Yes / Purpose. A recent study suggested that updated spectacles could increase falls rate in older people. We hypothesized that this may be due to changes in spectacle magnification and this study assessed the effects of spectacle magnification on adaptive gait. Methods. Adaptive gait and visual function was measured in 10 older adults (mean age 77.1 ¿ 4.3 years) with the participants¿ optimal refractive correction and when blurred with +1.00DS, +2.00DS, -1.00DS and -2.00DS lenses. Adaptive gait measurements for the lead and trail foot included foot position before the step, toe clearance of the step edge and foot position on the step. Vision measurements included visual acuity, contrast sensitivity and stereoacuity. Results. The blur lenses led to equal decrements in visual acuity and stereoacuity for the +1.00DS and -1.00DS and the +2.00DS and -2.00DS lenses. However, they had very different effects on adaptive gait compared to the optimal correction: Positive blur lenses led to an increased distance of the feet from the step, increased vertical toe clearance and reduced distance of the lead heel position on the step. Negative lenses led to the opposite of these changes. Conclusion. The adaptive gait changes did not mirror the effects of blur on vision, but were driven by the magnification changes of the lenses. Steps appear closer and larger with positive lenses and further away and smaller with negative ones. Magnification likely explains the mobility problems some older adults have with updated spectacles and after cataract surgery. / Federation of Ophthalmic and Dispensing Opticians

No / Purpose. To determine whether gait alterations due to monocular spherical lens blur were a safety strategy or driven by lens magnification. Methods. Adaptive gait and visual function were measured in 10 older adults (mean age, 74.9 4.8 years) with the participants' optimal refractive correction and when monocularly blurred with 1.00 DS and 2.00 DS lens over the dominant eye. Adaptive gait measurements for the lead and trail foot included foot position before the raised surface, toe clearance of the raised surface edge, and foot position on the raised surface. Vision measurements included binocular visual acuity, contrast sensitivity, and stereoacuity. Results. Equal levels of monocular positive and negative spherical lens blur led to very different stepping strategies when negotiating a raised surface. Positive blur lenses led to an increased vertical toe clearance and reduced distance of the lead foot position on the raised surface. Negative lenses led to the opposite of these changes. Conclusions. Findings suggest that step negotiation strategies were driven by the magnification effect provided by the spherical lenses. Steps appeared closer and larger with magnification from positive lenses and further away and smaller with minification from negative lenses and gait was adjusted accordingly. These results suggest that previously reported adaptive gait changes to monocular spherical lens blur were not safety strategies as previously suggested but driven by lens magnification. The significance of these findings in terms of prescribing large refractive changes in frail older patients is discussed.

Background: Cross-sectional survey of ocular biometry and visual function in healthy eyes across the life span of a German population aged 20 to 69 years (n = 218). Subject number in percent per age category reflected the percentage within the respective age band of the population of Leipzig, Germany. Methods: Measurements obtained: subjective and objective refraction, best-corrected visual acuity, accommodation, contrast sensitivity, topography and pachymetry with Scheimpflug camera, axial length with non-contact partial coherence interferometry, and spectral-domain optical coherence tomography of the retina. Pearson correlation coefficients with corresponding p-values were given to present interrelationships between stature, biometric and refractive parameters or their associations with age. Two-sample T-tests were used to calculate gender differences. The area under the logarithmic contrast sensitivity function (AULCSF) was calculated for the analysis of contrast sensitivity as a single figure across a range of spatial frequencies. Results: The results of axial length (AL), anterior chamber depth (ACD) and anterior chamber volume (ACV) differed as a function of the age of the participants (rho (p value): AL −0.19 (0.006), ACD −0.56 (< 0.001), ACV-0.52 (< 0.001)). Longer eyes had deeper ACD (AL:ACD 0.62 (< 0.001), greater ACV (AL:ACV 0.65 (< 0.001) and steeper corneal radii (AL:R1ant; R2ant; R1post; R2post 0.40; 0.35; 0.36; 0.36 (all with (< 0.001)). Spherical equivalent was associated with age (towards hyperopia: 0.34 (< 0.001)), AL (−0.66 (< 0.001)), ACD (−0.52 (< 0.001)) and ACV (−0.46 (< 0.001)). Accommodation was found lower for older subjects (negative association with age, r = −0.82 (< 0.001)) and contrast sensitivity presented with smaller values for older ages (AULCSF −0.38, (< 0.001)), no change of retinal thickness with age. 58 % of the study cohort presented with a change of refractive correction above ±0.50 D in one or both eyes (64 % of these were habitual spectacle wearers), need for improvement was present in the young age-group and for older subjects with increasing age. Conclusion: Biometrical data of healthy German eyes, stratified by age, gender and refractive status, enabled cross-comparison of all parameters, providing an important reference database for future patient-based research and specific in-depth investigations of biometric data in epidemiological research. Trial registration: ClinicalTrials.gov # NCT01173614 July 28, 2010

Clinicians are becoming increasingly aware of the effect of various pathologieso n the characteristicso f saccadice ye movements.A s such, an efficient and non-invasivem eano f measuringe ye-movementisn a clinical environmenti s of interest to many. The aim of this thesis is to investigate the clinical application of a non-invasive eye movement recording technique as a part of a clinical examination. Eye movements were measured using an IRIS 6500 infrared limbal eye tracker, which we customized for the direct recording of oblique eye movements as well as horizontal and vertical. Firstly, the eye-tracker itself was assessed. Visually normal observers made saccadic eye movements to a 10' stimulus in eight directions of gaze. Primary (ANOVA) and secondary analyses (mean error less than 5%) resulted in acceptance that averaging four measurements would give a representative measurement of saccadic latency, peak velocity, amplitude and duration. Test-retest results indicated that this technique gives statistically (± 1.96*STDEVDifference) repeatable responses. Severalf actors that could potentially influence clinically basedm easureso f eye-movementsw ere examined. These included, the effect of ageing, viewing distances, dioptric blur and cataract. The results showed that saccadic latency and durationa re significantly (p< 0.05) longer in older (60-89 years)o bserversc ompared to younger (20-39 years). Peak velocity and amplitude were not significantly affectedb y the age of the observer.A ll saccadicp arameters( SP) were significantly affected by direction (Chapter 5). The compact nature of this eye movement methodology is obtainable since there is no significant effect on viewing distance (300 cm vs. 49 cm) (Chapter 6). There is also no significant effect of dioptric blur (up to +LOODS) on any of the four SP. In contrast, a higher level of defocus (+3.O ODS)h as a larger probability of interfering with the measurementso f peak velocity and duration (Chapter 7). Saccadice ye-movementsw ere also recorded whilst normally sighted subjects wore cataract simulation goggles. The results suggested that the presence of dense cataract introduces significant increases in saccadic latencies and durations. No effect was found on the peak velocities and amplitudes.T he effect of amblyopiao n SP was also investigatedin order to examine if this methodologyi s able to detectn ormal from abnormalr esponses(i . e. increased saccadicla tencies).T his set of data (Chapter9 ) showedt hat using IRIS 6500, longer than normal latencies may be recorded from the amblyopic eye but no consistent effect was found for the other SP (peak velocity, amplitude, duration). overall, the results of this thesis demonstrateth at the IRIS 6500 eye-tracker has many desirable elements (it is non-invasive; comfortable for the observers and gives repeatable and precise results in an acceptable time) that would potentially make it a useful clinical tool as a part of a routine examination.

Ancré dans la didactique curriculaire et dans le champ de recherche essentiellement développé dans les pays anglo-saxons désigné par l’acronyme NoS (Nature of Science), ce travail examine la possibilité d’introduire l’histoire des sciences dans les cours de physique de l'enseignement secondaire tunisien afin de modifier l’image de la nature des sciences et de l’activité scientifique des élèves. Ces conditions portent sur la nature de l’innovation à expérimenter en classe et son impact sur les élèves, sur sa généralisabilité et donc sur le rapport à l’enseignement de la physique et à l’innovation des enseignants. Une partie des études théoriques a été consacrée à une revue de la littérature traitant de la culture scientifique (scientific literacy), de la nature des sciences et de l’histoire des sciences dans l’enseignement (NoS), l’autre à l’élaboration d’un cadre de référence épistémologico-historique. Nous y présentons les sciences comme une entreprise humaine réalisée dans un contexte socio-culturel, technique et politique d’une époque donnée et esquissons un panorama de l’histoire de la dioptrique orientée par les objectifs d’apprentissage épistémologique retenus pour la séquence d’enseignement innovante : montrer la diversité des enjeux de la physique et des démarches du physicien. Les études empiriques ont été conduites en Tunisie. Deux séquences d’investigation documentaires ont été expérimentées en classe à un an d’intervalle par le même enseignant auprès de deux groupes d’élèves, le premier de 20, le second de 25. Elles se distinguent par le fait que l’une vise uniquement l’acquisition de savoirs épistémologiques et que l’autre vise aussi l’acquisition de savoirs scientifiques sur la loi de la réfraction. Le suivi de ces ingénieries a été réalisé essentiellement à l’aide de questionnaires ouverts ou fermés. Un film et deux entretiens sous forme de questionnaires les complètent. La transmission de l’innovation pédagogique a été réalisée dans le cadre de la formation continue des enseignants et a donné lieu à une ingénierie qui a touché 50 enseignants du secondaire. Ceux-ci ont eu à réaliser le même travail que les élèves. Trente d’entre eux ont répondu aux mêmes questionnaires que les élèves ainsi qu’à deux autres questionnaires élaborés pour déterminer leur rapport à l’enseignement de la physique et à l’innovation. Les résultats obtenus confirment les hypothèses de recherche à propos de l’existence d’une vision empiriste et réaliste naïve des sciences chez les élèves et enseignants et d’une tendance des enseignants à privilégier les expériences dans l’enseignement de la physique. Ils sont encourageants quant à la possibilité de faire évoluer l’image de la nature de l’activité scientifique des élèves grâce à l’introduction de l’histoire des sciences relativement aux objectifs épistémologiques considérés. Nous terminons par la discussion des apports et limites du travail réalisé et présentons quelques pistes ultérieures de recherche. / Based on the research on curriculum and on the field of research mainly developed in English-speaking countries designated by the acronym NoS (Nature of Science), this work addresses the possibility of introducing innovative proposals based on the history of science in physics courses at the secondary level teaching in Tunisia in order to change the image of scientific activity among students. These conditions relate to the type of innovation to implement in class, to the impact of the implementation on students’ epistemological conceptions, to the relationship of teachers to science teaching and consequently to the generalizability. Part of the theoretical studies was devoted to a review of the literature on scientific literacy, on the nature of science and the history of science in education, the other to the elaboration of a reference framework based on history, philosophy and sociology of science. We consider the scientific knowledge as the result of activities—intellectual and practical—performed by individuals, working collectively, in the socio-cultural context of a given historical period. We outline an overview of the history of the dioptric guided by the epistemological learning objectives that we choose for the innovative pedagogical unit: showing the diversity of issues and approaches followed by physicists. Empirical studies have been conducted in Tunisia. Two units based on historical texts and inquiry-teaching were tested in class one year apart by the same teacher with two groups of students, the first one consisted of 20 students, the second one of 25. They differ in the fact that one is focused only on the acquisition of epistemological knowledge whereas the other also involves the acquisition of scientific knowledge on the law of refraction. Written questionnaires were elaborated in order to examine the evolution of the image of NoS of students and their relationship to the innovative unit. A film and two interviews of the teacher who implemented the units complete them. The transfer of the innovative proposal, carried out in the context of three in service teacher training sessions, affected 50 high school teachers. We proposed them the same work as students have to do. Thirty of them answered the same questionnaires as students. Two other questionnaires were designed in order to examine their relationship to the teaching of physics and to the training session. The results confirm the research hypotheses about the existence of a naive empiricist and realistic vision of science among students and teachers, and about a tendency among teachers to focus on experiences. They are also encouraging about the possibility of changing the image of the nature of science of students by introducing history of science in teaching on the particular features considered in the innovation. We conclude by discussing the contributions and limits of the work done and present some future research directions.

Clinicians are becoming increasingly aware of the effect of various pathologies on the characteristics of saccadic eye movements. As such, an efficient and non-invasive means of measuring eye-movement in a clinical environment is of interest to many. The aim of this thesis is to investigate the clinical application of a non-invasive eye movement recording technique as a part of a clinical examination. Eye movements were measured using an IRIS 6500 infrared limbal eye tracker, which we customized for the direct recording of oblique eye movements as well as horizontal and vertical. Firstly, the eye-tracker itself was assessed. Visually normal observers made saccadic eye movements to a 10' stimulus in eight directions of gaze. Primary (ANOVA) and secondary analyses (mean error less than 5%) resulted in acceptance that averaging four measurements would give a representative measurement of saccadic latency, peak velocity, amplitude and duration. Test-retest results indicated that this technique gives statistically (± 1.96*STDEVDifference) repeatable responses. Several factors that could potentially influence clinically based measures of eye-movements were examined. These included, the effect of ageing, viewing distances, dioptric blur and cataract. The results showed that saccadic latency and duration are significantly (p < 0.05) longer in older (60-89 years) observers compared to younger (20-39 years). Peak velocity and amplitude were not significantly affected by the age of the observer. All saccadic parameters (SP) were significantly affected by direction (Chapter 5). The compact nature of this eye movement methodology is obtainable since there is no significant effect on viewing distance (300 cm vs. 49 cm) (Chapter 6). There is also no significant effect of dioptric blur (up to +LOODS) on any of the four SP. In contrast, a higher level of defocus (+3.O ODS) has a larger probability of interfering with the measurements of peak velocity and duration (Chapter 7). Saccadic eye-movements were also recorded whilst normally sighted subjects wore cataract simulation goggles. The results suggested that the presence of dense cataract introduces significant increases in saccadic latencies and durations. No effect was found on the peak velocities and amplitudes. The effect of amblyopia on SP was also investigated in order to examine if this methodology is able to detect normal from abnormal responses (i.e. increased saccadic latencies). This set of data (Chapter9 ) showed that using IRIS 6500, longer than normal latencies may be recorded from the amblyopic eye but no consistent effect was found for the other SP (peak velocity, amplitude, duration). Overall, the results of this thesis demonstrate that the IRIS 6500 eye-tracker has many desirable elements (it is non-invasive; comfortable for the observers and gives repeatable and precise results in an acceptable time) that would potentially make it a useful clinical tool as a part of a routine examination.

La transparence et les propriétés optiques du greffon cornéen sont des qualités essentielles pour le résultat post opératoire après la kératoplastie perforante et la kératoplastie lamellaire antérieure qui sont les 2 greffes les plus utilisées au monde. Pourtant, la transparence est difficile à mesurer avec précision avec les techniques d’eye banking actuelles et les propriétés optiques ne le sont pas du tout car lors de la conservation cornéenne à 4°C et plus encore en organoculture, la cornée séparée du globe est moins transparente que sur le sujet vivant et comporte des plis. Nous avons développé un outil de conservation, un bioréacteur, permettant de simuler les conditions physiologiques de la cornée pendant la conservation, permettant ainsi la caractérisation optique du greffon. L’objectif de cette thèse a été la conception et la réalisation des instruments de caractérisation des propriétés optiques et tissulaires des greffons conservés en BR. Ces propriétés sont la densité cellulaire endothéliale, la transparence, la puissance, l’épaisseur et la détection d’interfaces cicatricielles / The optical properties of a corneal graft, namely its transparency, are pivotal to the post-operative result of penetrating keratoplasty and deep anterior lamellar keratoplasty, which are today the world’s two most performed grafts. However, transparency is difficult to accurately measure with modern eye banking techniques, and other optical properties are not measurable at all, as with both hypothermic storage and organ culture the enucleated cornea is less transparent than in a living eye, and presents endothelial folds. We developed a corneal storage device, a bioreactor, to simulate the eye’s physiological conditions during storage, thus allowing the measurement of the graft’s optical properties. The goal of this thesis was to create a set of instruments to be used in eye banking for the optical characterization of corneal grafts. The parameters to be measured are endothelial cell density, transparency, dioptric power, thickness and the presence of scar tissue

Background: Cross-sectional survey of ocular biometry and visual function in healthy eyes across the life span of a German population aged 20 to 69 years (n = 218). Subject number in percent per age category reflected the percentage within the respective age band of the population of Leipzig, Germany. Methods: Measurements obtained: subjective and objective refraction, best-corrected visual acuity, accommodation, contrast sensitivity, topography and pachymetry with Scheimpflug camera, axial length with non-contact partial coherence interferometry, and spectral-domain optical coherence tomography of the retina. Pearson correlation coefficients with corresponding p-values were given to present interrelationships between stature, biometric and refractive parameters or their associations with age. Two-sample T-tests were used to calculate gender differences. The area under the logarithmic contrast sensitivity function (AULCSF) was calculated for the analysis of contrast sensitivity as a single figure across a range of spatial frequencies. Results: The results of axial length (AL), anterior chamber depth (ACD) and anterior chamber volume (ACV) differed as a function of the age of the participants (rho (p value): AL −0.19 (0.006), ACD −0.56 (< 0.001), ACV-0.52 (< 0.001)). Longer eyes had deeper ACD (AL:ACD 0.62 (< 0.001), greater ACV (AL:ACV 0.65 (< 0.001) and steeper corneal radii (AL:R1ant; R2ant; R1post; R2post 0.40; 0.35; 0.36; 0.36 (all with (< 0.001)). Spherical equivalent was associated with age (towards hyperopia: 0.34 (< 0.001)), AL (−0.66 (< 0.001)), ACD (−0.52 (< 0.001)) and ACV (−0.46 (< 0.001)). Accommodation was found lower for older subjects (negative association with age, r = −0.82 (< 0.001)) and contrast sensitivity presented with smaller values for older ages (AULCSF −0.38, (< 0.001)), no change of retinal thickness with age. 58 % of the study cohort presented with a change of refractive correction above ±0.50 D in one or both eyes (64 % of these were habitual spectacle wearers), need for improvement was present in the young age-group and for older subjects with increasing age. Conclusion: Biometrical data of healthy German eyes, stratified by age, gender and refractive status, enabled cross-comparison of all parameters, providing an important reference database for future patient-based research and specific in-depth investigations of biometric data in epidemiological research. Trial registration: ClinicalTrials.gov # NCT01173614 July 28, 2010