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The binding theme of this thesis is the examination of both phakic and pseudophakic accommodation by means of theoretical modelling and the application of a new biometric measuring technique. Anterior Segment Optical Coherence Tomography (AS-OCT) was used to assess phakic accommodative changes in 30 young subjects (19.4 2.0 years; range, 18 to 25 years). A new method of assessing curvature change with this technique was employed with limited success. Changes in axial accommodative spacing, however, proved to be very similar to those of the Scheimpflug-based data. A unique biphasic trend in the position of the posterior crystalline lens surface during accommodation was discovered, which has not been alluded to in the literature. All axial changes with accommodation were statistically significant (p < 0.01) with the exception of corneal thickness (p = 0.81). A two-year follow-up study was undertaken for a cohort of subjects previously implanted with a new accommodating intraocular lens (AIOL) (Lenstec Tetraflex KH3500). All measures of best corrected distance visual acuity (BCDVA; +0.04 0.24 logMAR), distance corrected near visual acuity (DCNVA; +0.61 0.17 logMAR) and contrast sensitivity (+1.35 0.21 log units) were good. The subjective accommodation response quantified with the push-up technique (1.53 0.64 D) and defocus curves (0.77 0.29 D) was greater than the objective stimulus response (0.21 0.19 D). AS-OCT measures with accommodation stimulus revealed a small mean posterior movement of the AIOLs (0.02 0.03 mm for a 4.0 D stimulus); this is contrary to proposed mechanism of the anterior focus-shift principle.

The recording of visual acuity using the Snellen letter chart is only a limited measure of the visual performance of an eye wearing a refractive aid. Qualitative in addition to quantitative information is required to establish such a parameter: spatial, temporal and photometric aspects must all be incorporated into the test procedure. The literature relating to the correction of ametropia by refractive aids was reviewed. Selected aspects of a comparison between the correction provided by spectacles and contact lenses were considered. Special attention was directed to soft hydrophilic contact lenses. Despite technological advances which have produced physiologically acceptable soft lenses, there still remain associated with this recent form of refractive aid unpredictable visual factors. Several techniques for vision assessment were described, and previous studies of visual performance were discussed. To facilitate the investigation of visual performance in a clinical environment, a new semi-automated system was described: this utilized the presentation of broken ring test stimuli on a television screen. The research project comprised two stages. Initial work was concerned with the validation of the television system, including the optimization of its several operational variables. The second phase involved the utilization of the system in an investigation of visual performance aspects of the first month of regular daily soft contact lens wear by experimentally-naive subjects. On the basis of the results of this work an ‘homoeostatic’ model has been proposed to represent the strategy which an observer adopts in order to optimize his visual performance with soft contact lenses.

It has often been found that corneal astigmatism exceeds the amount exhibited by the eye as a whole. This difference is usually referred to as residual astigmatism. Scrutiny of the studies of corneal astigmatismreveal that what has actually been measured is the astigmatic contributionof the anterior corneal surface alone. This anterior surface is easily measured whereas measurement of the posterior corneal surface is much moredifficult. A method was therefore developed to measure the radius and toricity of the posterior corneal surface. The method relies upon photography of the first and second Purkinje images in three fixed meridians. Keratometry, comparison of anterior and posterior corneal Purkinje images and pachometricdata were applied to three meridional analysis equations, allowing the posterior corneal surface to be described in sphero-cylindrical form. Measurements were taken from 80 healthy subjects from two distinct age groups. The first consisted of 60 young subjects, mean age 22.04 years and the second consisted of 20 old subjects, mean age 74.64 years. The young group consisted of 28 myopes, 24 emmetropes and 8 hyperopes. The old group consisted of 6 myopes and 14 hyperopes. There was an equal number of males and females in each group. These groupings allowed the study of the effects of age, ametropia and gender on the posterior corneal toricity. The effect of the posterior corneal surface on residual astigmatism was assessed and was found to cause an overall reduction. This reduction was due primarily to the posterior corneal surface being consistently steeper relative to the anterior surface in the vertical meridian compared to the horizontal meridian.

The study evaluated sources of within- and between-subject variability in standard white-on-white (W-W) perimetry and short-wavelength automated perimetry (SWAP). The Influence of staircase strategy on the fatigue effect in W-W perimetry was investigated for a 4 dB single step, single reversal strategy; a variable step size, single reversal dynamic strategy; and the standard 4-2 dB double reversal strategy. The fatigue effect increased as the duration of the examination Increased and was greatest in the second eye for all strategies. The fatigue effect was lowest for the 4dB strategy, which exhibited the shortest examination time and was greatest for the 4-2 dB strategy, which exhibited the longest examination time. Staircase efficiency was lowest for the 4 dB strategy and highest for the dynamic strategy which thus offers a reduced examination time and low inter-subject variability. The normal between-subject variability of SWAP was determined for the standard 4-2 dB double reversal strategy and the 3 dB single reversal FASTPAC strategy and compared to that of W-W perimetry, The decrease in sensitivity with Increase in age was greatest for SWAP. The between-subject variability of SWAP was greater than W-W perimetry. Correction for the Influence of ocular media absorption reduced the between-subject variability of SWAP, The FASTPAC strategy yielded the lowest between-subject variability In SWAP, but the greatest between-subject variability In WoW perimetry. The greater between-subject variability of SWAP has profound Implications for the delineation of visual field abnormality, The fatigue effect for the Full Threshold strategy in SWAP was evaluated with conventional opaque, and translucent occlusion of the fellow eye. SWAP exhibited a greater fatigue effect than W-W perimetry. Translucent occlusion reduced the between-subject variability of W-W perimetry but Increased the between-subject variability of SWAP. The elevation of sensitivity was greater with translucent occlusion which has implications for the statistical analysis of W-W perimetry and SWAP. The influence of age-related cataract extraction and IOL implantation upon the visual field derived by WoW perimetry and SWAP was determined. Cataract yielded a general reduction In sensitivity which was preferentially greater in SWAP, even after the correction of SWAP for the attenuation of the stimulus by the ocular media. There was no correlation between either backward or forward light scatter and the magnitude of the attenuation of W-W or SWAP sensitivity. The post-operative mean deviation in SWAP was positive and has ramifications for the statistical Interpretation of SWAP. Short-wavelength-sensitive pathway isolation was assessed as a function of stimulus eccentricity using the two-colour Increment threshold method. At least 15 dB of SWS pathway Isolation was achieved for 440 nm, 450 nm and 460 nm stimuli at a background luminance of 100 cdm-2, There was a slight decrease In SWS pathway Isolation for all stimulus wavelengths with increasing eccentricity which was not of clinical significance. Adopting a 450 nm stimulus may reduce between-subject variability In SWAP due to a reduction In ocular media absorption and macular pigment absorption.

The observation that performance in many visual tasks can be made independent of eccentricity by increasing the size of peripheral stimuli according to the cortical magnification factor has dominated studies of peripheral vision for many years. However, it has become evident that the cortical magnification factor cannot be successfully applied to all tasks. To find out why, several tasks were studied using spatial scaling, a method which requires no pre-determined scaling factors (such as those predicted from cortical magnification) to magnify the stimulus at any eccentricity. Instead, thresholds are measured at the fovea and in the periphery using a series of stimuli, all of which are simply magnified versions of one another. Analysis of the data obtained in this way reveals the value of the parameter E2, the eccentricity at which foveal stimulus size must double in order to maintain performance equivalent to that at the fovea. The tasks investigated include hyperacuities (vernier acuity, bisection acuity, spatial interval discrimination, referenced displacement detection, and orientation discrimination), unreferenced instantaneous and gradual movement, flicker sensitivity, and face discrimination. In all cases tasks obeyed the principle of spatial scaling since performance in the periphery could be equated to that at the fovea by appropriate magnification. However, E2 values found for different spatial tasks varied over a 200-fold range. In spatial tasks (e.g. bisection acuity and spatial interval discrimination) E2 values were low, reaching about 0.075 deg, whereas in movement tasks the values could be as high as 16 deg. (DX 185,687)

This thesis first considers the calibration and signal processing requirements of a neuromagnetometer for the measurement of human visual function. Gradiometer calibration using straight wire grids is examined and optimal grid configurations determined, given realistic constructional tolerances. Simulations show that for gradiometer balance of 1:104 and wire spacing error of 0.25mm the achievable calibration accuracy of gain is 0.3%, of position is 0.3mm and of orientation is 0.6°. Practical results with a 19-channel 2nd-order gradiometer based system exceed this performance. The real-time application of adaptive reference noise cancellation filtering to running-average evoked response data is examined. In the steady state, the filter can be assumed to be driven by a non-stationary step input arising at epoch boundaries. Based on empirical measures of this driving step an optimal progression for the filter time constant is proposed which improves upon fixed time constant filter performance. The incorporation of the time-derivatives of the reference channels was found to improve the performance of the adaptive filtering algorithm by 15-20% for unaveraged data, falling to 5% with averaging. The thesis concludes with a neuromagnetic investigation of evoked cortical responses to chromatic and luminance grating stimuli. The global magnetic field power of evoked responses to the onset of sinusoidal gratings was shown to have distinct chromatic and luminance sensitive components. Analysis of the results, using a single equivalent current dipole model, shows that these components arise from activity within two distinct cortical locations.

This study investigated the detrimental effect of central field loss (CFL) on reading ability and general visual function. The aim was to improve the understanding of reading with eccentric retina in order that reading performances of individuals with CFL may be maximised. To improve visual ability of individuals with CFL, it is important to be able to accurately measure the outcome of any intervention. Various methods for determining visual function were therefore compared with perceived visual performance (as measured with a quality of life questionnaire) before and after surgical removal of choroidal new vessels (CNV) in macular disease patients. The results highlight the importance of low contrast measures (low contrast visual acuity and contrast sensitivity) when investigating perceived reading performance. Reading speed was found to be important for reflecting changes in general visual quality of life. Potential causes for reduced peripheral reading ability were investigated using both normally sighted and CFL subjects. For normally sighted subjects reading eccentrically with rapid serial visual presentation (RSVP) text, the inferior visual field was a better position (in terms of reading speed) for the presentation of the text. The size of the visual span was found to reduce with increasing eccentricity of fixation, providing a potential reason for reduced peripheral reading performances. The investigation of the ability to use context when reading with peripheral retina resulted in conflicting results. Studies in this thesis found both a reduction and no reduction in the ability of the peripheral retina to utilise context compared to the fovea. Individuals with long-term CFL showed no improvement in peripheral reading ability over that found for normally sighted subjects reading at the same eccentricity.

The Octopus Automated Perimeter was validated in a comparative study and found to offer many advantages in the assessment of the visual field. The visual evoked potential was investigated in an extensive study using a variety of stimulus parameters to simulate hemianopia and central visual field defects. The scalp topography was recorded topographically and a technique to compute the source derivation of the scalp potential was developed. This enabled clarification of the expected scalp distribution to half field stimulation using different electrode montages. The visual evoked potential following full field stimulation was found to be asymmetrical around the midline with a bias over the left occiput particularly when the foveal polar projections of the occipital cortex were preferentially stimulated. The half field response reflected the distribution asymmetry. Masking of the central 3° resulted in a response which was approximately symmetrical around the midline but there was no evidence of the PNP-complex. A method for visual field quantification was developed based on the neural representation of visual space (Drasdo and Peaston 1982) in an attempt to relate visual field depravation with the resultant visual evoked potentials. There was no form of simple, diffuse summation between the scalp potential and the cortical generators. It was, however, possible to quantify the degree of scalp potential attenuation for M-scaled full field stimuli. The results obtained from patients exhibiting pre-chiasmal lesions suggested that the PNP-complex is not scotomatous in nature but confirmed that it is most likely to be related to specific diseases (Harding and Crews 1982). There was a strong correlation between the percentage information loss of the visual field and the diagnostic value of the visual evoked potential in patients exhibiting chiasmal lesions.

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