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Thesis (M.S.)--University of Wisconsin--Madison, 1964. / eContent provider-neutral record in process. Description based on print version record. Bibliography: l. [108]-111.

Lasers have been involved in Ophthalmology in the treatment of myopia and hyperopia for several years. Laser systems have transformed patients‟ quality of life, freeing them from the need for glasses, as in the case of LASIK. Ultrafast lasers have played an important role in surgery of the eye. In LASIK, they are used to cut the flap that is lifted to expose the stroma for UV Excimer laser treatment of this region. They are now being used for surgery deeper into the eye,for instance, treating the lens as part of treatments for cataract surgery. The use of ultrafast lasers in cataract surgery and how they can be applied to achieve better surgical outcomes is the focus of this work. It reports on an investigation of laser interaction at and near the anterior of the lens, in particular the boundary between the fibrous mass, capsule, and anterior chamber of the eye. The study reviews the biomechanics of the eye, develops an interaction model with lens tissue, and reports for the first time clinically studies using ex vivo testing of porcine eyes. The components of the treatment laser system are described along with the requirements. Results of the experiments are outlined and discussed, followed by a summary and conclusions including discussion of areas for further research.

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In the UK, 11,000 new cases of open angle glaucoma (OAG) are diagnosed annually in people aged 40 to 70 years. However, two-thirds of UK OAG cases may remain undiagnosed, highlighting the need for improved detection. UK optometrists generate more than 95% of referrals for suspected glaucoma and ocular hypertension. Case-detection of glaucoma may be improved by using screening tests with better diagnostic accuracy, but standardised protocols for advanced technologies used alone, or in combination, to detect glaucoma are lacking. Chapter 2 reports on two cross-sectional surveys of UK community optometrists, determining the equipment and information technology (IT) used in optometric practice, and exploring the rationale behind the uptake of ophthalmic equipment and IT. UK optometrists are increasingly investing in new ophthalmic equipment and IT, including the latest technology. Longitudinal comparisons with previous surveys revealed an increase in use of Optical coherence tomography (OCT), Goldmann/Perkins tonometry and pachymetry. Variations in responses reflected differences in General Ophthalmic Services provision across the UK and involvement in community enhanced services. There was general agreement that specialised equipment enhances clinical care and permits increased involvement in enhanced services, but initial costs and ongoing maintenance can be a financial burden. Chapter 3 summarises a prospective cross-sectional study investigating the diagnostic accuracy of four advanced technologies for detecting POAG, used alone and in combination, in a representative sample (N=505) of the UK primary care population aged ≥60 years, and compared to a reference standard ophthalmic examination. Structural imaging using the iVue SD-OCT provided better discrimination between POAG and non-POAG/non-OHT subjects than either visual function test (Frequency Doubling Technology or Moorfields Motion Displacement Threshold). The low specificity of visual function tests precludes their use in isolation, but their use together with objective evaluation of optic nerve head structure by SD-OCT should improve case-detection of glaucoma. Chapter 4 describes a case-control study (N=78) evaluating the diagnostic effectiveness of two slit-lamp based techniques (van Herick and Smith’s) and imaging-based systems (Pentacam and Visante OCT) when compared to the reference standard gonioscopic observation, to screen for individuals at-risk of angle closure glaucoma (ACG). Overall, the van Herick test and Visante OCT, used either alone or in combination, showed best discrimination between narrow and open angles. Recording of either the temporal or nasal van Herick grade would be sufficient for case-finding in at-risk individuals. Chapter 5 summarises preceding chapters and details recommendations for future research.