The notion surfaces that, as fish evolved, left the sea and colonised the land, they then needed not only a supply of tears for their ocular surface to function, but also a means by which tears could be eliminated. The fascinating study of abnormalities of this system, which are common, frequently debilitating, and can be challenging to manage, is the purpose of this thesis. An attempt has been made initially to assess our current state of knowledge in the Introduction. In subsequent chapters, new concepts including plerolacrima, temporal plical shift and videoreflective dacryomeniscometry are introduced; some of these should prove useful clinically. Quality of life in affected preoperative and postoperative cohorts is then assessed. Original publications have been achieved in all but one of the following subsections. Conjunctivochalasis in watery eye patients has been examined for the first time in a sizeable study clinically and histopathologically. The lateral tarsal strip procedure has been described as a new method of dealing with the punctal apposition syndrome. A new assessment for success in dacryocystorhinostomy (DCR) surgery, the Valsalva bubble test, has been carried out. Tear osmolality has been studied in watery eye cohorts and compared with normal controls; this study suggests that tear production decreases significantly with obstructed lacrimal outflow. Videoreflective dacryomeniscometry has shown that watery eye patients have a higher tear meniscus than normal controls, and that this normalises following DCR surgery. Lower eyelid tensometry has been shown in patients to be unchanged compared with normal controls. Computerised tomography of the lacrimal drainage region has been used to study patients with nasolacrimal duct obstruction. The detailed clinical mechanics of syringing the canaliculus have been described. Transcaruncular medial orbitotomy surgery for laxity of the medial canthal tendon has been tested in human cadavers, and evaluated in adult living humans. In summary, this thesis may be regarded as a tentative approach to a re-evaluation of the clinical management of the watery eye.

No description available.

No description available.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Background: Reading rate is a measure of fluency, reflecting the level of reading performance especially in children, which is not typically measured during routine eye examinations. Optometric clinical tests such as Snellen visual acuity are often poor predictors of everyday reading performance, as they test the smallest print a person is able to read rather than fluency. Conventional reading rate tests for educational purposes presents with many limitations; they concentrate on linguistic skills, increase in complexity as the reading progresses, limited by the readers vocabulary but more importantly, they do not take the level of the child's vision into consideration. There is currently no reading rate chart that is designed with optometric notations specifically for children with normal vision and low vision. It is therefore necessary to design a reading rate chart that takes the above limitations into consideration. Aim: This study aimed to design a chart that can be used to measure reading rates in normal sighted and low vision primary school children. Methods: The aim of the study was achieved in four parts; the design, reliability, validity of a reading rate chart and finally the testing of the chart on low vision participants. In the design of the chart, ten frequently used words in grade one English reading books were randomly selected from five primary schools in KwaZulu-Natal province, South Africa. The reliability and validity of the chart were established on normal sighted children, aged nine to twelve years from two primary schools in the Durban area chosen by convenience sampling method, with sample size of 100 for reliability and 100 for validity. Reliability was established with test and retest reading rates using the new chart while validity was established by determining the reading rates using new the chart and the Wilkins reading rate chart. Data were analyzed using the Paired t-test, Pearson correlation, and Bland and Altman method. Finally, the testing of the new chart without and with low vision device, on fourteen low vision children, aged eight to nineteen years, attending a school for the visually impaired in KwaZulu-Natal. Data was analyzed using Paired t-test and Pearson correlation. Results: The words were arranged in random order, ten words per row and ten rows per paragraph. The chart consisted of six paragraphs (versions A, B, C, D, E and F) with six acuity levels and four optometric notations. Each version was printed on a separate sheet, in Arial and Times New Romans fonts and printed in black ink on approximately white cardboards. In reliability, the mean test and retest reading rates were 77.65 ± 25.30 and 78.23 ± 24.70 (p = 0.29, R² = 0.95). In Bland and Altman method, the mean difference was −0.58 with confidence limits at +10.07 and -11.23. In validity, reading rate for Wilkins chart and the new chart were 75.82 ± 23.64 and 74.92 ± 23.58 (p = 0.01, R² = 0.99) respectively. In Bland-Altman method, the mean difference was +0.90, upper limit at +6.33 and lower limit at –4.53. The mean reading rate, of the low vision children, without and with the low vision device were 59.32 ± 24.08 words per minute (wpm) and 67.04 ± 25.63 words per minute (wpm) respectively (p = 0.09 and r = 0.82). Conclusions: This chart can be used for reading rate assessment for both normally sighted and low vision children and is statistically reliable and valid. / Thesis (M.Optom.)-University of KwaZulu-Natal, Westville, 2012.

published_or_final_version / Public Health / Master / Master of Public Health

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 7 uppsatser.

Abstract In this thesis study, the primary structure of the human α1(XVIII) polypeptide was elucidated, its tissue distribution was studied, and the phenotypic changes in the mouse eye due to lack of type XVIII collagen in a knock-out mouse model were studied further. In addition, the consequences of simultaneous lack of both type XVIII and XV collagen were studied in a mouse model lacking both of these proteins. Two variant forms of human α1(XVIII) polypeptide were identified in this study, although, to date, a third form has also been characterized. The analysis of tissue distribution of the two polypeptide forms revealed differences in their tissue distribution, since the longest variant occurs prominently in the liver, while the short form is the major transcript in other tissues studied, e.g. in the kidney. The study of the type XVIII single null mouse eyes revealed abnormalities in the anterior eye segment in addition to the previously reported defects in the posterior eye part. In the type XVIII single null mice the iris was fragmented, pigment deposits could be seen in the pupil, and the pupillary ruff in the edge of a normal mouse iris was missing in these mice. The ciliary body was also abnormal, since the ciliary processes start to show regression in adult animals and eventually the basal infoldings of the non-pigmented ciliary body epithelia become flattened in the null mice. The intraocular pressure stabilizes to a lower level in adult mutant mice compared to controls, most likely reflecting the atrophied ciliary epithelia. The BM zones were also defective in the type XVIII null mouse eyes. The absence of an immunosignal with one of the antibodies detecting laminin γ2 chain in the type XVIII null mouse eyes may implicate conformational changes in the laminin γ2 chain due to lack of type XVIII collagen, and subsequently interaction between type XVIII collagen and laminin γ2 chain in normal mouse eye BMs. The study of the type XVIII and XV double null mice revealed that these mice were viable and fertile and had no major additional abnormalities compared to both single null mice. However, the regression of hyaloid capillaries (vasa hyaloidea propria, VHP) was studied in these mice, and a slight delay in the detachment of these vessels from the retina was noticed. Thus, the two collagens do not function entirely independently from each other. The studies with type XVIII collagen single null mice indicate that in addition to the posterior eye phenotype, this collagen is needed for the normal structural integrity of the anterior eye segment and basement membranes of the eye. The mouse model lacking both type XVIII and type XV collagen indicates that the roles of the two collagens are essentially diverse, although a slight compensatory effect was observed in the detachment of the hyaloid capillaries from the retina.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences