The crystalline lens is a unique cellular organ that performs metabolic processes while maintaining optical functionality. Mitochondria play a vital role in providing the cell with the energy necessary for these metabolic processes and have recently been shown to be more metabolically active than previously thought. To test the hypothesis that mitochondrial function directly influences the optical function of the lens, bovine lenses were treated with 50 μM, 200 μM, 600 μM and 1000 μM menadione, a mitochondrial specific toxin that renders the mitochondria inactive, and the Back Vertex Distance (BVD) variability was observed over 216 hours. Confocal micrographs of secondary fibre cells’ mitochondria were also analyzed for 50 μM, 200 μM, and 600 μM menadione treatment over 48 hours. Increase in BVD variability (± s.e.m.) was observed within 24 hours from 0.28 ± 0.021 to 1.83 ± 0.75 for the 600 μM treated lenses. Confocal micrograph analysis showed a trend toward a decrease in the average length of mitochondria from 7.9 ± 0.8 to 3.7 ± 0.9 over for 200 μM treated lenses and from 5.9 ± 1.0 to 3.6 ± 0.6 for the 600 μM treated lenses over 48 hours. These data show that indeed menadione has a detrimental effect on mitochondria as a function of both time and concentration and this change in mitochondria precedes changes in BVD variability directly linking mitochondrial function to optical function.

Sjogren’s syndrome (SS) is a systemic autoimmune disease that presents to eye care practitioners with the hallmark symptom of “dry eye.” Stratifying dry eye patients as Sjogren’s positive or negative is a critical differential diagnosis, as SS patients have numerous systemic complications and a forty times greater risk of developing lymphoma. As such, management of this relatively common dry eye sub-population requires specialized care. Since a firm diagnosis requires testing that is both invasive and expensive, patients should be protected from these tests if they are not warranted. In this thesis, studies were therefore undertaken to determine if SS dry eye could be differentiated from other forms of dry eye using two methods: 1) standard clinical tests used in a multi-disciplinary Sjogren’s syndrome clinic and 2) subsequent biological evaluation of collected tear samples and cells from the ocular surface. The former would allow eye care practitioners to conduct appropriate tests and pose suitable questions to ifferentiate these subgroups, and the latter might serve in the future as a relatively non-invasive quantitative means of differentiating such groups through biomarkers.

Introduction: Tear film osmolality is a product of the varying concentrations of dissolved solutes (proteins, lipids and mucins) in the tear fluid. Research suggests that a hyperosmotic tear film is a trait common to all forms of dry eye, and it may be the driving force causing the discomfort, ocular surface damage and inflammation found in both evaporative and tear deficient forms of dry eye disease. Tear film osmolality has been proposed to be the “gold standard” diagnostic test for the evaluation of dry eye disease, as a distinct separation between tear film osmolalities in normal and dry-eyed (aqueous deficient or evaporative) populations has become evident. Historically, tear film osmolality could only be measured in a laboratory setting and required a highly skilled technician to use the instrumentation. The recent development of easy-to-use, small volume osmometers has made it possible for tear film osmolality to be measured clinically. As these instruments are quite new, there has been very little research completed with them. Therefore, a series of studies was conducted to investigate the utility of one of these new osmometers – the Advanced Instruments Model 3100 Nanolitre Osmometer. The specific aims of each chapter were: - Chapter 3: To determine if the Advanced Instruments Model 3100 Nanolitre Osmometer was capable of quantitatively measuring tear film osmolality in a normal population, using 0.5μL tear samples. - Chapter 4: Previous studies have shown the Advanced Instruments Model 3100 Nanolitre Osmometer not significantly different from another commercially available osmometer (Wescor Vapor Pressure Osmometer) for the measurement of human tears. This chapter examined the repeatability of the new instrument over multiple measurements on the same sample and over multiple days. - Chapter 5: To determine if tear film osmolality values varied significantly over the course of a normal working day in a population that was primarily free from symptoms of dry eye. - Chapter 6: To investigate the relationships between tear film osmolality and other commonly used clinical tests for dry eye disease. The clinical tests examined included various questionnaires designed to assess patient symptoms (Single Item Dry Eye Questionnaire (SIDEQ), the Ocular Surface Disease Index (OSDI), and the McMonnies Dry Eye Questionnaire (MMDEQ) and a linear analogue comfort scale (LACS)), a non-invasive tear break-up time test (NIBUT), and examination of ocular surface redness and tear ferning (TF). Secondarily to determine if the other clinical tests demonstrated significant diurnal variations over the course of a normal working day. - Chapter 7: To measure tear film osmolality in a population with mild to moderate symptoms of dry eye disease, and to compare this value with the osmolality of a population of age-matched controls without the disease. Secondarily, to investigate the relationship between tear film osmolality and patient comfort in a population with mild to moderate symptoms of dry eye disease. Methods: - Chapter 3: Tears were collected from 40 volunteer participants with a capillary tube. Some participants were non-contact lens wearers (Non-CL), while others wore either soft or rigid contact lenses (CL). Tear film osmolality was measured with the Advanced Instruments Model 3100 Nanolitre Osmometer. - Chapter 4: Tears were collected from 10 volunteer participants using two different collection techniques. Collections were repeated on three separate days (6 study visits total); three osmolality measurements per collection were taken using the Advanced Instruments Model 3100 Nanolitre osmometer. - Chapter 5: Tears were collected from 40 volunteer participants in two separate studies (n=80 in total). Tears were collected with a capillary tube three times a day (morning, mid-day and afternoon), on two separate days (6 study visits total). Tear film osmolality was measured with the Advanced Instruments Model 3100 Nanolitre Osmometer. - Chapter 6: Clinical tests were administered and tear samples were collected using a capillary tube from 40 volunteer participants. Measurements were taken three times a day (morning, mid-day and afternoon), on two separate days (6 study visits total). Tear film osmolality was measured with the Advanced Instruments Model 3100 Nanolitre Osmometer. - Chapter 7: Participants were classified as either having dry eye disease (DE) or not having dry eye disease (NDE) based on a clinical examination that included a case history, phenol red thread test and biomicroscopy (white light and sodium fluorescein assessment). Tear samples were then collected from all participants using a capillary tube and tear film osmolality was measured with the Advanced Instruments Model 3100 Nanolitre Osmometer. Participants also completed the SIDEQ, the OSDI, and the MMDEQ. Results: - Chapter 3: The mean tear film osmolality of the population was 298.7±11.4mOsm/Kg. CL wear (soft or rigid) did not appear to have a significant effect on tear film osmolality (CL: 298.5±11.2mOsm/Kg vs. Non-CL: 298.9±11.5mOsm/Kg), although this study was not designed to specifically look at the effects of contact lens wear on tear film osmolality. - Chapter 4: There was reasonably good concordance between measurements of tear film osmolality taken with the Advanced Instruments Model 3100 Nanolitre Osmometer (intraclass correlations range from 0.6497 (F= 0.0582) to 0.9550 (F = 0.5893)). Repeatability appeared to be affected by significant changes in ambient humidity (>10% per day). Concordance was similar with both sampling techniques. - Chapter 5: In the first study, no significant diurnal change in tear film osmolality was found (p>0.05), although a significant difference in measurements taken on Day 1 compared to Day 2 was found (p=0.040). When the first and last 10 participants enrolled were compared, the difference between days was present in the first 10 participants, but not in the last 10; it is likely that the investigator underwent a learning process during the period of the study, and that reflex tearing occurred more often in the early portion of the study compared with the latter portion. In the second study, no significant diurnal change in tear film osmolality was found (p>0.05) and no significant difference in measurements taken on Day 1 compared to Day 2 was found (p>0.05). When tear film osmolality was compared with the number of hours participants were awake, no significant correlation was found (r = 0.07044). - Chapter 6: Significant correlations were not found between tear film osmolality and SIDEQ (r = 0.1347), OSDI (r = 0.0331), MMDEQ (r = 0.2727), LACS (r = -0.1622), NIBUT (r = -0.2280), subjectively graded redness (r=-0.2280), or objectively measured redness (r = 0.1233). A weakly significant correlation was found between TF and tear film osmolality (r = 0.3978). None of the clinical measures (LACS, NIBUT, subjective or objective redness or TF) varied significantly over the course of the day. - Chapter 7: Tear film osmolality was higher in both the right (DE = 311.1±12.4mOsm/Kg, NDE = 306.2±11.2mOsm/Kg) and left eyes (DE = 313.2±11.9mOsm/Kg, NDE = 304.0±7.5mOsm/Kg) of participants, but the difference was only statistically significant in the left eye. Tear film osmolality did not correlate significantly with DE patient symptoms using any of the questionnaires (SIDEQ, OSDI, MMDEQ). Conclusions: - Chapter 3: The Advanced Instruments Model 3100 Nanolitre Osmometer appeared to be capable of measuring tear film osmolality in a normal population. Our population mean was slightly lower than what is reported to be normal (305mOsm/Kg), but it still fell within the range of values reported as normal (297 – 318mOsm/Kg). - Chapter 4: The Advanced Instruments Model 3100 Nanolitre Osmometer demonstrated reasonably good repeatability for the measurement of human tear samples. Unfortunately, the instrumentation appeared to be affected by dramatic weather changes. Maintaining the instrument in a humidity controlled environment may resolve this problem. - Chapter 5: Tear film osmolality did not appear to vary significantly over a normal working day. Inducing reflex tearing, perhaps with an unskilled investigator collecting the tears, can be a significant source of error (as demonstrated in the first study). - Chapter 6: Tear film osmolality did not correlate well with other clinical instruments designed to assess either patient symptoms or signs of dry eye disease in a normal population. Tear film osmolality and tear ferning did demonstrate a weakly significant positive correlation. None of the clinical measures assessed demonstrated a significant diurnal variation over the course of a normal working day. - Chapter 7: Tear film osmolality appeared to be higher in participants with mild to moderate symptoms of dry eye when compared with age matched, asymptomatic controls. Tear film osmolality did not correlate well with patient symptoms in a population of mild to moderate severe dry eyed individuals.

The impact of uncoordinated growth of the optical components of the eye may stimulate different levels of monochromatic aberrations in the growing eyes of the children. This thesis aimed to examine the impact of age, visual acuity and refractive error on higher order aberrations as well as to determine the relationship between them. Hartman Shack images taken with the Welch Allyn® SureSight Autorefractor were calibrated in order to determine the Zernike coefficients up to the 8th order for a pupil diameter of 5mm. The MATLAB code proposed by Thibos et al that follows the standard for reporting the optical aberrations of the eye was the basis of code written for this study. Modification was required to suit the specific needs of the Welch Allyn® SureSight Autorefractor. After calibration the lower order aberrations could then be compared with the results from cyclopledged retinoscopy. RMS values of aberrations and Strehl ratios were computed to examine the optical performance of the eye. A total of 834 Hartmann-Shack images of 436 children (mean age 3.94± 0.94 years, range 3 to 6 years) were examined in this study (right eyes 436; left eyes 398).The sample had a mean (± STD) spherical equivalent of 1.19 ± 0.59D, a mean with-the-rule astigmatism (J0) of 0.055 ± 0.22D, and a mean oblique astigmatism (J45) of 0.01±0.14D. Visual acuity varied from 6/6 to 6/18. Moderate mirror symmetry was found between the eyes. Like refractive error, higher order aberrations declined with age in this sample. There was an impact of higher order aberrations on refractive error. Significantly higher ocular aberrations were found in the higher hyperopic group (SE>+2.0D) compared to emmetropic (-0.5<SE<+0.5D) and low hyperopic groups (+0.5<SE<+2.0D). The Strehl ratio was significantly lower in the high hyperopic group. Higher Strehl ratios were observed for better acuity groups but the average Strehl ratios among the different visual acuity groups were not statistically significant. In conclusion, there was an impact of age on the ocular aberrations. A wider range of age from birth to adolescence is required for further investigation. This could be indirectly influenced by the age related changes in refractive error as the correlation between refractive error and the higher order aberrations were significant. This finding also concludes that Strehl Ratio alone is not capable of perfectly describing the visual acuity of the eye; other metrics such as the neural transfer function and neural noise are necessary to describe the resultant visual performance of the eye.

Current understanding of sensitivity and sensation experienced across the ocular surface remains limited. This project explored the regional variation of corneal sensitivity and transducer function, interaction of sensory and autonomic nerves in the lacrimal functional unit, and the ocular surface sensitivity in Dry Eye and with silicone hydrogel (SH) lens wear. Experiments were undertaken, using Belmonte esthesiometer to deliver pneumatic mechanical, chemical and thermal stimuli and Cochet-Bonnet esthesiometer for tactile stimuli, to the cornea and conjunctiva. Psychophysical methods were used to determine the thresholds of stimulus detection, and the magnitude of sensations to suprathreshold stimulation was estimated assuming Steven’s power law. Additionally, tear secretion in response to corneal sensory input was determined by tear meniscus height measured using Optical Coherence Tomography. Sensitivity to pneumatic cool and mechanical stimuli varied slightly across the cornea while chemical sensitivity was not different between regions. The transducer function was also similar between central and peripheral cornea but different between stimulus modalities. In comparison, the reflex tearing response to suprathreshold stimuli was greater with central corneal stimulation. Also, corneal and conjunctival hypersensitivity was found in the dry eye symptomatic group, and it appeared to be associated with symptom severity, tear film stability and corneal epitheliopathy. Refitting with SH lenses after an initial no-lens interval led to increased conjunctival pneumatic mechanical sensitivity, while corneal tactile sensitivity showed a decrease. In addition, corneal staining induced by certain lens-solution combination appeared to be accompanied by increased corneal and conjunctival sensitivity. In conclusion, the position-invariant corneal sensitivity to pneumatic mechanical, chemical and thermal stimuli suggests that the distribution of human corneal sensory fibres may be more homogeneous than previously hypothesised. The mechanisms mediating the sensory aspect of corneal nociception may be similar across the cornea, while, perhaps due to the importance of the visual axis, the tear reflex response to central and peripheral cornea seems to be driven by different neural circuitry, perhaps at the higher levels of the sensory processing pathway. It appears that alteration in sensory processing of the ocular surface occurs in Dry Eye and accompanies SH lens-solution-induced corneal staining. This altered sensitivity seems to be more prominent in the conjunctiva than in the cornea.

Purpose: An important challenge for eye care practitioners is meeting the needs of an ever-increasing elderly population. Standard vision tests are inadequate for determining performance in real life situations. One test that was developed to address this issue is the Attended Field of View (AFOV) test (Coeckelbergh et al, 2004). This test was designed to assess the functional field of view when people are allowed to make habitual head and eye movements. The original AFOV test is no longer available. This research seeks to develop a replacement AFOV test and to demonstrate its reliability as an assessment tool. Methods: Two groups of participants were recruited. The first group consisted of seven participants between the ages of 15-41 years. The second group consisted of seven participants between the ages of 59–79 years. All subjects had visual acuities equal or better than 20/25 and no history of visual field loss. A computer-generated display was observed from a 60cm distance. The display consisted of 24 white circles on a gray background and one open circle (target). The circles were organized with one circle in the centre and eight located radially at three eccentricities (4, 8, and 12 degrees). Participants were required to locate the target circle and identify the gap direction. A response was considered correct when both the location and gap direction were accurate. Using a weighted staircase method based on presentation time each location was evaluated independently. Viewing efficiency [log (1/threshold presentation time)] was obtained for each location. The data was analyzed using repeated measures ANOVA. Results: A comparison of viewing efficiency for the two age groups demonstrates that viewing efficiency is consistently lower for the older group at all three visits. The main effect of age was observed (F1,12=25.842;p=0.000). In the older group, a significant difference was found between the second and third visits. This difference was not found in the younger group. A main effect of eccentricity was found in both groups (F2,36=30.84;p<0.000), but no interaction was observed between eccentricity and group (F2,36=0.42;p=0.662). Viewing efficiency values in the older group were lower in all directions (main effect of age) (F1,96=150.36;p<0.000). Directional variations in viewing efficiency were observed showing higher values in the horizontal axes (directions Right and Left) than along the vertical axes (directions Up and Down) in both groups. A comparison of superior and inferior hemifield data shows consistent differences for both age groups. The superior hemifield (average of directions located superiorly to the horizontal axis) demonstrate higher viewing efficiency values (better performance) than the inferior hemifield. Conclusions: The use of the new AFOV test requires a practice time before its use in order to avoid the confound of a learning effect, but subsequent data is reliable in young people. The learning effect was more significant in older people and for this reason the use of the test should be preceded by a longer practice session in this population. When interpreting the results of this test one must account for eccentricity, direction, and age.

Accommodation and vergence are two interacting ocular motor systems that function to maintain clear and single vision across a wide range of distances. Sustained fixation results in the adaptation of these ocular motor systems and has been widely investigated in adults but not in children. Moreover, limited reports have measured adaptation to disparities induced by ophthalmic lenses. This thesis used near addition lenses as a means to investigate binocular adaptation in children. The specific aims of this thesis were three-fold. First, the thesis aimed to gain insight into the mechanism of changes to accommodation and vergence during binocular adaptation in children. The second objective was to determine the role of vergence-bias category (eso/exo/normals) on adaptation. Lastly, this thesis evaluated the influence of myopia on binocular adaptation. Thirty- eight myopic and 38 emmetropic children between 7-14 years of age were examined for the purpose of this thesis. A series of studies were performed to evaluate adaptation using varying demands for accommodation and vergence, stimulated by binocular fixation at near (33 cm), through the addition of +2D and -2D over corrective lenses (closed loop accommodation) and using 10 base-out prisms (open-loop accommodation at 4M). In each closed-loop condition, measures of binocular and monocular accommodation (PowerRefractor, Multichannel systems) and near phoria (modified Thorington technique) were recorded at frequent intervals when children binocularly fixated a high contrast near target (33 cm) for 20 min. For the open-loop condition (obtained using 0.5 mm pinhole pupils), binocular accommodation and tonic vergence (distance heterophoria through pinhole pupils) were determined at frequent intervals when binocular fixation was sustained at 4M for 20 min. For all conditions, tonic accommodation was measured before and after the near task to measure accommodative adaptation. The results of this thesis make three major contributions to the literature. First, it outlines that the addition of +2D and -2D lenses alters both accommodation and near phoria during sustained binocular fixation, which can be explained based on the models of accommodation and vergence. Second, it shows that the direction of phoria influences the pattern of binocular vs. monocular accommodation in closed-loop conditions and alters the degree of vergence adaptation in both closed and open-loop accommodation. These changes have been primarily attributed to the varying demands on fusional vergence. Lastly, this thesis demonstrates that myopic children show reduced vergence adaptation when fusional convergence was initiated through plus adds or base-out prisms but not when fusional divergence was initiated through minus addition lenses. Further, myopic children also showed variations in other ocular motor parameters such as higher accommodative lags, greater variability of accommodative response, larger accommodative after-effects, and higher AV/A ratios compared to emmetropes. Consistent with the models of accommodation and vergence, the thesis highlights that it is necessary to measure changes to both accommodation and vergence when evaluating the response of the ocular motor system. The direction of phoria and type of refractive error play a significant role in determining binocular adaptation in children. Future studies should differentiate these parameters when evaluating adaptation of the ocular motor system.

Purpose: This is a pilot study to investigate gaze strategies for coping with glare when performing a simple visual task under intense contra light viewing conditions. Method: Twenty-four normally sighted participants were recruited for this study. They consisted of a young subgroup (n=12), aged 21-29 (mean = 25.3 ± 2.5), and an older subgroup (n=12), aged 51-71 (mean = 57.3 ± 6.1). Visual acuity (VA) and Brightness Acuity testing (BAT) were used to assess central vision. Participants were required to locate and approach (from 15m) a small platform that was contra lit by a powerful light source. Upon arrival at the platform, participants were required to insert a small ball into a similarly sized receptacle. An ASL Mobile Eye (Bedford, MA) eye tracker was used to monitor gaze position throughout until the task was completed. Scene and pupil videos were recorded for each participant and analyzed frame by frame to locate the participant’s eye movements. Results: Two participants (one from each subgroup) adopted aversion gaze strategies wherein they avoided looking at the contra lit task for more than 50% of the task completion time. For the remainder of the experimental trial, these two participants were either looking toward the glare source or blinking. The other twenty-two participants opted to endure the contra light condition by gazing directly into the glare for the majority of the task completion time. An individual t-test between the younger iv subgroup’s BA scores vs. the older subgroup’s BA scores was statistically significant (p<0.05). Significantly poorer BAT scores were found in the older subgroup, however, individual participant’s BAT scores did not necessarily predict the ability to cope with a contra lit glare source. Although, statistically significant differences were not found between the two subgroups when examining their VA and length of time to complete the course, a trend was found, as the older subgroup consistently had poorer VA scores and took longer to complete the course. Further research must be completed with a larger sample size to fully understand the glare aversion strategies one must elicit when dealing with a contra lit glare source within the built environment, and to confirm the three glare strategies proposed by this pilot study.

Introduction Nearly all flat panel video display monitors have luminance and colour variations as the angle of view varies from the monitor’s perpendicular. The new MicrotileTM displays developed by Christie Digital are no exception to this general finding. A review of any book on colour science will show that there is substantial amount of literature on just noticeable colour differences within various colour spaces. Despite the wealth of data on the topic, there is no general consensus across different industries as to which colour space and colour difference equations are appropriate. Several factors like the background colour, object size, texture of the stimulus are different for different studies; these factors make it very difficult to determine precisely the effect of viewing angle on the perception of coloured images on the Microtiles display based on previous research. Hence, the objective of this thesis was to quantify the measured colour shifts of a Microtile display at different viewing angles, in steps of perceptible thresholds and to evaluate the acceptability of distortions at different viewing angles for complex scenes. Methods A preliminary experiment was setup to study the behaviour of Microtile display primaries as a function of viewing angle. The aim was to measure the shift in hue and luminance of the three primaries at different eccentricities (from 0o to 40o). The measured trend was used to simulate Microtile shifts on complex images for the rating task. In the first part of the perceptibility experiment, three reference colours were picked and 12 vectors heading towards the blue-yellow region of the L*a*b* colour space (pertaining to the colour shifts noticed with the Microtile displays). A uniform reference colour was presented in three of the four quadrants on the CRT monitor and one quadrant changed colour in the direction of the sampled vector. An adaptive, four alternate forced choice procedure was employed to determine thresholds for each of the 3 reference colours. The adaptive technique used was a ZEST paradigm. In the second part of the perceptibility experiment, eighteen directions were sampled around each reference colour. The rating task was based on simulating the measured attenuations of the Microtile primaries on complex scenes. Subjects rated the images both in terms of acceptability/unacceptability and as percentage image degradation. The simulation was presented on three static complex images, car, landscape and portrait. A total of 60 subjects participated in the study, 20 subjects for each experiment. All subjects were between the age group of 15 to 35 years of age and underwent battery of colour vision tests before being included in the study. All subjects included had average to superior colour discrimination as categorized using the FM-100 Hue discrimination test. Results Study1: The preliminary study on Microtile display characteristics as a function of viewing angle showed that all the three primaries decreased in luminance with change in viewing angle. The red primary decreased at a faster rate compared to the other two primaries. The trend presents as a decrease in luminance with the hue shifting towards the blue-green region of the CIE1974 L*a*b* space. Study 2: Results from both the first and second parts of the perceptibility experiment showed that the vectors sampled in different directions approximated to ellipsoids in the L*a*b* colour space. This finding was consistent with the colour discrimination literature. Vectors on the equi-luminance plane were significantly longer than the vectors on the non equi-Luminance plane. Results showed that the average perceptibility thresholds in the non equi-luminance direction were lower than 1∆ELab¬¬¬¬. Study 3: Results from the rating experiments showed that irrespective of the complexities in the images, distortions greater than five times thresholds were less than 50% acceptable and were rated to be at least 30% degraded. This corresponds to a viewing angle greater than 10o for a Microtile display. The relationship between the stimulus (ΔE) and subjective Image degradation judgements followed a linear relationship, with the portrait and landscape having similar functions, whereas the car was rated more degraded at lower ΔEs and less degraded at higher ΔEs compared with the other two scenes. Conclusion Perceptibility thresholds for different reference colours showed that the conventionally used calibration precision of 1 ΔELab is a lenient criterion. Perceptibility thresholds are at least 25% less for the Microtile display reference condition. From the results of the rating data a distortion greater than five times thresholds is less than 50% acceptable and appears to be at least 30% degraded for static complex images. However, the image quality judgments appear to be related to scene context, which requires further study.

Purpose: The prevalence of diabetes (DM) is increasing globally with type 2 diabetes (T2DM) being primarily responsible for this alarming trend. Age and DM have been associated with an increased prevalence of AR cataract in earlier studies but T2DM has not been considered separately from type 1 diabetes. Furthermore, study results have been inconsistent in terms of whether nuclear sclerosis (NS), cortical cataract (CC) or posterior subcapsular (PSC) are specifically associated with DM. The purpose of this thesis was to provide Canadian data on these issues while considering the limitations found in earlier studies in terms of variable age group selection and cataract definition. Logistic regression analysis was extended beyond risk analysis to model the prevalence of AR cataract across the human age range. Finally, as statins are commonly prescribed for patients with T2DM, the impact of using this pharmaceutical on AR cataract prevalence was investigated. Methods: A file review of over 6397 clinic files was performed to create the Waterloo Eye Study (WatES) database. Abstracted data included patient age and sex, the presence of early to late AR cataract (NS, CC, PSC or related lens extraction-LE), systemic health diagnoses including a diagnosis of T2DM or type 1 diabetes, and any medication used. Data quality was looked at through repeatability with double-entry of files and calculation of missing data rates. Comparisons were done between the study population demographics (age and sex) and those available on the general population and representative Canadian optometric patients. Prevalence of AR cataract was determined for the entire study group and for yearly age-groups. The probability of AR cataract generated from logistic regression analysis was used to model the prevalence of AR cataract over the entire age range of patients. Similar functions were determined for T2DM and non-diabetic (ND) subgroups and then again after further subdividing them into patients who did and did not use statins. The age of 50% prevalence of AR cataract were determined for each of these functions. Distribution rates of mixed and uniform cataract were calculated and compared for the T2DM and ND subgroups. Age of first lens extraction and differences in LE rates were also determined for these groups. Multivariable logistic regression analysis was done to determine odds ratios (OR) for associations between variables (patient age, being female, having a diagnosis of T2DM, smoking, systemic hypertension, and statin use) and the outcome of AR cataracts or its subtypes. Results: Data abstraction repeatability was found to be high and missing data rates were found to be low. While significant differences existed between the demographics of the general population and this clinic population, the sex and age distributions were comparable to optometric practices in Canada. The overall prevalence of AR cataract, NS, CC,and PSC in this population was 35.3%, 28.8%, 9.9%, and 3.6% respectively. The yearly prevalence of AR cataract in this population was found to increase in a sigmoid trend over the course of the human age span that began to rise after 38 years of age and approached 100% by 75 years of age. When modelled into a probability of cataract function, 50% prevalence of AR cataract occurred at 56.6 years of age. T2DM was reported in 452 WatES patients; 97% of whom were over 38 years of age. The probability of 50% AR cataract, NS, and CC prevalence occurred almost four years earlier in the T2DM subgroup compared to those without diabetes. PSC was much less prevalent and did not reach 50% levels, but the age of 10% prevalence was eight year earlier in the T2DM group compared to the ND group. Patients with T2DM had more mixed cataract, a higher rate of LE and an earlier age of first LE than non-diabetics. Statin use was reported in 761 patients; 96% who were over 38 years of age. Statin use was 3.5 times more common in patients with T2DM compared to non-diabetics. When the diabetic subgroups were further subdivided by those who do and do not use statins, the age of 50% probability of AR cataracts was now almost eight years earlier in the T2DM patients using statins compared to the ND patients who did not. The probability functions were similar between T2DM patients not using statins and ND patients who did report statin use. Having a diagnosis of T2DM was significantly associated with early to late NS and CC when controlling for statin use, whereas statin use was significantly associated with NS and PSC when controlling for a diagnosis of T2DM. Conclusions: AR cataract, T2DM and statin use were prevalent conditions in this clinic population, especially over 38 years of age. Modelling the prevalence of AR cataract over a broad age range could assist predicting cataract in Canadian optometric patients. A diagnosis of T2DM resulted in an earlier development of all three cataract subtypes, resulting in increased rates of LE and mixed cataract. However, the association was only significant for NS and CC when controlling for statin use. Given the frequent use of statins in patients with T2DM, the significant association found between statin use and increased risk of AR cataract warrants further study.