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Thesis (M.A.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The overall goal of this research is to alleviate suffering and improve visual outcomes for burn patients during recovery, using amniotic membrane as a stabilized 'patch' for the corneal surface. Second and third degree facial burns result in scarring, which can lead to contraction of tissues around the eyelids, a condition called ectropion. This renders the burn patient unable to close their eyes or blink, which can be followed by loss of moisture, breakdown of defense mechanisms, permanent scarring and opacification of the cornea. Instead of continuously applying artificial tears to these victims' eyes, which would actually slow rate of recovery, the use of amniotic membrane would help seal in moisture as well as increase the rate of recovery, while not compromising corneal clarity. However, due to enzymes in the tears of inflamed eyes, the amniotic membrane is degraded fairly rapidly. It is the goal of this team's research efforts to determine an efficient way to stabilize the amniotic membrane by cross-linking its constitutive proteins, so that the rate of amnion degradation by enzymes is decreased but the levels of various beneficial pro-healing factors are preserved. While work is being done to assess the effects of cross-linking on the rate of amnion degradation, this study focused on the effects of protein crosslinking on the levels of transforming growth factor-beta (TGF-ß 1 ), one of the most abundant growth factors in human amniotic membrane. A specific protocol utilizing liquid nitrogen for the homogenization of de-epithelialized and cryopreserved human amniotic membrane (HAM) was created. TGF-ß 1 content in untreated, carbodiimide cross-linked, and photochemical tissue bonding (PTB) cross-linked HAM samples was measured using enzyme-linked immunoasorbent assay (ELISA). It was shown that while the stability of the membrane due to cross-linking of the collagen in the treated samples was increased, the protein content was severely affected; TGF-~1 levels in highly crosslinked HAM samples were extremely lower than that of the untreated. It was also demonstrated via ELISA that decreasing the extent of protein crosslinking by varying the treatment time with carbodiimide or decreasing the fluence of the light used in PTB resulted in equally stabilized amniotic membrane, but higher TGF-ß 1 content than in previously treated samples. This signifies that both chemical and photochemical protocols can result in beneficial collagen cross-linking, and potentially preserve the helpful growth factors already inherent in HAM for use in ophthalmology. / 2999-01-01

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.