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Biomedical subjects

W J Benjamin

Publications and source records attributed to W J Benjamin.

At least 19 recordsLinked to original sources

Vapor pressure osmometry: minimum sample microvolumes.

PURPOSE: Vapor pressure osmometers are currently designed to handle sample volumes as small as 2.0 microliters (microl) but smaller sample volumes are desirable in tear fluid studies. We determined the minimum sample size required for adequate validity and repeatability of osmolality measurements. METHODS: A standard saline solution (290 mmol/kg) was sampled by a variable, calibrated pipette. Forty samples were processed with a Wescor 5520 vapor pressure osmometer at each of the following volumes: 2.0, 1.6, 1.2, 1.0, 0.8, 0.7, 0.6 and 0.5 microl. Prior to each test series, the instrument was calibrated with the identical volume of 290 mmol/kg saline. Relevant descriptive statistics were computed and an analysis of variance (ANOVA) was performed on the resulting data. RESULTS: The mean osmolalities of the eight 40-sample groups ranged from 288.42 to 290.68 mmol/kg and were not significantly different from 290 mmol/ kg or each other (p>0.05). The standard deviations were inversely correlated with the sample volumes, gradually increased to approximately 1% as sample volume was reduced to 0.8 microl, then more rapidly increased as the sample volume was lowered still further. CONCLUSION: Sample microvolumes as small as 0.8 microl can be collected for accurate and repeatable results with the Wescor 5520 vapor pressure osmometer when a standard deviation of approximately 1% is acceptable. Microvolumes from 0.7 to 0.5 microl may also be used if the expanded spread of data can be offset by multiple repeated readings. Using a 2.0 microl sample volume, the ultimate accuracy and repeatability of the Wescor vapor pressure osmometer was +/-2% at 290 mmol/kg: 99%, of all readings (+/-3 standard deviations) should fall within +/-6 mmol/kg of the true value.

Equipment Design↗

Features of the partially expanded human inferior conjunctival sac.

Space in the inferior conjunctival sac has not been studied in sufficient detail to allow optimal physical design of conjunctival inserts. We analyzed shape and volume of partially expanded, anesthetized, left inferior conjunctival sacs in 10 young adult subjects by injection of a liquid polysiloxane molding compound. Mean volume, greatest thickness, central thickness, horizontal width, and vertical height of 60 molds were 125.7 microliters (SD = 55), 1.56 mm (SD = 0.69), 1.46 mm (SD = 0.62), 20.7 mm (SD = 2.2), and 8.9 mm (SD = 0.8), respectively. Volumetric and linear dimensions varied between subjects, but certain features were common to all molds: 1) a crescent shape horizontally; 2) a thick inferior horizontal ridge; and 3) a wedge-like shape sagittally. We postulate several advantages of conjunctival inserts with features representative of our molds of conjunctival sacs, e.g. such inserts may be more comfortable, less expelled, larger in volume, and contact more tissue area.

Adult↗

Human corneal oxygen demands at superior, central, and inferior sites.

BACKGROUND: Oxygen depletion of the superior and central cornea in response to standard conditions is of clinical interest because of pathological conditions, usually resulting from the hypoxia of contact lens wear, that affect these areas. A study was designed to determine if there are differences in oxygen depletion at these two sites. METHODS: Oxygen depletion times from a standard reservoir following corneal exposure to three different oxygenated environments (20.9%, 5%, and 0% oxygen) were assessed micropolarographically at central, superior, and inferior corneal surface positions on both corneas of six healthy young adult human subjects. RESULTS: Based on 48 measurements for each corneal position at each oxygen percentage (432 total measurements), the superior cornea 1.0 mm from the limbus was found to have longer oxygen depletion times (slower oxygen uptake rates) than the central or inferior corneal locations. The differences reduced to nearly zero during the course of the initial 1.5-day testing procedure, but were re-established months later when testing was resumed. CONCLUSIONS: There is a small reversible increase in superior corneal oxygen depletion time (a decrease of the oxygen uptake rate) due to the chronic hypoxia that results from the presence of an overlying superior eyelid or other physiological factors.

Adult↗

Oxygen performance of a prototype nonconventional hydrogel.

UNLABELLED: INTRODUCTION. Oxygen permeability (Dk) of available hydrogel materials used for soft contact lenses is currently restricted by the oxygen permeability of water at 80 Dk units. A predicted upper limit for conventional hydrogels amenable for use as a contact lens, has been 37 Dk units obtained with a water content of 80%. Methods for increasing oxygen permeability beyond that determined by water content must be explored, in order to further advance the physiological compatibility of hydrogel contact lenses. METHODS: Oxygen transport characteristics of a prototype nonconventional hydrogel contact lens material were derived in terms of human equivalent oxygen percentage (EOP) and thickness (L). The oxygen permeability of the material and oxygen transmissibilities (Dk/L) of various thicknesses were computed on the bases of a recently published nonlinear EOP vs. Dk/L relationship. RESULT: The material's oxygen permeability (Dk) was determined to be approximately 35 Dk units compared to 12.7 Dk units calculated for a conventional gel material having the same water content (52% H2O). Oxygen permeability equivalent to that obtained with high-water conventional gels was achieved using this mid-water nonconventional hydrogel. The prototype material was apparently also capable of low critical thicknesses typical of low-water conventional gels. DISCUSSION: Should new gel materials be durable with critical thicknesses in the "ultra-thin" range, nonconventional gel lenses could be capable of super and perhaps even hyper transmissibility with central minus lens EOP between 15-18.5% and Dk/L between 50-90 Dk/L units. The conventional relationships between water content and oxygen transmissibility of hydrogel contact lenses appear to have been surpassed. However, significant additional hurdles have yet to be overcome before nonconventional hydrogel materials can be ready for the ophthalmic marketplace.

Biocompatible Materials↗

Human basic tear fluid osmolality. I. Importance of sample collection strategy.

Osmolalities of 200 human tear prism fluid samples collected from two subjects were determined from their melting-point temperatures with the Clifton Nanoliter Osmometer by calibration with 200 standard solution samples (290 mOsm/kg). Comparisons were made between tear fluid osmolalities obtained using a single-sample simultaneous-recalibration method: 1) for tear samples collected using finely-drawn microcapillaries without biomicroscopy, vs secondly with biomicroscopic observation by illumination of only the sampling area on the inferior tear prism, the two collections separated by an interval of 10 min; and 2) for samples collected without biomicroscopy before, vs after a 10-min interval. Tear fluid collection using a biomicroscope resulted in values that were significantly lower than those collected without (overall mean = 299.5 and 306.6 mOsm/kg, respectively; p < 0.0001). The difference (7.1 mOsm/kg) may have resulted from mechanical, photic, and/or psychogenic reflex stimulation due to biomicroscopy, as the 10-min interval had no osmotic effect on samples collected without biomicroscopy. Based on these results from two subjects, we suggest that relatively rapid, repetitive collections of human tear prism fluid can be made without significantly disturbing the osmotic outcome. However, physiological representation of basic human tear fluid is more accurate by avoidance of reflex-inducing collection methods that were formerly considered unobtrusive. Basic human tear prism fluid is more hypertonic, by at least 7 mOsm/kg, than generally realized.

Humans↗

Human basic tear fluid osmolality. II. Importance of processing strategy.

Osmolalities of 100 human inferior tear prism fluid samples collected from two subjects and 100 standard solution samples (290 mOsm/Kg) were determined from their melting-point temperatures with the Clifton Nanoliter Osmometer. Accuracy and reliability comparisons were made for endpoints obtained using a single-sample simultaneous-recalibration (SS/SR) strategy, vs a lowest-of-six periodic-recalibration (LS/PR) strategy. Tear fluid osmolality values based on the LS/PR strategy were significantly lower (hypotonic) than for the SS/SR strategy (overall mean = 302.4 and 307.8 mOsm/Kg, respectively; p < 0.0012). The mean difference (5.4 mOsm/Kg) resulted from the combined effects of machine drift and reduced reliability of endpoint determination for tear fluid in comparison to that of a homogenous standard solution. LS/PR osmolality was linearly correlated to SS/SR osmolality with a slope of 0.433 and the two endpoint strategies resulted in equivalent values at 298.4 mOsm/Kg. Eighty-four percent (84%) of individual osmolality readings were greater than 298.4 mOsm/kg, and an 'averaging-type' effect caused LS/PR osmolalities to be increasingly less than SS/SR values above this value. These outcomes from two subjects were approximated by a parallel statistical model. We suggest that physiological representation of basic human tear fluid is more accurate using the single-sample simultaneous-recalibration strategy. Basic human tear prism fluid is more hypertonic and has a greater within-subject range in normal (non-dry eye) humans than previously realized.

Humans↗

EOP and Dk/L: the quest for hyper transmissibility.

The relationship between human equivalent oxygen percentage (human EOP) and oxygen transmissibility (Dk/L) was examined for 28 parallel- and nearly parallel-surfaced contact lenses having oxygen transmissibilities ranging from 14.2 to 134.4 Dk/L units as determined with a gas-to-gas method. EOP and Dk/L were positively related such that increases in Dk/L led to progressively smaller increases in human EOP, until Dk/L asymptoted at an EOP of approximately 20 percent. Human EOPs were semi-logarithmically correlated to Dk/L in a linear fashion (R2 = 0.95), though the semi-logarithmic linear equation didn't as closely predict the expected EOP vs. Dk/L curve at its extreme ends. Classifications of oxygen transmissibility and permeability were also standardized into ranges of equivalent oxygen percentage: contact lenses of low, medium, high, super, and hyper transmissibility and materials of low, medium, high, super, and hyper permeability were defined. While most available hydrogel lenses and materials are currently limited by their water contents to the low and medium Dk/L and Dk groups, some available rigid lenses and materials have attained super-Dk/L and hyper-Dk status. They should be better able to be fitted to the individual eye and to incorporate more complicated optical corrections, having partially alleviated dependency of corneal oxygen supply on lens design. The quest for hyper-permeable materials stable in thinner designs may produce lenses of hyper transmissibility with corneal oxygen supply nearly insensitive to lens design, as variation of thickness over lens apertures will then result in alterations of corneal oxygenation (EOP) having minimal clinical significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Membrane Permeability↗

Cleaning and storage of rigid contact lenses prior to dispensing.

Most care regimens used with rigid contact lenses are composed of three solutions: 1) a "cleaning" solution; 2) a "combination" solution intended for storage, disinfection, and wetting prior to placement of rigid lenses on the eye; and 3) an in-eye "rewetting" or "lubricating" solution. While solutions (1) and (3) have only single functions, solution (2) must fulfill three fairly disparate functions. A "2-solution" care regimen is offered by Sherman Pharmaceuticals and consists of (a) a solution for cleaning, storage, and disinfection; and (b) a "wetting" solution that doubles as an in-eye lubricant. Through a more compatible and efficient matching of multiple functions within solutions, Sherman Pharmaceuticals claims to more adequately clean and prepare rigid gas-permeable (RGP) lens surfaces for wear. We investigated this strategy in terms of in-eye wettability of initially "ill-prepared" RGP lens surfaces, as measured with the in vivo contact angle technique. For this study, lenses were intentionally not cleaned of residues or solvents by the manufacturer at the end of production so as to create the well-known "first-day non-wetting syndrome." The ability of the 2-solution care regimen to even then provide wettable surfaces was compared to that of a saline control "regimen" and the most popular competing "3-solution" care system. We concluded that use of both care regimens dramatically enhanced in-eye wettability and, therefore, reduced the incidence of the "first-day non-wetting syndrome". However, the 2-solution care regimen provided significantly better wettability overall, lower incidence of functionally non-wetting surfaces, and more consistently wettable RGP lenses.

Contact Lenses↗

Effect of humidity on the deswelling function of the human cornea.

The present study determined the effect of the full range of humidities on the deswelling function of the human cornea. The closed-eye deswelling function and the open-eye deswelling responses for five different levels of humidity (0%, 25%, 60%, 85%, and 100%) were assessed for 8 normal, young-adult subjects. Open-eye corneal deswelling for the 8 subjects was unaffected by relative humidities from 0 to 100%. Therefore, osmotically-driven corneal thinning effect of tear evaporation does not significantly contribute to the deswelling function of the human cornea. We conclude, contrary to recent reports, that the endothelial pump is the primary mechanism that maintains normal corneal thickness and provides recovery from stromal edema.

Adult↗

Assessing the risks of extended wear.

Risks associated with contact lens wear vary in the literature with respect to identity and severity. To more adequately portray these risks, a meta-analysis of complications was performed, using (1) contact lens package inserts; (2) reports of complications in nonreferral populations of extended-wear patients; (3) reports of complications for contact lens wearers seen in emergency rooms; (4) reports of corneal ulceration in referral populations of contact lens wearers; and (5) studies comparing daily- and extended-wear patients in terms of ulcerative keratitis. Total complication rates for extended wear of rigid and hydrogel lenses ranged from 7% to 31% of eyes over corresponding mean wearing durations of 12 to 22 months. Mean corneal ulceration rates were 0.44% and 0.21% per eye per year for the extended wear of hydrogel and rigid contact lenses, respectively. The risk of ulcerative keratitis among hydrogel extended-wear patients was 4.2 times that of hydrogel daily-wear patients, and rigid lens extended wear entailed roughly half of the risk of ulcerative keratitis of hydrogel extended wear. When applied to contact lens wearers in the United States, these risks indicate an estimated incidence of ulcerative keratitis greater than 71,000 cases per year, averaging approximately 1.7 ulcerations annually for each eye care practitioner in the United States.

Aphakia, Postcataract↗

Physiology of aging and its influence on the contact lens prescription.

The normal progressive physiological and visual effects of aging and its influence on the ability of contact lenses to provide ametropic correction is examined in this article. Of primary significance is the aging eye's perceptual ability especially in the mesopic range of vision. In addition, a recap of current available techniques is included for correction of presbyopia with contact lenses from the perspective of prescribing for an aging patient--not merely a patient who has lost only the ability to accommodate. One of the hallmarks of the profession of optometry has been its traditional support of the premise that patients should be provided with the best possible optical correction. While there are presbyopic patients who can achieve satisfactory vision via the contact lens modalities now in use, the physiological influences discussed here have been generally ignored by the profession. A redefinition of the criteria indicating patient "success" has evolved from achieving satisfaction through excellent vision derived from the optimum optical correction, to satisfaction obtained through patient selection and indoctrination to wear an optically inferior device. Unless the physiological, visual, and psychological effects of aging are adequately compensated by future contact lens designs, most elderly patients will remain likely to return to spectacles as the deficiencies of contact lens correction become progressively more apparent to them.

Accommodation, Ocular↗

Tonicity of human tear fluid sampled from the cul-de-sac.

A 'freezing point' depression technique was used to determine the osmolality of 384 samples of tear fluid originating from the middle of the lower tear prism and the lower cul-de-sac of one eye of each of 12 young adults. Tear fluid from the cul-de-sac (mean 341.0 mosm/kg) was found overall to be significantly hypertonic (p less than 0.0001) relatively to fluid from the tear prism (mean 315.5 mosm/kg). However, the difference between the two sampling sites was highly variable between individuals, ranging from a maximum mean site difference of 64.5. mosm/kg for one of the six cul-de-sacs found to be significantly hypertonic, to a mean site difference of 25.0 mosm/kg for one of the two cul-de-sacs found to be significantly hypotonic. These results suggest that a unique localised tear environment exists inside the lower cul-de-sac, which has several clinical consequences--for example, for pharmaceutical absorption, ocular microbiology, and hydrophilic contact lens performance.

Humans↗

Documenting informed consent for patients wearing disposable lenses.

Disposable contact lenses present new clinical and legal challenges to the contact lens practitioner. Although a frequent lens replacement program should reduce the opportunity for contact lens complications and improve patient compliance with lens care and follow-up procedures, problems still may arise from the manufacturing or packaging of lenses or the failure of the patient to comply with wearing instructions. Because there yet remain significant risks associated with the extended wear of hydrogel lenses, practitioners should use an informed consent agreement to assist in the communication of these risks to patients. Such an agreement also serves as evidence of the practitioner's compliance with legal requirements.

Contact Lenses↗