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Category Archives: optometry

Making a quick, single PDF file

Posted on November 5, 2018 by phil Posted in academia, geekery, optometry

I now more-or-less exclusively reach for my iPad for both reviewing documents (papers, agendas, minutes etc.) and when I need to have information available at my fingertips for meetings and the like. Increasingly, I seem to receive paperwork for meetings as a single, often long, PDF which is great.  This file format is, of course, is the digital lingua franca for bringing together documents which were originally generated from a range of programs.

Sometimes, though, I have the very first world problem of needing to review some work which is presented as a number of files of one or more formats.  Today, for example, I was about to board a plane (a prime paper reviewing opportunity) and recalled that I had recently been asked to review a paper for Contact Lens and Anterior Eye.  I pressed the various on-screen buttons to accept this invitation and was quickly able to download the five files – four Word documents and one image.  To generate a single PDF for airborne review would mean converting the Word files individually in some way and then either adding the image or converting them separately.  A bit tedious; and also slow when the queue was already beginning to form at Gate 206.

Some time ago, I found the easyPDF web site which allows you to drag in a bunch of files and it quickly generates a single PDF file for download.  As a default, it adds the the files in alphabetical sequence so some changing of file names might be required but apart from that, it works perfectly.  There is an iOS (and presumably an Android) app to act as the front end for this, also.  The site allows conversion of up to five files as part of its free tier.  It does other conversion magic as well although I’ve not used those other features.

I have previously struggled with methods to automate this process on my Mac (PDF creation means shoving information through a printer driver rather than a simple conversion process) so this is a much better solution which can easily be done when on the move.  The system is cloud-based so may not be suitable for sensitive of confidential documents but for other bits of work, it’s a great option.

 

Working with old PowerPoint files

Posted on October 7, 2018 by phil Posted in academia, geekery, lectures, optometry

Bit of a funny one, this.  Over the years, I’ve bemoaned the fact that I’ve not been able to open PowerPoint files from the mid 1990s and earlier.  This has never really been critical; key slides continued to migrate into newer versions of presentations (now regrettably commonly termed slide decks in US corporate vernacular) and survive to this day like a well maintained classic car.

However, I am occasionally curious about files from that era but they do not open with current (or the previous two versions) of PowerPoint on my Mac.  (As an aside, PowerPoint on the Mac pre-dates its launch for Windows).  I think they are older than the  ‘1997-2003’ file format which will still open today.

Every year or two, I explore this again but fail – until yesterday.

I have been preparing for a talk, given today in Utrecht at the Jaarbeurs conference complex, returning to a venue I came to a few times in the mid 1990s when Dutch optometry was developing quickly and there were lots of CET meetings and speaking invitations for those of us working in the contact lens area.

I found a presentation from September 1, 1997 which I gave at the same venue and thought it would be fun to look at the talk and see what it looked like (and include the opening slide in today’s talk under the guise of ‘I’ve been coming here a long time’ sortathing).

After yet more Google searching on the topic, I fluked on some information which – remarkably – worked.  It turns out it’s easy and requires the use of the Zamzar conversion site.  Here is the recipe:

  1. Duplicate the file (for safety) and edit the suffix to .pps
  2. Go to zamzar.com and upload file.
  3. Choose PPT (1997-2003) as the desired file format.
  4. Wait for e-mail from zamzar.com
  5. Download new file
Warning: this reveals the garish state of slide design in the 1990s when we were excited by colours on slides; or maybe that was just me.  I’m also not sure that the kerning is correct but I might not have the correct fonts any longer.
Proviso: this worked on a couple of files.  I didn’t check not changing the suffix so variants on this approach might work.
Note 1: I have not used PowerPoint routinely for many years as I am a convert to Apple Keynote.
Note 2: AV guys at conference centres remain sniffy about Keynote files.
Note 3: Keynote export to PowerPoint is now excellent and almost perfect with the exception that start/end times of movie clips are not respected so you can always fall back on this as I had to today (see Note 2).
Note 4: Always have a PDF back up on a USB memory stick of a conference talk just in case.
Note 5: I still give a variant of Dk – don’t know? today.

How we can improve patient compliance

Posted on May 19, 2017 by phil Posted in academia, lectures, optometry

Screen Shot 2016-01-17 at 22.03.26

This note gives a number of references and resources for my talk on how we can help our patients improve their compliance and in doing so, help them minimise the risk of keratitis during contact lens wear.  Many of the links are to articles in the literature.  Full access to most/all of these papers is available to members of the College of Optometrists via an Athens account as I have written about here.

The Science of Compliance booklet

Inflammation on Wikipedia

Efron editorial on contact lens wear being an inflammatory stimulus

Suzi Fleiszig’s brilliant review of microbial keratitis in contact lens wear

The Epidemiology of Contact Lens Related Infiltrates

ISO 18259

Risk factors for acanthamoeba keratitis in contact lens users: A case-control study

Trends in UK contact lens prescribing 2015

Graeme Young’s 49 steps for contact lens compliance

The Incidence of Contact Lens-Related Microbial Keratitis in Australia

An international analysis of contact lens compliance

Case care and lens rinsing can be improved

Handwashing can get better

NHS guide to handwashing

Impact of air-drying lens cases in various locations and positions

Toilet aerosol effect

Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections

BCLA guidance for the public on the use of contact lenses

Innovations in contact lenses

Posted on June 13, 2016 by phil Posted in academia, lectures, optometry

the-belfry-hotel-resort

This page provides links and other supporting information for my talk at the BCLA UK meeting at The Belfry in June 2016.

‘Athens’ access to journals through the College of Optometrists

EU population projections

Contact lens prescribing in 2015

Electronic liquid crystal contact lenses for the correction of presbyopia

Graphene electrodes for adaptive liquid crystal contact lenses

Novartis to start human tests with Google lens in 2016

Johnson & Johnson business review web cast

A single-pixel wireless contact lens display

Triggerfish lens for glaucoma monitoring

Innovega system

Myopia control review in Optician

Prevalence and progression of myopic retinopathy in an older population

The impact of contemporary contact lenses on contact lens discontinuation

Effect of Three Interventions on Contact Lens Comfort in Symptomatic Wearers: A Randomized Clinical Trial

Friction and comfort

Incidence and epidemiologic associations of corneal infiltrates with silicone hydrogel contact lenses

Is contact lens wear inflammatory?

Stepping up to the demands of today’s contact lens wearers

Posted on January 30, 2016 by phil Posted in academia, lectures, optometry

blue eye

This lecture explores the rationale for fitting daily disposables vs. reusable lenses, and also conventional hydrogels vs. silicone hydrogels.  In the list below is a range of papers and other resources which support my presentation.  Some are full documents – others feature at least the abstract of the paper.  Access to full papers is generally available to those accessing from a university (or similar) IP address or those with ‘Athens’ access.  Members of the College of Optometrists have ‘Athens’ accounts as part of their annual membership.  I explain this here.

Dumbleton, K., Woods, C. A., Jones, L. W., & Fonn, D. (2013). The impact of contemporary contact lenses on contact lens discontinuation., 39(1), 93–99.

TFOS report on contact lens discomfort (free download)

Peterson, R. C., Wolffsohn, J. S., Nick, J., Winterton, L., & Lally, J. (2006). Clinical performance of daily disposable soft contact lenses using sustained release technology. Contact Lens and Anterior Eye, 29(3), 127–134. 

Morgan, P. B., Efron, N., Hill, E. A., Raynor, M. K., Whiting, M. A., & Tullo, A. B. (2005). Incidence of keratitis of varying severity among contact lens wearers. British Journal of Ophthalmology, 89(4), 430–436.

Stapleton, F., Keay, L., Edwards, K., Naduvilath, T., Dart, J. K. G., Brian, G., & Holden, B. A. (2008). The Incidence of Contact Lens-Related Microbial Keratitis in Australia. Ophthalmology, 115(10), 1655–1662.

Dart, J. K. G., Radford, C. F., Minassian, D., Verma, S., & Stapleton, F. (2008). Risk Factors for Microbial Keratitis with Contemporary Contact Lenses. Ophthalmology, 115(10), 1647–1654.e3.

Chalmers, R. L., Keay, L., McNally, J., & Kern, J. (2012). Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates. Optometry and Vision Science, 89(3), 316–325. 

Morgan, P. B., Efron, N., & Woods, C. A. (2013). Determinants of the Frequency of Contact Lens Wear. Eye & Contact Lens: Science & Clinical Practice, 39(3), 200–204. 

Efron, N., Efron, S. E., Morgan, P. B., & Morgan, S. L. (2010). A “cost-per-wear” model based on contact lens replacement frequency. Clinical & Experimental Optometry : Journal of the Australian Optometrical Association, 93(4), 253–260.

Efron, N., Morgan, P. B., Woods, C. A., International Contact Lens Prescribing Survey Consortium. (2013). An international survey of daily disposable contact lens prescribing. Clinical & Experimental Optometry : Journal of the Australian Optometrical Association, 96(1), 58–64.

Morgan, S. L., Morgan, P. B., & Efron, N. (2003). Environmental impact of three replacement modalities of soft contact lens wear. Cont Lens Anterior Eye, 26(1), 43–46.

Diligent Disinfection in 49 Steps

Morgan, P. B., Efron, N., Toshida, H., & Nichols, J. J. (2011). An international analysis of contact lens compliance. Cont Lens Anterior Eye, 34(5), 223–228. 

Dumbleton, K., Richter, D., Woods, C., Jones, L., & Fonn, D. (2010). Compliance with contact lens replacement in Canada and the United States. Optometry and Vision Science : Official Publication of the American Academy of Optometry, 87(2), 131–139. 

Navascues-Cornago, M., Morgan, P. B., & Maldonado-Codina, C. (2015). Effect of Three Interventions on Contact Lens Comfort in Symptomatic Wearers: A Randomized Clinical Trial. PloS One, 10(8), e0135323–13. 

Korb, D. R., Greiner, J. V., Herman, J. P., Hebert, E., Finnemore, V. M., Exford, J. M., et al. (2002). Lid-wiper epitheliopathy and dry-eye symptoms in contact lens wearers. The CLAO Journal : Official Publication of the Contact Lens Association of Ophthalmologists, Inc, 28(4), 211–216. 

Roba, M., Duncan, E. G., Hill, G. A., Spencer, N. D., & Tosatti, S. G. P. (2011). Friction measurements on contact lenses in their operating environment. Tribology Letters, 44(3), 387–397. 

Maldonado-Codina, C., Morgan, P. B., Schnider, C. M., & Efron, N. (2004). Short-term physiologic response in neophyte subjects fitted with hydrogel and silicone hydrogel contact lenses. Optometry and Vision Science : Official Publication of the American Academy of Optometry, 81(12), 911–921.

Wenn es hart auf hart kommt, bleiben nur die Harten am Ball

Posted on March 29, 2014 by phil Posted in academia, lectures, optometry

A.-Front3This post provides key links and references to my talk on the management of presbyopia, When the going gets tough, the tough get going.  The presentation was first delivered in Hamburg, thus the German title which is (apparently) a reasonable translation from the English.  The best management of presbyopes with contact lenses presents a range of challenges to the optometrist or optician and this lecture outlines that we are generally reluctant to fit presbyopes with the best form of correction and then how we can target comfort and vision as the main stumbling blocks to successful ongoing wear.  A number of relevant links are provided below:

Billy Ocean in Wikipedia

International contact lens prescribing in 2013

Statistisches Bundesamt

An international survey of contact lens prescribing for presbyopia.

Prevalence of refractive error in the United States, 1999-2004.

The impact of contemporary contact lenses on contact lens discontinuation.

TFOS workshop on contact lens discomfort

Overview of factors that affect comfort with modern soft contact lenses.

Consequences of wear interruption for discomfort with contact lenses.

Lid-wiper epitheliopathy and dry-eye symptoms in contact lens wearers.

Friction measurements on contact lenses in their operating environment.

Hubner thesis on lens edges

Contact lens-induced circumlimbal staining in silicone hydrogel contact lenses worn on a daily wear basis.

Characterization of soft contact lens edge fitting using ultra-high resolution and ultra-long scan depth optical coherence tomography.

Protein deposition and clinical symptoms in daily wear of etafilcon lenses.

Assessment of stromal keratocytes and tear film inflammatory mediators during extended wear of contact lenses.

Early symptomatic presbyopes–what correction modality works best?.

Visual comparison of multifocal contact lens to monovision.

Utility of short-term evaluation of presbyopic contact lens performance.

 

iPads and vivas

Posted on March 23, 2013 by phil Posted in academia, geekery, optometry

20130323-110327.jpg
Leaving aside that the term viva is a bit of a funny one (the important bit of viva voce is missed out; I’m sure it should be pronounced v-eee-va and not v-eye-va; there was a now-considered-hilarious 1970s car of the same name) this oral examination is a key part of the postgraduate research assessment process. In the UK at least, it remains essentially the only way in which the work of a PGR student is examined.

To head off on a brief tangent, this is not the case in Australia or the United States. In the former, at least in my direct experience, three external examiners receive copies of the final thesis and provide detailed written comments which go to a panel which gathers all the opinions and comes to a final verdict.

Students in the US defend their work but this part of the process can be something of a formality and it’s perhaps not quite the same as the traditional see-the-whites-of-their-eyes all-or-nothing high adrenaline British method.

Anyway, the approach I have used myself over the years as an examiner is to read through the weighty tome and make various comments in a separate word processing file and perhaps add various Post-It notes into the thesis to keep track of the key pages. This method comes with a large administrative overhead. For example, you are obliged to type something like ‘Change the term ‘staining of the corneal epithelium’ to ‘corneal epithelial staining’…’ in your list of recommend amendments. Repeat. Many times. It’s burdensome and it does my head in, as the kids say.

Last week I had the opportunity to run the whole process on my iPad. Theses are now routinely provided to examiners as PDF files, and so it was a simple process of using a PDF annotation app (I’m currently using iAnnotate but there are lots available) to work through the report, making edits, adding comments and so on. It was a breeze to work through these during the viva because the program has a button which allows you to advance sequentially through the edits. Extra thoughts and ideas were noted as we discussed the work and it all ended up added into the PDF.

At the conclusion of the process, the student needs to see the examiner comments and again, it was trivial to email a copy of the comments and edits. In fact, the automated email included the annotated PDF and a separate list of each change. This is much better for the examiners, but also an improved situation for the student who receives a more informative list of changes more rapidly.

New VA rules for bus and lorry drivers

Posted on March 13, 2013 by phil Posted in optometry

London_bus_9

The DVLA has just announced some new health-related rules for drivers. For car drivers, there is a new stipulation regarding epilepsy; however, for bus and lorry drivers, visual acuity requirements have been relaxed.

Previously the threshold was 0.8 (6/7.5) in the better eye and at lease 0.5 (6/12) in the poorer eye. These values are now 0.8 and 0.1 (6/60), respectively.

Driving is an unusual visual task inasmuch as there are large eye movements than in most everyday tasks. It might be that with the specific angles of wing- and rear view-mirrors, there are different implications for ‘poorer right’ and ‘poorer left’ drivers, and they might notice a difference between right-hand and left-hand drive cars.

Overall, though, it seems this is all of little functional consequence. This 1991 paper suggests little or no practical difference between monocular and binocular drivers.

The inflammatory response and contact lens-associated keratitis

Posted on March 12, 2013 by phil Posted in lectures, optometry

Screen Shot 2013-03-12 at 16.19.09

Understanding the inflammatory response of the cornea during contact lens wear is one of the remaining major challenges for researchers and the contact lens industry.  This lecture outlines the pathophysiology of inflammation and its relationship to contact lenses.  Relevant resources for this talk are shown below.

Manchester Collaborative Centre for Inflammation Research (MCCIR)

Inflammation on Wikipedia

Is contact lens wear inflammatory?

Assessment of stromal keratocytes and tear film inflammatory mediators during extended wear of contact lenses.

In vivo confocal microscopic evaluation of langerhans cell density and distribution in the corneal epithelium of healthy volunteers and contact lens wearers.

Clinical characterization of corneal infiltrative events observed with soft contact lens wear.

Adverse events and discontinuations with rigid and soft hyper Dk contact lenses used for continuous wear.

Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates.

Incidence of keratitis of varying severity among contact lens wearers.

Rethinking contact lens associated keratitis.

The size, location, and clinical severity of corneal infiltrative events associated with contact lens wear.

Contact lenses and other risk factors in microbial keratitis.

The Incidence of Contact Lens-Related Microbial Keratitis in Australia.

Risk factors for acanthamoeba keratitis in contact lens users: A case-control study.

Refractive error and corneal curvature

Posted on March 12, 2013 by phil Posted in optometry

20130312-180028.jpg

An interesting question arose in our contact lens clinic last week: are myopic corneas steeper than those of ametropes or hyperopes? Anecdotally, it was felt that perhaps myopes had flatter corneas. Most optometrists should be aware that most refracts errors are axial: myopes have big eyes and it’s the reverse for those who are longsighted. However, myopes having flatter corneas would be counter-intuitive.

Ametropia can be due to a normal length eye hosting a cornea that’s the wrong shape (too steep or too flat). However, I wasn’t sure if this was a general trend – do myopes tend to have steep corneas?

So, to the literature. This paper describes a study in Taiwan of 500 subjects aged 40 and over. The authors measured a range of ocular parameters and whilst a strong (ish) correlation was found between refractive error and axial length (r-value -0.65), no such relationship was demonstrated between refractive error and corneal curvature (r = -0.02). Overall, then, randomly selected hyperopes will have similar corneal curvature to a group of randomly selected myopes.

A slightly different story arises from this very large study from Canada. This work, on over 3,000 eyes finds a general increasing of corneal power with more myopia. It’s not a very strong relationship (r = -0.25) but it’s the sort of finding you can get with large data sets.

So, our anecdotal feeling-in-our-water was incorrect. Overall, myopes do have steeper corneas, but it’s a rather weak relationship and they are much more likely to have longer eyes.  Predicting K readings from refractive error for an individual is unlikely to be accurate.

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