration in lens movement, 31% showed a decrease in lens movement > 0.25 mm during the first half-hour of wear. Optimal predictability of lens mobility after 8-h wear was achieved 5 min after insertion, with 77% of subjects displaying lens movement within +/- 0.25 mm of the final value. In-office assessment of lens movement is best achieved 5 min after insertion, although clinical and real world lens mobility will differ significantly in about one in four patients.

Blinking

The role of pili in the attachment of Pseudomonas aeruginosa to unworn hydrogel contact lenses.

Contamination of contact lenses is thought to increase the risk of infectious keratitis, yet factors promoting attachment of bacteria to contact lenses are not fully understood. It has been suggested that strains of Pseudomonas aeruginosa attach to mucosal surfaces via pili which are appendages found on some strains. This study investigated the role of pili and the effect of incubation time on the attachment of P. aeruginosa to 20 unworn hydrogel lenses representative of each of the four FDA categories. Ten lenses were incubated for 15 minutes and another ten for 180 minutes. Lenses were incubated with either PAK + P. aeruginosa which possessed pili or its isogenic mutant pair, PAK-, which was genetically similar except for the absence of pili. Bacteria were quantified, following homogenization of the contact lens, by viable counts. Non-piliated bacteria were significantly more likely to adhere to the lenses (p < 0.001). A significant interaction between lens type and incubation time was observed (p < 0.05); thus it is difficult to generalize about either of these effects in isolation. These results show that surface characteristics may confer an attachment advantage to bacteria.

Bacterial Adhesion

Comparative efficacy of contact lens disinfection solutions.

Using the D value method of analysis, we evaluated the relative antimicrobial effectiveness of eight contact lens disinfection solutions against a standard population of challenge organisms as defined in the Microbiological Guidelines proposed by the Food and Drug Administration (FDA). Six bacteria (Escherichia coli, Staphylococcus aureus, S. epidermidis, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Serratia marcescens) and two fungi (Aspergillus fumigatus, Candida albicans) were investigated. The disinfectants included hydrogen peroxide (AOSept, MiraSept, Oxysept), chlorine-based solutions (Aerotab and Softab), soaking solutions containing synthetic, high molecular weight preservatives (ReNu and Opti-Free) and a thimerosal preserved soaking solution (Hydrocare Cleaning and Soaking Solution). The one-step hydrogen peroxide system (AOSept) was evaluated both with and without the catalytic disk. To facilitate comparison of the disinfecting solutions, we defined a new measure of performance, namely "power" of solution. This has an advantage over the "safety factor" because the solution power is independent of the size of the initial inoculum. Because different approaches to analysis may yield a wide range of D values for one set of survival data we call for adoption of a standardized approach. Our results suggest that one of the chlorine-based solutions fails to meet the FDA recommendations for bacterial challenge. Most solutions performed poorly against mycotic challenge. However, when used over longer disinfecting periods, 3% hydrogen peroxide and the Hydrocare solution gave adequate performance against fungi.

Bacteria

Effect of hydrogel lens wear on tear film stability.

Noninvasive break-up time (NIBUT) of the tears was measured in a controlled, randomized, double-masked study to assess: (1) the stability of the prelens tear film during wear of new high and low water content lenses and (2) the stability of the precorneal tear film following lens removal after 1 h of wear. The prelens tear film NIBUT of 6 subjects was found to be relatively constant over a 1-h wearing period, averaging 6.1 +/- 1.1 s (mean +/- SEM). These values were significantly (Scheffe's S test, p less than 0.05) lower than those recorded for the precorneal tear film before lens insertion (33.5 +/- 10.6; mean +/- SEM), although 85% of prelens tear film NIBUT's were greater than the 3-s average interblink period reported previously for soft lens wearers. After lens removal, precorneal tear film NIBUT was reduced significantly compared to prewear levels (Scheffe's S test, p less than 0.05) for up to 15 min. Application of the monomolecular growth model to the NIBUT recovery data revealed a half-time for recovery of 6.0 min, with recovery 95% complete 25.8 min after lens removal. Lens type was not a significant factor in tear film stability, either during wear or after lens removal. The basis for reduced precorneal tear film NIBUT after lens removal is unknown; however, a disruption of the mucin layer coating the corneal epithelium is the most likely mechanism. Indeed, the technique of measuring precorneal tear film NIBUT after lens removal may be a useful determinant of the extent to which contact lens wear disrupts the precorneal mucin layer, providing an indication of the susceptibility of the cornea to a variety of complications.

Blinking

Esthesiometry as an indicator of corneal health.

We review the literature regarding changes in the structure and function of the cornea as an index of the physiological status of the tissue. Accurate measurement of corneal sensitivity may be the most reliable test of long-term corneal compromise inasmuch as the edema response, the most popular test of corneal physiological integrity, shows "adaptation". Although reduced sensitivity has been associated with corneal hypoxia, decreased corneal pH may also play a major role. Certainly, small departures of pH from normal levels in the body can lead to major depression of neural function. Traditionally, mechanical sensitivity of the cornea has been measured with procedures based on the von Frey hair. More recently, esthesiometry has been performed with the use of a puff of air, a chemical stimulant, and heat. Results from early trials with these procedures are encouraging in terms of the development of a viable clinical method for assessing metabolic effects on the cornea from contact lens wear.

Adaptation, Physiological

Clinical application of the oxygen transmissibility of powered contact lenses.

Stipulation of the oxygen transmissibility (Dk/L) of a contact lens based upon oxygen permeability (Dk) and nominal lens thickness (L) can be misleading since center thickness, average thickness, and hence Dk/L of a contact lens vary with lens power. While earlier confusion regarding determination of Dk has now been resolved, this data has yet to be fully incorporated into a clinically applicable model. We developed a graphical solution describing variations in Dk/L with power for a representative sample of currently available hydrogel and rigid contact lenses. The Dk/L is found to be optimal for lenses of low minus power (approximately -2.50 D). The model presented here will assist practitioners in assessing the potential oxygen performance of different lens designs with respect to a given power. We advocate that lens manufacturers print the average Dk/L on lens packaging, according to the model described in this paper, along with the parameters that are usually stated.

Contact Lenses, Hydrophilic

The effect of soft lens lubricants on symptoms and lens dehydration.

In order to establish the efficacy of soft lens lubricants and their mode of action, we conducted a controlled, double-masked, randomized study. Symptoms of dryness as well as lens water content were assessed in 30 symptomatic hydroxyethylmethacrylate (HEMA) contact lens wearers who each applied either saline or one of two soft lens lubricants every 2 hours over a 6-hour wearing period. Short- and long-term symptomatic relief from ocular dryness was provided by both lens lubricants (ANOVA, P less than .05). However, neither lubricant was found to be significantly superior to saline. Contact lens dehydration was not significantly reduced by the instillation of any solution. A psychological rather than a physical (lens hydration) or physiological basis to the symptomatic relief provided by soft lens lubricants cannot be discounted.

Adolescent

In vivo dehydration of disposable (Acuvue) contact lenses.

The in vivo dehydration of the Acuvue disposable contact lens was measured in six subjects using a contact lens refractometer. On average, the lenses dehydrated 6.2 +/- 1.9% after 20 min and 10.2 +/- 3.9% after 6 h of wear. The magnitude of dehydration is greater than has been reported for other hydrogel lens types of similar water content. This information may assist practitioners in the interpretation of clinical signs pertaining to lens behavior and associated patient symptoms.

Adult

Soft lens lubricants and prelens tear film stability.

Soft contact lens wearers complaining of "dry eye" are frequently prescribed rewetting drops, although the mode of action and efficacy of this treatment have not been established. Enhancement of prelens tear film (PLTF) stability could provide a basis for symptomatic relief with solution instillation. Thirty symptomatic hydroxyethyl methacrylate (HEMA) lens wearers participated in 4 separate trials of no solution (baseline), saline, and 2 soft lens lubricants. Solutions were applied for a 6-h adaptation period, and PLTF noninvasive break-up time (NIBUT) was monitored for 1 h after a final instillation. PLTF NIBUT was significantly elevated 1 min after instillation of all solutions (p less than 0.001, logrank test) but this effect persisted for less than 5 min. The transient enhancement of PLTF stability arising from the instillation of these rewetting solutions is unlikely to provide a basis for prolonged symptomatic relief.

Adolescent

The Dk project: an interlaboratory comparison of Dk/L measurements.

The oxygen transmissibilities (Dk/L) of a set of 48 contact lenses made from 8 different materials were measured by 4 laboratories. The L/Dk measurements from each laboratory were compared and correlated. Samples which were not masked with a fixed front surface aperture during measurement were corrected for edge effects. This paper shows that provided L/Dk is calculated for each lens using the same technique and Dk is derived using a graphical method of calculation, similar results can be obtained by all laboratories. However, the agreement was less good for materials of Dk greater than 70 x 10(-11) (cm2/s) (ml O2/ml x mm Hg).

Contact Lenses

Oxygen permeability of collagen shields.

The oxygen permeability (Dk) of ten 24-hr collagen shields was measured directly by polarographic methodology at approximately 2 hr of hydration. Edge and boundary effects were included in the calculations. Dk was found to be approximately 26 x 10(-11) cm ml O2/sec ml mmHg at 35 degrees C. Mean water content of the shields was 65.7% (SD = 1.0%) as measured by a hand refractometer. Therefore, the projected oxygen transmissibility of collagen shields is expected to be compatible with normal corneal metabolism.

Bandages

Reliability of corneal oxygen flux measurements.

Serial oxygen flux measurements were obtained from the same cornea of 5 human subjects after exposure to ambient air, a test gas mixture (2% oxygen, balance nitrogen) and 100% nitrogen at 2 individual measurement sessions. Analysis of variance (ANOVA) of the individual flux measurements for the test gas indicates that there were significant differences in corneal oxygen flux rates among subjects and sessions. Referencing the flux data for the test gas to the data for ambient air reduced the variability of data between sessions, although significant intersubject differences were still present. By referencing the flux data for the test gas to the concurrent air and nitrogen data, differences among subjects, as well as sessions, were reduced to the extent that they were not statistically significant. Standardization of data is important in the interpretation of corneal oxygen flux data so that intersubject and intersession differences can be minimized.

Air

Symptomatology of HEMA contact lens wear.

Identification of the determinants of patient symptoms is a requisite for successful patient management in contact lens practice. Symptoms reported by 104 patients wearing hydroxyethyl methacrylate (HEMA) contact lenses, who presented consecutively to a large contact lens clinic, were analyzed. Dryness was reported more frequently than the symptoms scratchy and watery (p less than 0.001). Females using oral contraceptives were more likely to experience the symptoms of scratchiness (p less than 0.01) and dryness (p less than 0.05) than females who were not using oral contraceptives. The symptoms dryness was reported more frequently by patients whose lenses were older than 6 months (p less than 0.05), and those wearing toric lenses (p less than 0.01). These findings will assist practitioners to anticipate those patients who are likely to develop contact lens-related symptoms and lay the foundations for a model of symptomatology during contact lens wear.

Acrylates

Theoretical principles of optical pachometry.

Various configurations have been suggested for the optical measurement of corneal thickness by slit beam doubling, and corresponding ray traces have been provided to relate actual thickness to apparent thickness. In this report, a set of equations is provided which apply to the general situation in which neither the angle of illumination nor the angle of observation are aligned with or symmetrical about the normal to the cornea. An explicit solution to these equations giving true corneal thickness in terms of apparent thickness cannot be established, and an iterative procedure is used to develop a relationship for a number of different pachometer configurations. The near linearity of these relationships suggests the existence of a simple equation to relate these entities. By making appropriate assumptions, a linear approximation relating the inverse of the true thickness to the inverse of the apparent thickness is developed. An equation for determining the location of measurements of peripheral corneal thickness is also derived. The equations presented here may be generally applied to all optical pachometer configurations, can be used to estimate the relative contributions of various sources of error in pachometry and provide a basis for obtaining uniform absolute derivations of corneal thickness.

Cornea

Extended contact lens wear in the developing cynomolgus monkey eye. Recovery from adverse responses.

Soft extended wear contact lenses were designed for and fitted to 12 eyes of 11 infant semiwild cynomolgus monkeys. The lenses were satisfactorily worn over observation periods of up to 465 days, the longest continuous period of lens wear being 69 days. However, some of the corneas were subject to a pattern of complications analogous to that in human contact lens wear. Nine eyes showed adverse responses, and of these, the ocular complications were severe enough in four cases to cause abandonment of lens wear. The most remarkable feature of the complications was the rapid recovery of severe reactions to near normality in less than 24 h, indicating an impressive ability of the cornea to tolerate and survive insult. Another feature was the recurrent nature of mild complications in certain monkeys despite apparent resolution from previous episodes. There appeared to be no correlation between duration of lens wear and appearance of the first or recurrent episodes of corneal infiltration and vascularization.

Age Factors

Ocular surface temperature.

A wide-field color-coded infra-red imaging device was applied to the measurement of i) the temperature profile across the ocular surface and ii) the temporal stability of central corneal temperature, on 21 subjects. The thermographs showed a pattern of ellipsoidal isotherms (major axis horizontal) approximately concentric about a temperature apex (coldest point) which was slightly inferior to the geometric center of the cornea (GCC). The GCC had a mean temperature (+/- SD) of 34.3 +/- 0.7 degrees C (range 32.8 to 35.4 degrees C). Temperature increased towards the periphery of the cornea with the limbus being 0.45 degrees C warmer than the GCC (p less than 0.0001). Following a blink, the GCC cooled at a mean (+/- SD) rate of 0.033 +/- 0.024 degrees C/s (p less than 0.0001) over the first 15s. Subjects whose corneas cooled more slowly following a blink demonstrated a greater capacity to avoid blinking for a prolonged period (p less than 0.05). This improved method of measuring ocular surface temperature has important applications in modeling corneal physiology and pathology.

Adult