Dissertations / Theses on the topic 'Intraocular pressure – Measurement'

Intraocular pressure (IOP) measurement is a routine procedure and a fundament in glaucoma care. Elevated IOP is the main risk factor for glaucoma, and to date, reduction of IOP is the only possible treatment. In a retrospective clinical material, the prevalence of open angle glaucoma was estimated on the west coast of Iceland. IOP measurement and optic nerve head examination were used to capture glaucoma suspects, within the compulsory ophthalmological examination for the prescription of eye glasses. The results were mainly in agreement with a recent prospective study in the same region. This indicated that retrospective data, under certain conditions, may contribute with useful information on the prevalence of glaucoma. However, normal tension glaucoma is underestimated if perimetry and/or fundus photography are not included in the examination. Three studies focused on the measurement of IOP. Goldmann applanation tonometry (GAT) is the standard method. GAT is affected by corneal properties, e.g. central corneal thickness (CCT) and corneal curvature (CC). Refractive surgery changes these properties. This has put focus on how corneal biomechanics translate into tonometric errors and stimulated the development of new methods. As a result, Pascal ® Dynamic Contour Tonometry (PDCT) and Icare® rebound tonometry have been introduced. A method under development by our research group is Applanation Resonance Tonometry (ART). It is based on resonance technology and estimates IOP from continuous measurement of force and contact area. Comparison of PDCT, Icare and GAT in a prospective study showed that the concordance to GAT was close to the limits set by the International Standard Organization (ISO) for PDCT, while Icare was outside the limits. To investigate if laser-assisted subepithelial keratectomy (LASEK) affects tonometry, a study was performed where measurements with GAT, PDCT and ART were obtained before, three and six months after LASEK. The hypothesis was that PDCT and ART would be less affected by LASEK than GAT. The results showed a statistically significant reduction of measured IOP three and six months after LASEK for all tonometry methods. Change in visual acuity and IOP between three and six months suggested a prolonged postoperative process. A servo-controlled prototype (ART servo) was developed. A study was undertaken to assess the agreement of ARTservo and a further developed v manual prototype (ART manual) with GAT. The study design was in accordance with the requirements of the ISO standard for tonometers. ARTmanual fulfilled the precision requirements of the ISO standard. ARTservo did not meet all the requirements of the standard at the highest pressure levels. Four tonometry methods, GAT, PDCT, Icare and ART, were investigated. None of them was independent of both CCT and CC. The inconsistencies in the results emphasize the importance of study design. A meta-analysis comprising healthy eyes (IOP ≤ 21 mmHg) in the three papers, revealed age as an important confounder. In summary, glaucoma prevalence in Iceland was investigated and the results indicated that a retrospective approach can contribute with meaningful information. ART and PDCT had a similar agreement to GAT. ART manual fulfilled the precision requirements set by the ISO-standard, ARTservo and PDCT were close, while Icare was distinctly outside the limits. All tonometry methods were affected by LASEK and no method was completely independent of corneal properties.

This dissertation describes the development of a portable, hand-held tonometer for measurement of the intraocular pressure through the eyelid. The primary use of such device will be by people diagnosed with the eye disease glaucoma. Glaucoma is the second leading cause of blindness in the world and is asymptomatic to the patient in its early stages. This allows it to remain undiagnosed for prolonged periods, causing irreversible damage to the affected person's vision. Elevated intraocular pressure is the main risk factor associated with the development of glaucoma, and is currently the only symptom that is treatable for the slowing down or stopping of the progression to blindness caused by the disease. The effectiveness of the medications or procedures aimed at reducing the pressure to below risk levels is currently monitored through visits to the ophthalmologists' offices, which makes the frequent monitoring of the pressure inconvenient, expensive and sometimes impossible. Due to the variation of the pressure throughout the day and during different activities or food and beverage intake, the portability of the device is important in order to allow the user to carry it with them and take measurements as frequent as needed. The option to perform the measurement through the eyelid avoids direct contact with the eye, eliminating possible discomfort, the use of anesthetics, and the risk of contamination.Several designs and measuring concepts are evaluated using a custom made pressure regulation system. A series of prototypes have been built and tested and the results are reported in the respective sections of the dissertation. The final concept selected for the measurement technique was based on multiple force probe indentation and a custom MEMS-based force sensor for it was designed and tested.The main contributions of this dissertation are the design, fabrication and test of the prototype devices and the MEMS force sensors. The obtained results and experience described here can serve as a platform for further optimization and improvement of the device, and eventual development of a prototype capable of performing clinical research studies and passing FDA approval for home and clinical use.

Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2005.
Includes bibliographical references (leaves 70-71).
Glaucoma, caused by an elevated intraocular pressure (IOP), is one of the leading causes of blindness. As constant monitoring of IOP is essential in the treatment of glaucoma, the IOP measurement techniques described in patents and patent applications since 1950 are examined. None of the methods provides a simple and comfortable approach for patients to self monitor their IOPs at different times throughout the day. A through-the-eyelid tonometry method is proposed to address the deficiencies of the previous techniques. Two through-the-eyelid tonometers are designed, and parts of the prototypes are built.
by Flora T. Chiu.
M.Eng.

In the work of this doctoral dissertation a new resonator sensor technique, first presented in 1989, has been further developed and evaluated with focus on technical characteristics and applications within the medical field.

In a first part a catheter-type tactile sensor using the resonator sensor technique was evaluated in a silicone model and applied to human prostate in vitro. The main finding was that different histological compositions of prostate tissue correlated with the frequency shift, .fS, of the resonator sensor and that the common property was the hardness of the tissue. The results indicated that hardness of the prostate tissue, and maybe hardness of human tissue in general, can be expressed according to a cone penetration standard (DIN ISO 2137) and that the hardness can be measured with this tactile sensor system. The tissue hardness application for the resonator sensor technique has to be further developed and evaluated in a larger study. The study also produced results that has led to the basic understanding of the resonator sensor system. One important result was that .fS of the sensor system was related to the contact area between sensor and sample. This indicated that the resonance sensor could be used for contact area measurement.

In a second part, containing three studies, the area-sensing capability from the first study was utilised in the development and evaluation of the applanation resonator sensor (ARS) for measurement of intraocular pressure (IOP). For the purpose of evaluating IOP-tonometers, an in vitro pig-eye model was developed, and it was shown that a saline column connected to the vitreous chamber could be used successfully to induce variations in IOP.

A ARS sensor with a flat contact surface was applied onto the cornea with constant force and .fS was measured. A mathematical model based on the Imbert-Fick law and the assumption that .fS was linearly related to contact area was proposed and verified with a convincing result. IOP measured with the ARS correlated well (r=0.92, n=360) with the IOP elicited by a saline column.

The ARS in a constant-force arrangement was evaluated on healthy human subjects in vivo. The results verified the sensor principle but revealed a nonnegligible source of error in off-centre positioning between the sensor and cornea. The sensor probe was redesigned and evaluated in the in vitro model. The new probe, with a spherical contact surface against the eye reduced the sensitivity to off-centre positioning. It was also shown that a .fS normalisation procedure could reduce the between-eye differences.

The ARS method for IOP measurement was further developed using combined continuous force and area measurement during the dynamic phase when the sensor initially contacts the cornea. A force sensor was included with the resonator sensor in one probe. Evaluation was performed with the in vitro pig-eye model. The hypothesis was that the IOP could be deduced from the differential change of force and area during that phase. The study showed good accuracy and good reproducibility with a correlation of r=0.994 (n=414) between measured pressure in the vitreous chamber and IOP according to the ARS. Measurement time was short, 77 ms after initial contact. Problems with inter-eye differences and low resolution at high pressures were reduced. The ARS method is the first to combine simultaneous, continuous sampling of both parameters included in the applanation principle. Consequently, there is a potential for reducing errors in the clinical IOP tonometry.

The purpose of this thesis was to investigate the effect of corneal swelling on the accuracy of Goldmann tonometry estimates of intraocular pressure (IOP). In the first experiment, central corneal thickness (CCT, ultrasonic pachymetry), IOP (Goldmann tonometry) and corneal curvature (keratometry) was measured in one eye of 25 subjects every two hours for 24 hours, except for 8 hours overnight (no measurements taken), and for the first two hours after awakening (measurement frequency 20 minutes). CCT (+20.1??10.9 pm) and IOP (+3.1??2.4 mmHg) peaked on eye opening, and then decreased at a similar rate (r=0.967, p<0.001) for the next two hours. Corneal swelling may have influenced the accuracy of Goldmann IOP measurements during this time. In the second and third studies, the CCT, IOP and corneal curvature were measured in both eyes of two groups of 25 subjects before and after the induction of corneal swelling, resulting from two hours of monocular closed eye contact lens wear. The increase in IOP was correlated to the increase in CCT at a rate of 0.33 to 0.48 mmHg per 10 pm, which signified an overestimation error in Goldmann IOP measurement. However, the change in IOP could not be accounted for solely by the change in CCT. In the fourth study, CCT, IOP and corneal curvature were used in conjunction with the Orssengo-Pye algorithm to determine the range of Young's modulus in the normal population, which was 0.29??0.06 MPa. Physiological variations in Young's modulus had a similar effect on Goldmann tonometry to CCT. In the fifth study, the data collected for studies 2 and 3 was used to calculate the Young's modulus changes associated with corneal swelling, again with the assistance of the Orssengo-Pye algorithm. No systematic change in Young's modulus was recorded after contact lens wear, but the model suggested that corneal biomechanical changes were responsible for the remainder of the change in IOP. All experimental results were combined to develop a model to calculate the diurnal variation of Goldmann IOP errors. The likely error in IOP due to overnight corneal swelling was 0.6 to 1.4 mmHg, which may explain as much as 45% (1.4 mmHg) of the 3.1 mmHg diurnal variation of IOP. In summary, small amounts of corneal swelling were shown to have a clinically significant impact on the accuracy of Goldmann tonometry. This may interfere with the measurement of the diurnal variation of IOP, particularly if measurements are taken prior to the resolution of overnight corneal swelling.

This thesis addresses the reliability of Goldmann-type applanation tonometers (GAT). It deals with the investigation of the relation between predicted intraocular pressure, IOPG and true pressure, IOPT. The problem of the accuracy of GAT readings has acquired special importance over the last two decades as new types of surgical procedures to correct vision disorders are being explored and gain universal acceptance. The overall aim of the present study is to assess the effects of individual variations in the corneal central thickness (CCT), material properties of the involved tissues and paracentral applanation on the accuracy of IOPG. Two finite element models have been constructed: a two-dimensional axisymmetric model of the cornea and a three-dimensional model of the whole corneoscleral envelope. Various material descriptions were adopted for the cornea in 2D, whereas the 3D model accounted for collagen microstructure and represented a hyperelastic ber reinforced material. Nonlinear analyses were carried out using the commercial general-purpose finite element software ABAQUS. An extensive literature survey and consultations with ophthalmologists and clinicians were the platform for establishing relevant modelling procedures. The results reveal a clear association between all considered parameters and measured IOPG. The effect of assumed CCT is highly dependent on the corneal material properties. Material model alone has a profound effect on predicted IOPG. Variations in tonometer tip application produce clinically signi cant errors to IOPG measurements. Potential effects of corneal stiffness and paracentral applanation on GAT readings are larger than the impact of CCT. The behaviour of the models is broadly in agreement with published observations. The proposed procedures can be a useful tools for suggesting the magnitudes of corrections for corneal biomechanics and possible human errors. The present modelling exercise has an ability to reproduce the behaviour of human cornea and trace it under IOP and GAT, providing potentially useful information on the distribution of stresses and strains. Some recommendations can be drawn in pursuit of the clinical imperatives of ophthalmologists.
QC 20100729

碩士
國立陽明大學
臨床醫學研究所
92
Glaucoma refers a group of diseases with characterized optic neuropathy. They share certain features, including retinal ganglion cell apoptosis, and progressive cupping and atrophy of the optic nerve head, which has attendant visual field loss. Elevated intraocular pressure (IOP) is the most prominent risk factor for glaucoma, and lowering of IOP is the only contemporary ophthalmic intervention that can be reliably effective. Accurate estimation of IOP is important because it is an essential factor in precise patient classification in diagnosis and efficacy assessment of glaucoma treatment. Of all the tonometers being used, Goldmann applanation tonometer (GAT) was considered as the gold standard for IOP measurements for decades. However, studies comparing measurements with manometry and tonometry indicate that measuring central corneal thickness (CCT) is essential to properly interpret the results obtained with GAT. The IOP would be over- or under-estimated in subjects with thick or thin corneas respectively. The realization of a wide range of CCT in normal eyes and the advent of excimer laser refractive surgery prompted ophthalmologists to pay attention to the impact of CCT on IOP measurements. Besides, corneal curvature is also considered as a possible source of error in applanation tonometry. The noncontact tonometer (NCT) is now widely used as a screening tool for glaucoma. However, little is known about the impact of CCT on the NCT measurements. The ocular blood flow tonometer (OBFT) has been introduced as another option to measure IOP and pulsatile ocular blood flow. The manufacturers claim that IOP measurements with the OBFT are not affected by variations in CCT, a statement needs to be verified. In this study, we used three kinds of tonometers (GAT, NCT and OBFT) to measure IOP and performed ultrasound pachometry, and keratometry on glaucoma, ocular hypertension and control subjects. We compared the IOP measurements obtained with the various tonometers and then evaluated the relationship between CCT or corneal curvature and these measurements. After reviewing the literature, we adopted several correction formulae that take CCT and/or corneal curvature into account to estimate the true intraocular hydrostatic pressure from the GAT readings. We quantified the NCT and OBFT measurement errors related to the variation in CCT by using the corrected GAT values as the standard. We found that pressure readings with the GAT, NCT and OBFT were all affected by CCT, with the NCT being the one most affected and the GAT the least. A linear regression model indicated that a 10μm change in CCT could yield a 0.47 – 0.98 mmHg deviation in the NCT measurements and a 0.29 – 0.81 mmHg deviation in the OBFT measurements. For eyes with keratometric astigmatism less than 2 diopters, corneal curvature had no significant correlation with the IOP measurements.

碩士
國立交通大學
電控工程研究所
103
In order to achieve long-term intraocular pressure (IOP) monitoring, this thesis presents a wireless readout system based on radio frequency identification (RFID) technology used to readout contact lens IOP sensor device. A digital baseband circuit, receive antenna and transmit antenna has been designed and fabricated to implement a pre-testing wireless IOP sensing tag. Considering the restriction on antenna size which is limited by contact lens, this thesis used 860 ~ 960 MHz as communication frequency band, designed a single-loop like antenna using inductive coupling to obtain higher energy transmission efficiency in near field under the conditions that the size of antenna is much smaller than the wavelength. The proposed sensing tag can perform 2 cm wireless sensing with 12.6 dBm RF power, and reached the maximum sensing distance of 7 cm under 30 dBm, which has met the requirement of our application. Furthermore, a next generation receive antenna has been designed and simulated, according to the pre-testing result, a 18.2 dBm RF power is needed to accomplish wireless sensing at distance of 2 cm.

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2006.
Source: Dissertation Abstracts International, Volume: 68-02, Section: B, page: 1116. Advisers: Jamshid Ghaboussi; David Pecknold. Includes bibliographical references (leaves 120-126) Available on microfilm from Pro Quest Information and Learning.

碩士
國立交通大學
電機與控制工程系所
97
The purpose of this thesis is to provide a Non-contact intraocular pressure measurement. The intraocular pressure variation will cause cornea deformation. That can be used to calculate intraocular pressure by optical measure, and to give up the measurement that used contact cornea to cause specific deformation. It will achieve the goal that used non-contact intraocular pressure measurement and provide a more comfortable measurement. On the side, we build up the finite element model for cornea. It can be used to simulate intraocular pressure variation about deformation, and discuss about corneal thickness and Young’s modulus. We also try to find out the relationship from intraocular pressure variation and deformation. That will be used to calculate the intraocular pressure and demonstrate feasibility for the non-contact intraocular pressure measurement.

碩士
國立交通大學
電控工程研究所
102
The main sensing principle based on intraocular pressure(IOP) caused by natural variations in corneal deformation, using capacitive IOP contact lenses sensor paste clothes in cornea and sensing changes in the manner in which the corneal contour changes in intraocular pressure indirectly. This paper reports a study of the use of MEMS manufacturing technology to fabricate a flexible IOP sensor that can be embedded in a contact lens, using a transparent parylene C as a substrate and an insulating layer, gold as the upper and lower electrode of the capacitor electrode. It is a cyclic structure consists of two structural sandwich plates which is filled by HEMA and between top plate and bottom plate. Then the sensor will combined with contact lens molds. After combining contact lens surface smooth and no wrinkles. Biocompatible materials had been used. This sensor shows a high sensitivity, fast dynamic response, and less susceptible to environmental effects. Also it won’t be affected by high frequency signal, and can reduce the difficulty of the design of circuit. In the dynamic measurement section, the sensor is placed on self-designed and size similar bionic eye for sensor dynamic testing. Results show that when the bionic eye cavity was poured into 50 uL of water, bionic eye curvature produce very small changes, the sensor can correctly detect and have a fairly good reproducibility and response speed. Sensor sensitivity is about 0.5 pF / mmHg.

碩士
國立交通大學
電控工程研究所
103
The main sensing principle is detecting the corneal deformation caused by the variations of intraocular pressure(IOP), using capacitive IOP contact lenses sensor wear on corneal. The variations of intraocular pressure will be transformed into the change of capacitance values and the values will be exported by RFID system. Reach the goals of long time, comfort, and wireless measurement. This paper reports a study of using MEMS manufacturing technology to fabricate a flexible IOP sensor that can be embedded in a contact lens with the feasibility fabrication. The first part is the fabrication of sensing unit which is a sandwich structure which is filled by HEMA between top plate and bottom plate, using a transparent parylene C as the substrate and the insulating layer, gold as the top and bottom electrode of the capacitor electrode. The second part is the fabrication of sensor, it will be integrated by using the Flip-Chip technology to combine the sensing unit and the chip with read-out circuit, molding into contact lenses with PDMS, and curing with oven. Last, the experiment of the qualitative and quantitative of the sensor will be implemented by using isolated pig eyes and living rabbit eyes.

Glaucoma is the leading cause of irreversible blindness worldwide effecting more than 2.7 million people in the U.S alone. Treatments exist in the form of both pharmaceutical and surgical options, but often do not provide the desired efficacy. For example, the failure rate of a trabeculectomy procedure is 39% within 5 years. Additionally, none of the current glaucoma treatments allow for closed loop monitoring of pressure, therefore requiring more frequent doctor visits. Glaucoma management can be improved through the use of a closed loop application of electroceutical treatment. The goal is to develop an implantable device that will be inserted into the eye to monitor intraocular pressure (IOP) and provide responsive therapeutic stimulation to the eye. I designed a discrete pressure monitoring system that interacts with a bare die piezoresistive pressure sensor. The system is based on a Wheatstone bridge design which translates the input resistances of the pressure sensor into a voltage output. This system has an average accuracy of 0.53 mmHg and draws 295 µW of power. I then combined this pressure system with data processing code and Howland current pump stimulation circuitry. This simulation system can output up to 1.05 mA of current for electroceutical intraocular stimulation to lower IOP. Future work will involve miniaturizing the circuitries in the form of an ASIC and packaging the entire system into an ocular implant. This implant can wirelessly monitor IOP and provide therapeutic stimulation to lower IOP. A reliable, closed loop method of lowering IOP would greatly benefit the ever-growing population affected by glaucoma.

Le glaucome est la première cause de cécité irréversible dans le monde. Bien que sa pathogenèse demeure encore nébuleuse, les propriétés biomécaniques de l’oeil sembleraient jouer un rôle important dans le développement et la progression de cette maladie. Il est stipulé que la rigidité oculaire (RO) est altérée au travers les divers stades de la maladie et qu’elle serait le facteur le plus influent sur la réponse du nerf optique aux variations de la pression intraoculaire (PIO) au sein du glaucome. Pour permettre l’investigation du rôle de la RO dans le glaucome primaire à angle ouvert (GPAO), la capacité de quantifier la RO in vivo par l’entremise d’une méthode fiable et non-invasive est essentielle. Une telle méthode n’est disponible que depuis 2015. Basée sur l'équation de Friedenwald, cette approche combine l'imagerie par tomographie par cohérence optique (TCO) et la segmentation choroïdienne automatisée afin de mesurer le changement de volume choroïdien pulsatile (ΔV), ainsi que la tonométrie dynamique de contour Pascal pour mesurer le changement de pression pulsatile correspondant. L’objectif de cette thèse est d’évaluer la validité de cette méthode, et d’en faire usage afin d’investiguer le rôle de la RO dans les maladies oculaires, particulièrement le GPAO. Plus spécifiquement, cette thèse vise à : 1) améliorer la méthode proposée et évaluer sa validité ainsi que sa répétabilité, 2) investiguer l’association entre la RO et le dommage neuro-rétinien chez les patients glaucomateux, et ceux atteints d’un syndrome de vasospasticité, 3) évaluer l’association entre la RO et les paramètres biomécaniques de la cornée, 4) évaluer l’association entre la RO et les pics de PIO survenant suite aux thérapies par injections intravitréennes (IIV), afin de les prédire et de les prévenir chez les patients à haut risque, et 5) confirmer que la RO est réduite dans les yeux myopes. D’abord, nous avons amélioré le modèle mathématique de l’oeil utilisé pour dériver ΔV en le rendant plus précis anatomiquement et en tenant compte de la choroïde périphérique. Nous avons démontré la validité et la bonne répétabilité de cette méthodologie. Puis, nous avons effectué la mesure des coefficients de RO sur un large éventail de sujets sains et glaucomateux en utilisant notre méthode non-invasive, et avons démontré, pour la première fois, qu'une RO basse est corrélée aux dommages glaucomateux. Les corrélations observées étaient comparables à celles obtenues avec des facteurs de risque reconnus tels que la PIO maximale. Une forte corrélation entre la RO et les dommages neuro-rétiniens a été observée chez les patients vasospastiques, mais pas chez ceux atteints d'une maladie vasculaire ischémique. Cela pourrait potentiellement indiquer une plus grande susceptibilité au glaucome due à la biomécanique oculaire chez les patients vasospastiques. Bien que les paramètres biomécaniques cornéens aient été largement adoptés dans la pratique clinique en tant que substitut pour la RO, propriété biomécanique globale de l'oeil, nous avons démontré une association limitée entre la RO et ces paramètres, offrant une nouvelle perspective sur la relation entre les propriétés biomécaniques cornéennes et globales de l’oeil. Seule une faible corrélation entre le facteur de résistance cornéenne et la RO demeure après ajustement pour les facteurs de confusion dans le groupe des patients glaucomateux. Ensuite, nous avons présenté un modèle pour prédire l'amplitude des pics de PIO après IIV à partir de la mesure non-invasive de la RO. Ceci est particulièrement utile pour les patients à haut risque atteints de maladies rétiniennes exsudatives et de glaucome qui nécessiteraient des IIV thérapeutiques, et pourrait permettre aux cliniciens d'ajuster ou de personnaliser le traitement pour éviter toute perte de vision additionnelle. Enfin, nous avons étudié les différences de RO entre les yeux myopes et les non-myopes en utilisant cette technique, et avons démontré une RO inférieure dans la myopie axiale, facteur de risque du GPAO. Dans l'ensemble, ces résultats contribuent à l’avancement des connaissances sur la physiopathologie du GPAO. Le développement de notre méthode permettra non seulement de mieux explorer le rôle de la RO dans les maladies oculaires, mais contribuera également à élucider les mécanismes et développer de nouveaux traitements ciblant la RO pour contrer la déficience visuelle liée à ces maladies.
Glaucoma is the leading cause of irreversible blindness worldwide. While its pathogenesis is yet to be fully understood, the biomechanical properties of the eye are thought to be involved in the development and progression of this disease. Ocular rigidity (OR) is thought to be altered through disease processes and has been suggested to be the most influential factor on the optic nerve head’s response to variations in intraocular pressure (IOP) in glaucoma. To further investigate the role of OR in open-angle glaucoma (OAG) and other ocular diseases such as myopia, the ability to quantify OR in living human eyes using a reliable and non-invasive method is essential. Such a method has only become available in 2015. Based on the Friedenwald equation, the method uses time-lapse optical coherence tomography (OCT) imaging and automated choroidal segmentation to measure the pulsatile choroidal volume change (ΔV), and Pascal dynamic contour tonometry to measure the corresponding pulsatile pressure change. The purpose of this thesis work was to assess the validity of the methodology, then use it to investigate the role of OR in ocular diseases, particularly in OAG. More specifically, the objectives were: 1) To improve the extrapolation of ΔV and evaluate the method’s validity and repeatability, 2) To investigate the association between OR and neuro-retinal damage in glaucomatous patients, as well as those with concomitant vasospasticity, 3) To evaluate the association between OR and corneal biomechanical parameters, 4) To assess the association between OR and IOP spikes following therapeutic intravitreal injections (IVIs), to predict and prevent them in high-risk patients, and 5) To confirm that OR is lower in myopia. First, we improved the mathematical model of the eye used to derive ΔV by rendering it more anatomically accurate and accounting for the peripheral choroid. We also confirmed the validity and good repeatability of the method. We carried out the measurement of OR coefficients on a wide range of healthy and glaucomatous subjects using this non-invasive method, and were able to show, for the first time, that lower OR is correlated with more glaucomatous damage. The correlations observed were comparable to those obtained with recognized risk factors such as maximum IOP. A strong correlation between OR and neuro-retinal damage was found in patients with concurrent vasospastic syndrome, but not in those with ischemic vascular disease. This could perhaps indicate a greater susceptibility to glaucoma due to ocular biomechanics in vasospastic patients. While corneal biomechanical parameters have been widely adopted in clinical practice as surrogate measurements for the eye’s overall biomechanical properties represented by OR, we have shown a limited association between these parameters, bringing new insight unto the relationship between corneal and global biomechanical properties. Only a weak correlation between the corneal resistance factor and OR remained in glaucomatous eyes after adjusting for confounding factors. In addition, we presented a model to predict the magnitude of IOP spikes following IVIs from the non-invasive measurement of OR. This is particularly useful for high-risk patients with exudative retinal diseases and glaucoma that require therapeutic IVIs, and could provide the clinician an opportunity to adjust or customize treatment to prevent further vision loss. Finally, we investigated OR differences between non-myopic and myopic eyes using this technique, and demonstrated lower OR in axial myopia, a risk factor for OAG. Overall, these findings provide new insights unto the pathophysiology of glaucomatous optic neuropathy. The development of our method will permit further investigation of the role of OR in ocular diseases, contributing to elucidate mechanisms and provide novel management options to counter vision impairment caused by these diseases.

M.Phil. (Optometry)
The primary aim of this research was to investigate whether the Icare® rebound tonometer may be used in place of the Goldmann tonometer to obtain accurate and reliable intraocular pressure measurements on a sample of the general population seeking eye care, in a South African context. Due to the portability of the Icare®, lack of dependency on other instrumentation and power source, together with the ease of use with minimal training, and without the use of topical anaesthetic favourable results of the instrument may lead to its widespread use. This could aid in earlier diagnosis of glaucoma where intraocular pressure remains the only modifiable risk factor. In the South African context, where a high prevalence of undiagnosed primary open angle glaucoma has been found, access and accuracy of intraocular pressure measurement could save and extend functional vision in this country. Patients presenting at the Department of Optometry for routine eye examinations were selected utilizing convenience sampling. The right and left eyes of 113 patients were assessed using both the Icare® TA01i and the Goldman applanation tonometer by independent examiners for each method, all readings of intraocular pressure with the Goldman being taken by the same experienced examiner. The age of the patients ranged from 20 to 89 years with a mean age 50.29 ±20.97 years. Using the Oculus Pachycam® when it became available, central corneal thickness was obtained on 71 patients (142 eyes). Analysis of data using descriptive statistics from SPSS (Statistical Programs for the Social Sciences) was performed in addition to the Bland-Altman method of comparative analysis for sets of data of corrected and uncorrected measurements between the instruments...