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Biomedical subjects

Sudi Patel

Publications and source records attributed to Sudi Patel.

9 recordsLinked to original sources
PubMed2006

Evidence for delayed presbyopia after photorefractive keratectomy for myopia.

PURPOSE: To evaluate uncorrected near visual acuity (NVA), accommodation, corneal aberrations, and the optical quality of the retinal image in presbyopic eyes after photorefractive keratectomy (PRK). DESIGN: Nonrandomized comparative retrospective study. PARTICIPANTS: Ten post-PRK patients and 10 normal patients. METHODS: Twenty eyes (10 right and 10 left after PRK for myopia, minimum of 10 years after the operation; group A) were compared with 20 eyes (10 right and 10 left age- and gender-matched normal controls; group B). All subjects were over 40 years of age. MAIN OUTCOME MEASURES: With best distance correction, NVA was measured at 40 cm (Jaeger, J series), and the range of accommodation (diopters [D]) was measured subjectively (negative relative amplitude and positive relative amplitude). The modulation transfer function (MTF) and corneal aberrations such as comalike, spherical (SAs), and higher order (HOAs) were measured with a Hartmann-Shack aberrometer. From the MTF curves, the spatial frequencies corresponding to contrast values of 0.1 and 0.5 were noted. RESULTS: Mean ages (+/- standard deviations [SDs]) were 46.3 years (4.7) for group A and 47.6 years (4.9) for group B (P>0.05). Near acuity was J1 or better in 12 of 20 post-PRK and 4 of 20 control eyes. Mean accommodations (+/- SDs) were 3.2 D (1.14) for right group A eyes and 2.1 D (0.94) for right group B eyes (P = 0.0152), and 3.4 D (0.99) for left A eyes and 2.3 D (1.02) for left B eyes (P = 0.0168). Total HOA indexes (+/- SDs) were 1.449 (0.409) for right group A eyes and 0.824 (0.241) for right group B eyes (P = 0.008), and 1.464 (0.388) for left A eyes and 1.067 (0.542) for left B eyes (P = 0.0752). Pooling the data from post-PRK and control eyes, a significant correlation was found between near acuity and SA (right eyes, r = -0.535, P = 0.015; left eyes, r = -0.493, P = 0.027). Significant associations were found between accommodation, near acuity, HOA, and comalike aberration for right eyes only. Mean spatial frequencies (+/- SDs) corresponding to contrast values of 0.1 for right and left eyes were 14.96 (5.71) for right group A eyes and 22.02 (6.85) for right group B eyes (P = 0.074), and 15.11 (7.80) for left A eyes and 21.41 (9.00) for left B eyes (P = 0.271). Mean spatial frequencies (+/- SDs) corresponding to contrast values of 0.5 for right and left eyes were 2.86 (0.63) for right group A eyes and 3.21 (0.35) for right group B eyes (P = 0.596), and 2.76 (0.98) for left A eyes and 3.22 (0.27) for left B eyes (P = 0.194). CONCLUSIONS: Compared with normal eyes, in previously myopic eyes treated with first-generation PRK lasers there is a tendency for (1) the optical quality of the retinal image to be reduced at low contrast, (2) the aberrations attributed to the corneal surface to increase, and (3) both measured subjective accommodation and near acuity to be greater than expected. We postulate that the corneal aberrations induced by PRK for myopia may reduce the quality of the retinal image for distance but enhance near acuity by way of a multifocal effect that can delay the onset of age-related near vision symptoms.

Accommodation, Ocular↗
PubMed2006

Tear meniscus height, lower punctum lacrimale, and the tear lipid layer in normal aging.

PURPOSE: The purposes of this study are to investigate the tear meniscus height (TMH), lipid layer, and critical dimensions of the lower punctum lacrimale (DPL) in normal human subjects over a large age range; and to determine the shape and general characteristics of the lower punctum lacrimale in a normal population. METHODS: TMH and DPL were measured using a graticule set at the eyepiece of a slit lamp biomicroscope (magnification 32x). Lipid layer was assessed by interferometry (Tearscope, Keeler). Only one eye (right) of each subject was assessed. All subjects were normals without any tear-related disorders and/or symptoms. RESULTS: Four hundred forty-four subjects were assessed (268 females, age range, 6-91 years; 176 males, age range, 6-91 years). Mean (+/-standard deviation) TMH in females was 0.19 mm (+/-0.11) and in males was 0.19 mm (+/-0.10). TMH was related to age (x): in females, TMH=0.13+0.0009x (r=0.2393, p<0.001); in males, TMH=0.14+0.0008x (r=0.2492, p<0.001). TMH increased from 0.15 mm (+/-0.06) in the young (<20 years) to 0.21 mm (+/-0.10) in the elderly (>80 years). The punctum was closed in 10.8%, slit shaped in 24.3%, oval in 5.4%, and round in 59.5% of all cases. Mean age and TMH of those presenting with closed puncta was significantly higher than those presenting with open puncta (p<0.001). Mean (+/-standard deviation) area of open puncta was 0.008 mm (+/-0.013) in females and 0.010 mm (+/-0.018) in males. The difference was not significant. Diameter of round puncta was inversely related to age in females (r=-0.4985, n=149, p<0.001) but not within the males. A total of 14.6% of females and 12.5% of males presented with no discernible lipid layer. Lipid layer tended to be thinner in older subjects (one-way analysis of variance, F=6.667, p<0.001). There was no clear relationship between TMH and the lipid layer. CONCLUSIONS: There is a gradual increase in TMH and shift in size and shape of the punctum lacrimale with advancing years. Age-related changes in the lipid layer are expected to reduce tear volume by way of increased evaporation. On balance, it would appear any effects on tear volume by a thinning lipid layer are outweighed by changes in the puncta.

Adolescent↗
PubMed2006

Correction of presbyopia by technovision central multifocal LASIK (presbyLASIK).

PURPOSE: To investigate central multifocal presbyLASIK based on the creation of a central hyperpositive area. METHODS: Twenty-five patients (50 eyes) underwent presbyLASlK in an open-label, prospective, non-comparative pilot study. Mean patient age was 58 years (range: 51 to 68 years), mean preoperative spherical equivalent refraction was +1.6 +/- 0.63 diopters (D) (range: +0.50 to +3.00 D), and mean spectacle near addition was +2.27 +/- 0.37 D (range: +1.75 to +3.00 D). The ablation pattern was performed with proprietary software from Technovision using an H. Eye Tech. excimer laser platform. RESULTS: Mean postoperative spherical equivalent refraction was -0.37 +/- 0.55 D (range: -1.50 to + 1.00 D) and mean spectacle near addition was +1.72 +/- 0.34 D (range: +1.25 to +2.25 D). After 6 months, 16 (64%) patients achieved a distance uncorrected visual acuity (UCVA) of > or = 20/20 and 18 (72%) patients achieved a near UCVA of > or = 20/40. Seven (28%) patients lost a maximum of 2 lines of best spectacle-corrected visual acuity (BSCVA). The safety index for distance was 0.98 binocular and for near was 0.99 binocular. After 6 months, no significant change was noted in contrast sensitivity at 1.5 cycles/degree. A significant mean reduction was found at spatial frequencies of 3, 6, 12, and 18 cycles/degree (P<.001). There was a significant change in corneal aberrations after surgery. The coefficients for coma increased and the coefficients for spherical aberrations decreased. A significant decrease was noted in point spread function values (P=.0018). CONCLUSIONS: Central presbyLASIK may be used to provide improvement in functional near vision in patients with presbyopia associated with low and moderate hyperopia. However, factors involved in the loss of BSCVA in some cases and loss in vision quality should be further clarified prior to its general use.

Adult↗
PubMed2005

Some factors governing the efficacy of positional pseudoaccommodative intraocular lenses.

PURPOSE: To examine the effects of ametropia (spherocylindrical), corneal curvature, target anterior chamber depth (ACD), misplacement, and some design features on the performance of positional pseudoaccommodative intraocular lenses (PPAIOLs). DESIGN: Theoretical investigation based on computer models to determine the practical limitations of PPAIOLs. METHODS: Using a suitable model eye featuring gradient index optics within the cornea, the PPAIOL curvatures were calculated for axial ametropia ranging from -10 diopters (D) to +10 D, where the IOL was located at an ACD of 4.05 mm. The change in refraction (y) of the hypothetical pseudophakic eye was calculated for each millimeter of forward movement (x) of the PPAIOL up to 1 mm from the pole of the corneal back surface. The computations were repeated for a range of hypothetical PPAIOL refractive indices (1.49-1.70), ACDs, equiconvex and meniscus (back surface radius, -10 mm and -25 mm), corneal astigmatism (-1 D to -5 D), and radii (after corneal refractive surgery). MAIN OUTCOME MEASURES: Diopter/millimeter values represent the gradient of the relationship between x and y. Mathematical models describe the association between the diopter/millimeter gradient and key clinical dependent variables. RESULTS: (1) For a polymethyl methacrylate (refractive index, 1.49) PPAIOL of equiconvex design and 4.05-mm ACD, the predicted diopter/millimeter value is a function of ametropia (a), where diopter/millimeter = 1.666+0.136a+0.0018a2. (2) For 6-mm ACD and a refractive index of 1.7, diopter/millimeter = 1.836+0.159a+0.0027a2. (3) The equiconvex design benefits hyperopic but not myopic eyes. (4) For PPAIOLs correcting >4 D of astigmatism, more than 0.5 D of residual astigmatism is present at near after 1 mm of IOL displacement. (5) In emmetropic cases, the predicted diopter/millimeter value is a function of the corneal radius (r) where diopter/millimeter = 7.376-1.162r+0.0545r2. (6) Positional pseudoaccommodative IOL misplacement does not significantly affect the accommodative ability. CONCLUSIONS: (1) Hyperopic eyes with relatively steep corneas should benefit more from the PPAIOL than myopic eyes with relatively flat corneas. (2) A full, binocular, near refraction should be performed to correct any residual spheroastigmatism in anisometropia and cases in which the PPAIOL is toric.

Accommodation, Ocular↗
PubMed2005

Changes in water content of high plus hydrogel lenses worn on an extended wear basis in a geriatric aphakic population.

PURPOSE: To investigate the water content of hydrogel lenses of relatively high plus power hydrogel lenses after 3 months extended wear and compare values with unused lenses. METHOD: Geriatric aphakic extended wear soft lens patients were fitted with one of four different brands of hydrogel lenses (A) Incanto 78 (Cantor and Nissel, UK), (B) PSL72 (Prospect lenses, UK), (C) ES70 (Ocular Sciences), (D) Proclear (Coopervision). After 3 months continuous wear the lens was removed and water content (WC) was determined at both lens surfaces using an Abbé refractometer. The water content was also measured for 40 unused lenses (+10 to +20D, 10 lenses per brand). RESULTS: One hundred and thirty-two lenses were checked after 3 months extended wear. Mean (+/-S.D.) WC values for front (f) and back (b) surfaces of worn and unworn lenses were, respectively, (A) Worn (n=45): f 73.2(4.13) b 73.8(4.33); unworn f 80.5(0.68) b 81.1 (0.80). (B) Worn (n=37); f 70.5(4.49) b 70.9 (3.89); unworn f 72.5(0.94) b 72.3 (0.89). (C) Worn (n=34); f 68.3(3.18) b 68.4(3.63); unworn f 70.6 (0.48) b 71.1 (0.55). (D) Worn (n=16); f 63.4(3.68) b 63.3(3.19); unworn f 60.9 (1.56) b 61.5 (1.92). There was a significant correlation between WC measured from front and back surfaces (p < 0.01). In worn A-C lenses, front surface WC tended to be lower than back surface WC. For lenses A and C at both surfaces the WC of worn lenses was significantly lower than unworn lenses (p < 0.05). For lens D, mean WC of worn lenses was significantly higher than unworn lenses (p < 0.05). In 80% of B lenses, surface WC of worn lenses were significantly lower than WC of unworn lenses (p < 0.05). There was no relationship between WC and lens power. CONCLUSION: On average, A and C lenses tended to desiccate but D lenses tended to swell as did 20% of B lenses. The front surface of worn lenses measured lower water content than the back surface suggesting the front surface is drier than the back. This apparent difference in water content between the surfaces could be an artefact emanating from differential rates of surface deposition.

Aged↗
PubMed2004

Noninvasive assessment of corneal sensitivity in young and elderly diabetic and nondiabetic subjects.

PURPOSE: To investigate the effect of age and diabetes on corneal sensitivity using the noncontact corneal aesthesiometer (NCCA). METHODS: One hundred sixteen nondiabetic subjects and 111 diabetic subjects (33 type I and 78 type II) were recruited and divided into three age groups: Young ( or=60 years). The exclusion criteria included patients with severe retinopathy requiring treatment, a history of invasive ocular surgery, or a history of conditions known to affect corneal sensitivity. The corneal cooling sensation threshold, for the right eye of each subject, was assessed with a double-staircase method-of-limits technique with the NCCA. This instrument uses a controlled pulse of air to produce a small, localized reduction in the surface temperature of the eye, which is detected by the nerves in the corneal epithelium. RESULTS: Analysis of the scatterplot of each subject's central cooling sensation threshold revealed a gradual loss of sensitivity with increasing age (nondiabetic, r(2) = 0.349; diabetic, r(2) = 0.131). Within the nondiabetic group, inter-age-group comparisons found significant differences between the central corneal cooling sensation thresholds for the three age groups (t-test, P < 0.01). Within the diabetic group, a significant difference was found between the Middle and Older categories only (t-test, P < 0.05). In summary, the Young group was more sensitive than the Middle group, which was more sensitive than the Older group. Within both type I and type II diabetic subjects, there was neither a significant relationship between duration of the disease and corneal sensitivity (t-test, P > 0.05) nor a gender-based difference (t-test, P > 0.05). CONCLUSIONS: There is a gradual reduction in corneal sensitivity with increasing age in both nondiabetic subjects and diabetic subjects, along with an increasing variation in the measured threshold. There is no relationship between corneal sensitivity and the time since diagnosis of diabetes for a thermally cooling stimulus, suggesting that the A partial differential and C fibers of the corneal innervation are affected differently by abnormal glucose metabolism in the diabetic cornea.

Adult↗
PubMed2002

Objective assessment of aberrations induced by multifocal contact lenses in vivo.

PURPOSE: This study examined the effects of a soft multifocal progressive contact lens on individual Zernike coefficients describing the aberrations of the eye. METHODS: Ocular wavefront aberrations (OWA) of 10 subjects not wearing contact lenses were quantified using a Shack-Hartmann aberrometer and were repeated after lens insertion (two lenses,+2 diopters [D], and -2D distance power, order of insertion was randomized). All data were captured and stored on computer. Each coefficient of the Zernike polynomials representing, coma, spherical aberration (SA), and the fifth-order aberrations were evaluated for each OWA. Pupil size was monitored using an infrared device. RESULTS: After subjecting the data to various permutations, the following relationships and chief findings were detected: (1) Comparing coefficients with and without lenses, significant correlations for coma (Z(1)3 [rho,theta], P=0.0056; -2D and P=0.0399, +2D); SA (Z(0)4 [rho,theta], P=0.0006; -2D; and P=0.0061,+2D). Fifth-order aberration (Z(-1)5 [rho,theta], P= 0.0029,+2D). (2) With the -2D lens, the average root-mean-square (RMS) value for the SA coefficient Z(4)4 (rho,theta) and fifth-order Z(-3)5 (rho,theta) increased (P=0.045 and 0.0392, respectively). (3) With the +2D lens, the average RMS value for fifth-order coefficient Z(1)5(rho,theta) increased (P=0.0278). (4) Coma (Z(1)3 [rho,theta] coefficient) correlated with pupil size (P<0.05). Initial mean (+/-SD) pupil size (mm) was 3.05 (0.499), and this did not change significantly. CONCLUSIONS: Z(1)3(rho,theta) and Z(0)4(rho,theta) coefficients may be useful objective markers of success or failure for such contact lenses. The -2D lens had a more predictable effect on SA compared with the +2D lens design. The opposite occurs when considering the effects on the higher fifth-order order aberrations.

Contact Lenses, Hydrophilic↗
PubMedDate not supplied

Effect of hyperopic photorefractive keratectomy on corneal sensitivity: a longitudinal study.

PURPOSE: To investigate corneal sensitivity after photorefractive keratectomy (PRK) for low hyperopia, as measured with a non-invasive stimulus. METHODS: Two experimental groups were recruited: a control group of 17 patients (mean age 61.65 years) who underwent no treatment, and a PRK group of 11 patients (mean age 58.64 years) who underwent one of three attempted hyperopic corrections: +2.00 D (two patients), +3.00 D (four patients), +4.00 D (five patients). Corneal sensitivity was assessed centrally and peripherally, at temporal, medial, and inferior locations, approximately 1 mm from the limbus, using the Non-Contact Corneal Aesthesiometer (NCCA). Measurements were taken at each location for the control group and at preoperative, and postoperative weeks 1 and 2, 1, 3, and 6 months for the PRK group. RESULTS: Comparison of control and PRK groups (preoperative sensation threshold) (t-test): central P=.715, temporal P=.719, medial P=.943, inferior P= .920. Comparison of longitudinal changes in PRK group (one-way ANOVA): central P=.612, temporal P=.997, medial P=.981, inferior P=.993. CONCLUSIONS: Using the Non-Contact Corneal Aesthesiometer, no significant difference was found between the control and PRK groups for preoperative sensation thresholds, and no significant change in corneal sensitivity was found between any of the test time periods at any of the four corneal test locations for the PRK group.

Adult↗