Adrian S Bruce

• OD PhD FAAO
• Lead Optometrist, Australian College of Optometry at University of Melbourne

For details see the publisher bookstore. http://www.elsevierhealth.com.au/optometry/anterior-eye-disease-and-therapeutics-a-z-paperback/9780729539579/

Purpose To determine normative reference ranges for higher-order wavefront error (HO-WFE), compare these values with those in common ocular pathologies, and evaluate treatments. Methods A review of 17 major studies on HO-WFE was made, involving data for a total of 31,605 subjects. The upper limit of the 95% confidence interval (CI) for HO-WFE was...

Background: The symptom of dryness in hydrogel lens wear is common but its origins remain poorly understood. To assess the theory that anterior lens surface interactions are responsible for the sensation of dryness during lens wear, 50 contact lens wearers were evaluated. Method: The Efron comfort scale was used to divide the group into subjects wi...

Prelens tear thinning time (PLTTT) was used to quantify tear stability relative to symptoms of dryness. Twenty-two subjects were measured for PLTTT in this investigator-masked study. Specular reflection was performed, and the timed appearance of a colored interference fringe within the reflection under high magnification indicated PLTTT. Two sympto...

There is a need to understand better the biomaterial characteristics responsible for tear film stability during hydrogel lens wear. The underlying cause of pre-lens tear film instability may be indicated by the distribution of sites of breakup. The purpose of this study was to compare the distribution of rupture sites during wear of a common biomat...

Mini-scleral lenses are an increasingly popular contact lens modality; however, there are relatively few reports regarding the unique aspects of their fitting and potential complications. We report a complication of mini-scleral lens wear in a 44-year-old female patient using the lenses for keratoconus. Her mini-scleral contact lenses were non-fene...

This title is is a handy A-Z pocket book that covers a broad range of posterior segment eye conditions and how to manage them with ocular therapeutics. It provides essential treatment protocols and down-to-earth sensible advice and lists differential diagnoses. The A-Z format gives instant access to clinical information Each condition is covered in...

Written in a concise, practical, outline manner, Manual of Contact Lens Prescribing and Fitting, 3rd Edition follows the logical progression of patient care, from basic prefitting topics, through rigid lens, soft lenses and advanced/specialty issues. Valuable management information assists in fitting and problem-solving situations, and clinical pea...

Holden and Mertz established the foundations for the new generation of silicone hydrogel contact lenses for daily and extended wear in 1984. Absence of lens-induced corneal swelling was their premise and although this was possible with daily wear, the goal with extended wear seemed almost impossible because of the limitation of hydrogel materials....

A 56-year-old man presented with symptoms of monocular diplopia and reduced vision in his left eye. Visual acuities were R6/6, L6/12. At his previous visit left visual acuity was 6/6. An irregular area of anterior corneal stromal scarring was evident, encroaching on the visual axis of the left eye. Rigid lens fitting improved left visual acuity to...

Despite global standardisation in measurement of oxygen transmissibility (Dk/t), in our clinic we continue to see limbal vasculature changes in patients wearing some disposable lenses. The use of central Dk/t as a simple designator of a contact lens oxygen performance has clearly failed, it being acknowledged as often unrelated to the oxygen perfor...

To determine the effect of topical treatments on the conjunctiva in dry eye. N = 134 dry eye subjects were diagnosed using a protocol of McMonnies dry eye symptom survey score > 14, fluorescein break up time (FBUT) < 10 s and presence of rose Bengal staining. Differential diagnosis of dry eye subtypes was based on biomicroscopic signs and ocular/me...

To highlight a possible causal effect of eye rubbing in the etiology of keratoconus. A 43-year-old man presented to the practice of one of the authors (I.F.G.) with the complaint of gradual onset reading difficulty. History revealed the patient to have experienced constant epiphora in the right eye throughout his life as a result of punctal agenesi...

Two morphological cone variants are identified in keratoconus; nipple and oval. The present study was designed to assess the impact of aetiological factors on cone morphology. As part of a prospective controlled study, keratoconic subjects from a suburban practice (n = 89) underwent videokeratograph examination and completed a questionnaire detaili...

Basic image-editing techniques on digitized photographs related to contact lenses are demonstrated. Digitized images can be edited with brightness correction, corrective filtering, and reduction of color depth. A simulated tear thickness interpretation map is derived from a simple fluorescein pattern.

Several flaws exist with the lipid-diffusion model for tear-film breakup. The aim of this study was to test an alternative model of tear-film rupture in which the negative hydrostatic pressure in each tear meniscus (related to the tear-meniscus radius of curvature) is proposed to influence the formation of breaks in the tear film. Measurements of n...

This article describes a method of determining the misalignment of a toric soft lens, by use of the patient's ocular refraction as well as the refraction obtained over the mislocating lens. Matrix optics are used to facilitate the calculation of the effective back vertex power of the toric lens on the eye. On the basis of this calculation, the degr...

Purpose. To determine whether there are differences between strains of P. aeruginosa in their susceptibility to hydrogel contact lens disinfectants. Methods. The minimum inhibitory concentrations (MIC) of 26 strains of P. aeruginosa (laboratory, contact lens and ocular isolates, from 1987-1996) at 18 hrs and >42 hrs was measured for two chemical co...

Assessment of the tear film meniscus is a quantitative, minimally invasive, direct measurement of tear film quantity. The aim of this study was to assess the efficacy of tear meniscus parameter measurement in the diagnosis of dry eye. Tear meniscus radius of curvature, height, width and cross-sectional area (TMC, TMH, TMW, XSA) were determined by p...

Lens adherence and a reduced postlens tear film circulation have been suggested as factors contributing to some adverse reactions in extended wear of hydrogel contact lenses. In this study, we determined lens fitting and postlens tear film characteristics during closed-eye wear. Twenty subjects wore hydrogel lenses for 3 h of eye closure, followed...

Little is understood about the mechanism by which soft lenses settle on the eye, although it has been suggested that lens base curve, steepening with in-eye lens dehydration or tear film changes may influence lens movement in the initial period of wear. In this study, we investigated the role of postlens tear fluid expulsion by assessing lens movem...

This review of ocular changes in contact lens wear is designed to be an accessible contact lens reference for ophthalmologists. Ocular changes are organised according to presumed cause to assist underlying scientific principles. Conditions attributed to hypoxia and hypercapnia are covered in the first section. In section 2, conditions related to in...

We studied the depletion of the post-lens tear film as contributing to inferior arcuate staining with ultrathin high water content hydrogel lenses. We monitored the post-lens tear film specular reflection of hydrogel lenses (0.04 mm center thickness, 67% nominal water content), which caused inferior arcuate staining. A standard thickness (0.12 mm)...

The fitting characteristics of thin, high-water-content hydrogel lenses are influenced by variations in postlens tear film morphology; however, the determinants of postlens tear film morphology have not been fully established. We tested the hypothesis that increased lens dehydration due to evaporation at the lens front surface may cause postlens te...

The objective of this study was to determine if there are differences in accommodative-convergence/accommodation (AC/A) and convergence-accommodation/convergence (CA/C) ratios in subjects with increasing age. The authors aimed to relate the findings to the present theories of the development of presbyopia. Using a Canon AutoRef R-1 to measure accom...

The determinants of postlens tear film (PTF) composition in hydrogel lens wear are poorly understood, although this layer has important roles in lens movement and corneal integrity. We investigated the hypothesis that the PTF could be depleted by instillation of hypotonic saline, using a randomized, double masked, placebo controlled study design. S...

The gradient stimulus and heterophoria stimulus measures of the accommodative convergence/accommodation (AC/A) ratio are simple and widely-used techniques. We compared these two clinical methods with the more accurate and objective gradient response AC/A ratio method. Twenty-three subjects, with ages ranging from 17 to 42 years and with normal bino...

Abstract only A variety of clinical factors that could influnce satisfaction and visual performance with monovision correction were examined. Sicty presbyopic subjetc were monovision for 8 weeks. The subjects' initial rating of monovision at the delivery consulation was significantly influnced by factors such as acuity loss, crossed dominace and...

Many patients who begin wearing monovision contact lenses report that it requires days or weeks for them to become adjusted to the anisometropia; however, it is not clear if there are measurable improvements in their vision during this period. We therefore studied both the objective and subjective characteristics of adaptation to monovision over a...

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 an...

The determinants of hydrogel lens movement with thin mid-water content lenses may be better understood by taking into account the lubrication properties of the tear film. We assessed lens movement, postlens tear film (PTF) status, and tear meniscus height with 58% water content (Acuvue) lenses worn over 6 h on each of 2 consecutive days. Median len...

Print size is one of the numerous factors affecting reading rate. The purpose of this study was to investigate the print sizes which give maximum reading rates for adults and children. Using a forced scrolling technique to move the reading material and a constant field size of 15 characters, a print size of 0.5 logh4AR (N8 at 320 mm) produced maxim...

Reliable tear function tests are required both in clinical practice and for research. Between-sessions repeatability of the phenol-red thread and tear thinning time tests was assessed for 17 young normal Caucasian subjects on two consecutive days. A single phenol-red thread result and the mean of three tear thinning times were recorded on each day....

Recent studies have determined that movement of mid- and high-water contact lenses is little influenced by the central cornea-lens-bearing relationship; however, the possible influence of variations in the peripheral corneal contour has not yet been established. We measured central and peripheral corneal power using the Topographic Modeling System...

We wished to determine whether the treatment outcomes of vision screenings for visual display unit (VDU) users could be predicted on the basis of subject age or level of symptoms. The outcomes of eye tests were assessed for a group of 70 VDU users in the Australian Taxation Office who received testing as part of an existing voluntary vision testing...

We compared the relative value of biomicroscopy, pachometry, esthesiometry, and corneal oxygen flux measurements for the detection of corneal hypoxia in myopic patients wearing hydrogel extended wear lenses. Measurements were standardized by relating the change in each parameter to its test-retest reliability. After 3 months of extended wear the gr...

We investigated the contamination of disinfection solution bottles after 2 weeks of patient use. Forty-four subjects participated in the study and each used three soft lens care systems (cross-over study). The order in which the three care systems were dispensed was randomized to eliminate systematic bias. Sixteen subjects used only one of the syst...

Postlens tear film morphology, lens movement and symptoms were assessed in 100 subjects wearing hydrogel contact lenses on a daily wear schedule. Postlens tear film appearance in specular reflection was categorized as amorphous, coloured, striated or dynamic (variable with blinking), and subjects' symptoms were assessed using a questionnaire. Non-a...

Corneal epithelial, stromal, and endothelial edema were assessed in 19 subjects before and after a 4-month period of hydrogel contact lens extended wear. A thick hydrogel lens was worn under closed-eye conditions for 3 hours to induce stromal edema and endothelial edema (blebs), and eye bathing with a hypotonic solution was used to induce epithelia...

We investigated the effect of 3 months of daily soft contact lenswear on corneal topography. Thirty young myopic subjects who had not previously worn contact lenses were fitted with hydroxyethyl methacrylate (HEMA) soft lenses. Corneal topography was measured in each eye before and after the 3-month period using a videokeratoscope, the Topographic...

In a prospective study, we have investigated the effect of lens care system instructions on the rate of compliance of 44 subjects who each used three different lens care systems (cross-over design), each system for a two-week period. All three lens care system instructions recommended hand washing prior to lens handling, a daily cleaning procedure,...

Psychogenic amblyopia and Stargardt's disease are visual loss in children; however, their prognoses and management differ greatly. Stargardt's disease is a progressive bilateral macular dystrophy, with autosomal recessive inheritance. In time, visual acuity may decrease to 6/60. Stargardt's disease is characterised by retinal pigment epithelial def...

The value of visual field indexes in differentiating between glaucomatous and normal fields was determined using a masked prospective experimental design. Indexes for threshold fields (Humphrey Field Analyser (San Leandro, CA) and screening fields (Henson CFA3000 (Keeler, Windsor, UK) were calculated for 27 patients with primary open-angle glaucoma...

Binding is an infrequent but potentially disturbing complication of hydrogel lens wear. The condition has been reported following exposure to swimming pool water or with profuse tearing. This paper discusses hydrogel lens binding following closed-eye wear and proposes a mechanism of soft lens binding. The post-lens tear film of bound low-water-cont...

Recently, a number of papers have addressed the international history of contact lens practice. In this paper, the unique features of early Australian contact lens practice are reviewed. The most important landmark was the introduction of ground glass haptic lenses to Australia during the 1920s. However, Australian ophthalmologists subsequently ent...

The Contact Lens Society of Australia is an active learned society, currendy celebrating its 30th anniversary. Its chief objectives are to promote scientific research in the field of contact lenses and to encourage communication among persons engaged in the fitting of contact lenses. While the activities of the society have occasionally appeared in...

A recent study has measured the corneal topography of normal and keratoconic patients using the Topographic Modelling System (TMS). The study showed that keratoconus could be characterised using three indices:1. corneal dioptric power in the central ring; 2. the difference between the central power of each eye; and 3. the difference in dioptric pow...

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 "adapt...

Contact lens wear induces a wide spectrum of changes in the appearance and function of the cornea. The most salient effect of lens wear is the hypoxically induced reduction in the rate of metabolic activity of the corneal epithelium and its sequellae. Other important alterations to corneal health associated with contact lens wear may be caused by a...

Recent work has shown that the dot-matrix coloured DuraSoft 3 contact lens produces a slight depression of visual sensitivity. These studies have compared the tinted lens to a clear lens condition and they fail to address the possibility that patients may present to optometrists wanting to wear these lenses for a cosmetic (that is, non-refractive)...

A 61 -year-old female patient wearing rigid gas permeable (RGP) lenses on a daily basis presented with considerable pain and hyperaemia in the right eye. Biomicroscopic examination revealed marked stromal and endothelial oedema with folds in Descemet's membrane, and a focal infiltrate near the inferior limbus. The infiltrate was diagnosed as steril...

Some hydrogel contact lenses are susceptible to changes in hydration when soaked in hydrogen peroxide solutions of acidic pH. This study uses a hand refractometer to assess the water content of four Hydrocurve Elite hydrogel contact lenses during prolonged hydrogen peroxide disinfection. A 3-week period of soaking in peroxide solution lead to a dec...

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 an...

The post-lens tear film was evaluated during the initial period of wear of a number of contact lenses by biomicroscopic observation of the brightness and uniformity of the specular reflection at the posterior surface of the lens. When the lens was initially applied to the eye, the reflection at the posterior surface was relatively uniform, although...

The visible light and ultraviolet (UV) radiation transmission was measured for 6 UV absorbing contact lenses and for 2 different coloured hydrogel contact lenses. It was found that the Equalens and Vistakon UV-bloc lenses effectively blocked UV radiation up to 380nm, while the Permaflex lenses were slightly less effective. The Hydron opaque pupil h...

To examine whether certain aspects of the environment can have a significant effect upon the steady-state water content of hydrogel contact lenses during normal wear, nine volunteers monitored ambient temperature, ambient humidity, and the water content of their contact lenses over a 5-day period of daily lens wear. Three subjects wore Hydron zero-...

To examine whether certain aspects of the environment can have a significant effect upon the steady-state water content of hydrogel contact lenses during normal wear, nine volunteers monitored ambient temperature, ambient humidity, and the water content of their contact lenses over a 5-day period of daily lens wear. Three subjects wore Hydron zero-...

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The visible light and ultraviolet (UV) radiation transmission was measured for four different tints from two contact lens companies. It was found that luminous transmittance ranged from 60 to 82% and mean UV transmission from 15 to 74% for the lenses under investigation. Differences in luminous transmittance between the two lenses of each tint eval...

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