Thesis Summary
Aston University
Dirk Johan Booysen
Doctor of Optometry
May 2016
Aims
Research on use of contact lenses as drug delivery systems continues. Disposable lenses are often used to treat corneal injuries. Accurate intraocular pressure (IOP) measurements with lenses in situ will enhance patient care and save valuable chair time.
Inter- and intraobserver reliability of rebound tonometer (RBT) and intraobserver reliability of ocular response analyser (ORA) with and without contact lenses of 50 (15 male, 35 female) healthy well adapted contact lens wearers between 18 – 55 years (M = 38.90, SD = 9.23) were examined. Clinical comparisons of IOP measurements with ORA and RBT were done. Accuracy of IOP measurements with four commonly prescribed disposable contact lenses (Acuvue Oasys, Frequency XC, Acuvue 1-Day Moist, and Pure Vision with powers -6.00 − +6.00 D) in situ was evaluated. Physiological and physical factors influencing IOP measurements with both instruments were determined.
Findings
Intraobserver reliability of RBT without and with lenses was excellent (ICC > 0.88; > 0.92 respectively). Interobserver reliability of RBT was excellent without or with lenses (ICC 0.81; 0.88 respectively). Intraobserver reliability of ORA was good for all metrics measured except for corneal hysteresis (CH) (ICC: CH 0.63; corneal resistance factor (CRF) 0.79; corneal compensated IOP (IOPcc) 0.77; IOPg 0.87).
RBT and ORA IOPg (Goldmann equivalent IOP) measurements were clinically and statistically comparable without or with lenses (differences < 0.6 mmHg). ORA IOPcc and RBT were less comparable (differences < 1.45 mmHg).
Accurate RBT and ORA tonometry (within 2 mmHg) was possible with low minus power (range -0.50 to -6.00 D); moderate modulus of elasticity (< 0.75 MPa); thin silicone hydrogel (Acuvue Oasys) and hydrogel (Frequency XC; Acuvue 1-Day Moist) contact lenses in situ.
Multiple regression analyses showed biomechanical metrics CRF and CH affected RBT and ORA (IOPcc and IOPg) measurements strongly (p < 0.0001). Therefore, cornea’s biomechanical properties had greater influence on accuracy of IOP measurements with these two instruments than other variables examined.
Key words
Intraocular pressure, disposable contact lenses, modulus of elasticity, rebound tonometry, and ocular response analyser.
Dedication
This work is dedicated to the memory of Jan George Booysen and Dr John Leslie Eidelman.
Acknowledgements
I would like to thank my supervisor Dr’s Amy Sheppard and Leon Davies for their guidance, support and encouragement over the past five years. In addition I would also like to thank Suzette Swart for the editing of this manuscript as well as my colleagues Gerrie Kruger, Magda Le Grange, and Marolize Botha for their help with the data collection and recording. Many thanks to Stephen Hugo and Lawrence Abrahamson from General Optical Pty. Ltd (SA) for the loan of the Reichert ocular response analyser used in the study. Thank you also to the 50 subjects (my patients) who volunteered to be part of the study. Finally, I must thank my family Sarah Leigh, Meagan, John Leslie, Angela, and Hester for their love understanding and encouragement to complete this work.