Purpose: To test the hypothesis that the fixational stability (FS) of the amblyopic eye (AME) in strabismics will improve when binocular integration is enhanced through ocular alignment and inter-ocular suppression is attenuated by reducing the contrast to the fellow eye (FFE). Methods: 7 strabismic amblyopes (age: 30.8±9.7 yrs) (5 esotropes and 2 exotrope) (VA: AME=0.50±0.30; FFE=-0.12±0.04) showing clinical characteristics of central suppression were recruited. Suppression was then attenuated by a balance point procedure where the contrast to the FFE was reduced in order to maximize binocular integration during a global motion task (GMT) (Baker, 2007). In one case the balance point could not be determined, and the participant was excluded. Ocular alignment was established with a haploscope. Participants dichoptically viewed similar targets [a cross (2.3°) surrounded by a square (11.3°) visual angle] set at 40cm. Target contrasts presented to each eye were either equal (EQ) or attenuated in the FFE (UNEQ) by an amount defined by the GMT. FS was measured over a 5 min period (Viewpoint® Eye Tracker, Arrington Research) and quantified using bivariate contour ellipse areas (BCEA) in four different binocular conditions; unaligned/EQ, unaligned/UNEQ, aligned/EQ and aligned/UNEQ. FS was also measured in 6 control subjects (Age: 25.3±4 yrs; VA: -0.1±0.08). Results: Alignment of the AME was transient and lasting between 30 to 80 seconds. Accordingly, FS was analyzed over the first 30 seconds using repeated measures ANOVA. Post hoc analysis revealed that for the amblyopic subjects, the FS of the AME was significantly improved in aligned/EQ (p=0.015) and aligned/UNEQ (p=0.001). FS of FFE was not different statistically across conditions. BCEA(FFE) & BCEA(AME) were then averaged for each amblyope in the 4 conditions and compared with normals. This averaged BCEA (reduced FS) was significantly greater (p=0.0205) in amblyopes compared to controls except in the case of alignment coupled with reduced suppression (aligned/UNEQ) (p=0.1232). Conclusion: Fixation stability in the amblyopic eye of strabismics appears to improve directly with the degree of binocular integration. The hypothesis is therefore retained.

Purpose To investigate the impact of cigarrete smoking in a group of otherwise healthy young individuals on: 1) Retinal blood flow using Doppler based SD-OCT, 2) Retinal vascular reactivity using a gas sequencer to provoke hypercapnia via constant changes in PETCO2 (end-tidal partial pressure of CO2) and in PETO2 (end-tidal partial pressure of O2). Methods An automated gas flow controller was used to achieve normoxic hypercapnia in ten non-smokers (mean age 28.9 yrs, SD 4.58) and nine smokers (mean age 27.55 yrs, SD 4.77). Retinal blood flow measurements were obtained using Doppler OCT and cannon laser blood flowmeter (CLBF) during baseline, normoxic hypercapnia (15% increase in PETCO2 relative to homeostatic baseline) and post-hypercapnia in both the groups. Exhaled carbon monoxide level was measured in all subjects. Results In non-smokers, retinal arteriolar diameter, blood velocity and flow increased by +4.1% (SD 2.8, p<0.0001), +16.7% (SD 14.6, p=0.0004) and +29.6% (SD 12.5, p<0.0001) respectively, during normoxic hypercapnia; Similarly, the venous area, venous velocity and total retinal blood flow increased by 7% (SD 8.6, p=0.0418), 18.1% (SD 20.8, p=0.0068) and 26% (SD 22.9, p<0.0001) respectively. In smokers, normoxic hypercapnia resulted in a significant increase in velocity by 12.0% (SD 6.2, p=0.0019) and flow by 14.6% (SD 9.5, p=0.0029); though arteriolar diameter increased by 1.7% (SD 1.7, p=0.2616), the result was not statistically significant. Total retinal blood flow increased significantly by 19.3% (SD 18.4, p=0.002) in response to normoxic hypercapnia. However, there was no significant difference in venous area (p=0.3322) and venous velocity measurements (p=0.1185) during hypercapnia compared to baseline and recovery. Comparing smokers and non-smokers, only the percentage change in arteriolar diameter (p=0.0379) and flow (p=0.0101) was significantly different among the groups. Group mean PETCO2 was increased by 15.9% in the non-smoking group and by 15.7% in the smoking group, with a concomitant increase in PETO2 by approximately 1.5 to 2% in both groups. There was no significant difference in baseline PETCO2 level between smokers and non-smokers. Conclusions Retinal vascular reactivity in response to normoxic hypercapnia is significantly reduced in young healthy individuals who smoke compared to non-smokers. Further studies are needed to elucidate the exact reason behind the impaired retinal autoregulation to provocative stimuli in smokers.

Ongoing efforts to quantify changes in quality of life attributable to low vision rehabilitation have focused on the utility of a single test instrument to measure this multidimensional concept. It is hypothesized that quality of life is best assessed using multiple instruments to capture some of its component facets, including functional status and psychosocial impact. Low vision devices have a predictably spontaneous impact on functional vision status, but associated psychosocial impact occurs with different magnitudes and over more protracted time intervals. The National Eye Institute Visual Function Questionnaire (NEI VFQ-25) measures the functional status of individuals in key vision areas that are associated with quality of life. The Psychosocial Impact of Assistive Devices Scale (PIADS) is an instrument that measures the psychosocial impact of assistive device intervention in three quality of life domains: competence, adaptability, and self-esteem. 68 participants were obtained from an ongoing parent study. These participants were recruited through the Low Vision Clinic at the University of Waterloo. They had a primary diagnosis of age-related macular degeneration (ARMD) and were obtaining a CCTV system for the first time. Assessments from the parent study used in this thesis included follow-up from 2 weeks, 1 month, 3 months, and 6 months post-adoption of the CCTV. The two tests administered were to measure functional vision status (NEI VFQ-25) and perceived psychosocial impact (PIADS), according the framework outlined by the Consortium for Assistive Technology Outcomes Research (CATOR). Multivariate repeated-measures ANVOA results confirmed that CCTV systems have an immediate and robust effect on the daily visual functioning of their users, and that this effect is stable over long periods of device use. The psychosocial impact of CCTV device use peaks in the shorter term and then seems to wane in the longer term for reasons that are not yet understood. The NEI VFQ-25 and the PIADS appear to have differential sensitivity to important influences on low vision rehabilitation outcomes. This project has demonstrated the value of longitudinal outcomes research in low vision rehabilitation. After obtaining a CCTV, visual function status remains static while psychosocial impact is dynamic during 6-months of follow-up.

Purpose: Previous studies have shown that some digital filters can enhance picture-image visibility for people with visual impairment. The ultimate purposes of this study are to determine the improvement of picture-image visibility for people with maculopathy using digital image enhancement, and to compare the enhancement effects of generic filters and custom-devised filters. The secondary interests are to investigate the effect of age and maculopathy on supra-threshold contrast matching and to investigate the spatial frequency characteristics of picture-images. Methods: In order to develop effective custom-devised filters, supra-threshold contrast matching and contrast thresholds for two age groups of subjects with normal vision (14 aged 20-50 years and 15 aged 51+ years) and three groups of people with maculopathy (13 with atrophic ARMD, 14 with exudative ARMD, and 8 with JMD) were measured. Amplitude spectrum at each spatial frequency and the slope of amplitude versus spatial frequency were measured to investigate the spatial frequency characteristics of single face and general scene images. To investigate the preference for filters, 7 generic filters and 4 custom-devised filters were applied to single faces and general scenes. The generic filters were high-pass/unsharp masking, contrast enhancement, Sobel edge enhancement, DoG convolution, DoG FFT, Peli’s adaptive enhancement, and a band-pass filter with equi-emphasis of spatial frequencies. The custom-devised filters were band-pass filters based on contrast sensitivity (CS) loss, contrast matching at 3.6% and 27.9%, and emphasis of the peak of the CS curve. Subjects with maculopathy were required to rate the visibility of each image with and without filtering. Nine subjects with maculopathy participated to assess the enhancement quantitatively during which the recognition of facial expression and details in general scenes was tested with and without filtering. Results: Contrast constancy was demonstrated in age-matched controls and people with maculopathy. Single faces were found to be of significantly lower average amplitude than the other groups of images. Eight filters were found to be effective in improving perceived visibility; contrast enhancement, Peli’s adaptive enhancement, DoG convolution, high-pass/unsharp masking, Sobel edge enhancement, band-pass based on 3.6% and 27.9% contrast matching and equi-emphasis band-pass filters. These filters specifically were found to be effective for one or more combinations of maculopathy type and image category. The most commonly preferred filters were the generic filters, contrast enhancement and Peli’s adaptive enhancement. The two highest rated filters for each subject significantly reduced the number of errors of facial expression and errors of recognition of detail within general scene images. Conclusions: The visual system adjusts to compensate for CS loss with aging and maculopathy. Single faces are unique in spatial frequency characteristics. Some generic and custom-devised filters are effective in enhancing image visibility. The custom-devised filters are not superior to the generic filters. Visibility enhancement can be assessed quantitatively.

Accommodation and vergence, the two important oculomotor systems, exhibit the property of adapation which maintains the response for comfortable prolonged viewing. Several mathematical models have been developed to describe the basic underlying mechanism of accommodation and vergence. Currently used models contradict with each other in the placement of critical elements in the model. This thesis addressed this controversy and empirically verified these models. The effect of vergence adaptation and its influence on certain critical oculomotor parameters have been evaluated in two studies. The specific aims, methods, results and conclusions of each chapter are as follows: Chapter 3 Aim To evaluate the effect of vergence adaptation on convergence accommodation (CA) response and the effect of CA stimulation on accommodative adaptation to determine the model that best fits human accommodation and vergence interaction. Methods This study investigated the effect of vergence adaptation on the convergence accommodation (CA) response as a function of vergence stimulus magnitude and duration in 10 emmetropes. Convergence was induced using no prism, 6, and 12 prism dioptres as stimuli at 0.4m, viewed for 5, 10 & 15 minutes of duration in randomized separate sessions. Phoria measures and CA responses were recorded at the baseline, immediately following prism insertion and following specific durations of viewing through the prism (post-task). Also the effect of CA cross-link on the tonic accommodation (TA) adaptation was investigated where TA response was measured before and after the convergence task. Results & conclusions Repeated measures of ANOVA showed no significant (p > 0.05) phoria adaptation or CA response change with no prism as the stimulus. For 6 and 12 prism dioptres, there were significant reductions (p< 0.01) in CA with phoria adaptation. No significant (p>0.05) phoria adaptation or reduction in the CA response between 5, 10 and 15 minutes of viewing showing no effect of duration. No significant difference (p = 0.85) between the pre and post task TA response while vergence was adapted. The results of the study show that vergence adaptation reduces CA response supporting models which predict the CA crosslink to reduce its output as tonic vergence adaptation progresses. However the convergence accommodation does not appear to lead to increased output of tonic accommodation. Chapter 4 Aim The purpose of this study was to evaluate certain critical parameters of vergence and accommodation under vergence adaptation (induced with a BO Δ), before and after positive fusional vergence training. Methods Eleven emmetropes with normal binocular vision participated in the study. Distance & near phoria, AC/A & CA/C ratios, & positive fusional amplitude at near were evaluated before and after two weeks of positive fusional vergence training. Phoria adaptation and CA responses were monitored every 3 minutes for 15 minutes while the subjects viewed through 12Δ BO under open-looped accommodation at 0.4m before and after training. On a separate vergence adaptation session (before training), phoria adaptation was induced under dual closed-loop condition using 12Δ BO at 0.4m. Cross-link ratios, BO fusional amplitude at 0.4m and near phoria were measured following 15 minutes of prism adaptation. Subjects underwent 2 weeks of positive fusional vergence training using variable tranaglyphs and aperture rule at 0.4m. Phoria adaptation and CA responses monitored over time were exponentially fit and were compared before and after training. AC/A & CA/ C ratios and BO to blur value at 0.4m taken before training, under the vergence adapted state and after training were analyzed using repeated measures ANOVA. Results & conclusions No significant difference (p > 0.05) in the cross-link ratios were found before and after training. However, there was a significant (p < 0.01) increase and decrease in the AC/A and CA/C ratios respectively under the vergence adapted state. BO to blur value at 0.4m was significantly increased (p < 0.01) from the pre training value under both vergence adapted condition and following training. Rate constants and magnitudes of phoria adaptation and CA response reduction were significantly (p < 0.01) different following training demonstrating robust and greater magnitude of vergence adaptation in the BO direction reducing the CA response faster. However, this improved vergence adaptability is not reflected in the static measures of AC/A and CA/C ratios. The increased BO to blur value following training is caused by the increased speed of prism adaptation reducing the CA response during BO fusional amplitude testing.

Purpose and hypothesis: The purpose of this study was to optimize and standardize the following parameters of sweep Visually Evoked Potential (sVEP) in adults: criteria for fitting the regression line to estimate threshold, luminance, electrode placement, temporal frequency, sweep direction, presence of fixation target and stimulus area. The hypothesis is that the parameters chosen will have an impact on the measured visual acuity, contrast threshold and on the number of viable sVEP plots. Methods: The Power Diva software, Version 1.9 was used for this study. Five gold cup active electrodes, one reference electrode and one ground electrode were used to measure the Electroencephalography (EEG) signals. Six adult participants (aged 17 to 35 years), with corrected to normal visual acuity and no history of ocular disease took part in each experiment, except for the repeatability experiment in which 3 subjects participated. Four criteria for regression line fitting were compared. Psychophysical thresholds were used to validate the sVEP measures for the different criterion and repeatability of sVEP was estimated for 10 sessions. The effect of luminance (25 cd/m2, 50 cd/m2, 100 cd/m2), electrode placement (Power Diva and ISCEV), temporal frequency (6 Hz, 7.5 Hz, 10 Hz), sweep direction, fixation target and stimulus area were investigated. A repeated measure ANOVA statistical method was used to analyze the average threshold and the number of viable plots out of five active channels for all subjects. Results: Criterion 2 and 3 gave better visual acuity, higher contrast sensitivity, better repeatability and gave results that were closer to the psychophysical threshold than criterion 0 and 1. Luminance of 25 cd/m2 gave significantly fewer viable readings than 50 and 100 cd/m2 while measuring visual acuity (F = 5.11, df = 2, p = 0.0295). Temporal frequency of 7.5 Hz gave significantly more viable readings than 6 and 10 Hz while measuring visual acuity (F = 50.53, df = 2, p < 0.0001) and contrast threshold (F = 9.87, df = 2,p = 0.0043). There was a highly significant interaction of criterion with temporal frequency (F = 1536.98, df = 6, p < 0.0001) while measuring contrast threshold. There was a significant interaction of criterion with sweep direction (F = 4.26, df = 3, p = 0.0231) and for the number of readings (F = 3.75, df = 3, p = 0.0343) while measuring visual acuity. There was an interaction of criterion with sweep direction (F = 4.97, df = 3, p = 0.0136) while measuring contrast threshold at a spatial frequency of 1 cpd. There was a significant effect of fixation target (F = 7.64, df = 1, p = 0.0396) while measuring visual acuity. There was a significant effect of stimulus area (F = 11.78, df = 4, p < 0.0001) on the number of readings while measuring contrast threshold. Conclusion: The sVEP parameters chosen do have a significant effect on visual acuity, contrast threshold and on the number of viable readings. The following parameters are recommended in adults on the basis of results; Criterion 2 or 3 for fitting regression line (C2 - regression line fitted from the signal peak amplitude to the last data point with a signal to noise ratio (SNR) >1; C3 – similar to criterion 2, but the threshold should be within sweep range used), luminance of 50 or 100 cd/m2 , either Power Diva (PD) or International Society for Clinical Electrophysiology of Vision (ISCEV) electrode placement, temporal frequency of 7.5 Hz, either sweep direction, measurement with the central fixation target, larger stimulus area.

Abstract Both in the closed and open eye state the superior limbus is covered by the upper lid. This region is of physiological interest and clinical importance because in chronic hypoxia, neovascularization of the cornea commonly occurs here. The limbal region in general is additionally of importance as the stem cells which are the source of the new corneal cells are located in the epithelium of the limbus and these are vital for normal functioning and are affected under certain adverse conditions. Purpose: In this experiment I examined corneal morphology in the limbal area and in particular under the upper lid in order to primarily examine the variation in the corneal limbal epithelial and total thickness as well as epithelial and endothelial cell density. Methods: I measured 30 eyes OD/OS (chosen randomly) of thirty healthy subjects aged from 18 to 55 years in the first study and twelve participants in the second study, with refractive error ≤ ±4 D and astigmatism ≤ 2 D. The thickness and cell density of five positions: superior, inferior, temporal, nasal limbal and central cornea was determined with optical coherence tomography (OCT) and confocal microscopy. At least three scans of each position were taken in both studies with OCT. At least 40 of 100 adjacent sagittal scans of each image were measured using OCT software program. In the confocal study, image J software was used to determine cell densities. Results: The epithelial and corneal limbal thickness were significantly thicker than the epithelial and central corneal thickness (p<0.05). The limbal, inferior cornea is thinner than the three other positions and the temporal region of the cornea is the thickest both in epithelial and total cornea. Epithelial cell density was significantly lower in the superior cornea than the four other positions. There was no significant difference in the endothelial cell density. Conclusions: Using OCT with high resolution and cross-sectional imaging capability and confocal microscope with high magnification, I found that the limbal cornea is significantly thicker than the central cornea both in total and in epithelial thickness. In the limbus, one might expect the superior cornea (under the lid) to be thickest (because of the expected hypoxia) whereas I found the temporal cornea was thickest. The epithelial cell density was lower in the superior cornea but there was no significant difference in cell densities in the endothelium. Further morphological investigation is of interest.

PURPOSE: Systemic hyperoxia has been induced using inspired gases in many studies to investigate vascular reactivity in the retinal vasculature. Technical limitations in the past resulted in inadequate control of systemic partial pressures of O2 and CO2, the latter of which tended to decrease secondary to induced hyperoxia. Recent development of a computerized gas delivery instrument has enabled the specific control of end-tidal CO2 (ETCO2) and fractional expired O2 (FeO2), independent of each other and of minute ventilation. The specific aims of each chapter are as follows: Chapter 3: To compare the magnitude and variability of the retinal vascular reactivity response to an isocapnic hyperoxic stimulus delivered using a manually-operated method to the newly developed computer-controlled gas sequencer. Chapter 4: To investigate the retinal hemodynamic response to incremental changes in hyperoxic stimuli during isocapnia. METHODS: Chapter 3: Ten young, healthy adults inhaled gases in a sequence of normoxic baseline, isocapnic hyperoxia, and normoxic recovery, using both gas delivery systems in random order. Chapter 4: Twelve healthy, young adults participated in a gas protocol consisting of 4 phases at varying fractional expired oxygen levels (FeO2): baseline (15%), hyperoxia I (40%), hyperoxia II (65%), and recovery (15%). End-tidal carbon dioxide (ETCO2) was maintained at an isocapnic level (~ 5%) throughout the experiment. In both Chapters 3 and 4, blood flow was derived from retinal arteriolar diameter and simultaneous blood velocity measurements of the superior temporal arteriole, acquired at 1-minute intervals during each of the phases of the gas protocol. RESULTS: Chapter 3: There was no interaction effect between the phases and gas delivery methods (p = 0.7718), but ETCO2 was significantly reduced during hyperoxia (p = 0.0002) for both methods. However, the magnitude of change in ETCO2 was physiologically insignificant i.e. <1%. The two systems differed in terms of FeO2 during hyperoxia, at a level of 85.27 ± 0.29% for the manual method, and 69.02 ± 2.84% for the computer method (p < 0.05). Despite this difference in oxygen concentrations, there was no difference in the vascular reactivity response for diameter (p = 0.7756), velocity (p = 0.1176), and flow (p = 0.1885) for equivalent gas phases between the two gas delivery systems. The inter-subject variability of retinal hemodynamic parameters was consistently lower using the computer-controlled gas sequencer. Chapter 4: Repeated measures ANOVA showed that there were significant influences of incremental changes in FeO2 on arteriolar diameter (p < 0.0001), blood velocity (p < 0.0001), and blood flow (p < 0.0001) in the retina. Paired t-tests of these retinal hemodynamic parameters during each phase in the gas sequence showed they were significantly different (p < 0.05) from each other, with the exception of baseline and recovery values. Incremental increases in FeO2 caused a linear decrease in group mean arteriolar diameter (R2 = 1, p = 0.002), group mean blood velocity (R2 = 0.9968, p = 0.04), and group mean blood flow (R2 = 0.9982, p= 0.03). CONCLUSIONS: Chapter 3: Inter-subject variability for virtually all retinal hemodynamic parameters was reduced using the computer-controlled method, presumably due to a higher degree of gas control. However, care needs to be exercised in the interprtetation of these results due to the relatively small sample size. A similar retinal hemodynamic response to isocapnic hyperoxia was induced using the two gas delivery systems, despite different levels of maximal FeO2. Chapter 4: Isocapnic hyperoxia elicits vasoconstriction and the reduction of retinal arteriolar blood flow in a dose-dependent manner over the range of FeO2 explored in this study.

Myopia is a common ocular condition worldwide and the mechanism of myopia is still not clear. A number of animal models of myopia and refractive error development have been proposed. The fact that form deprivation myopia could be induced in tilapia fish, as shown previously in my research, suggests the possibility that tilapia could be a new animal model for myopia research. In the first part of this thesis the tilapia model was perfected and then, based on this model, the effect of systemic hormones (thyroid hormones) associated with eye and body development was investigated during refractive error development. Lastly, the physiological and morphological changes on the retina were further studied with optical coherence tomography (OCT). In these experiments, significant amounts of myopia, and hyperopia were induced within two weeks using goggles with lens inserts as in other higher vertebrate animal models, e.g. chicks. The results from form deprivation treatment also show that the sensitivity of tilapia eyes may be an age related effect during the emmetropization process. The larger the fish, the less hyperopic the fish eye, though the small eye artefact may be a factor. The susceptibility of the refractive development of the eye to the visual environment may be also linked to plasma hormone levels. It was found that induced refractive errors could be shifted in the hyperopic direction with high levels of thyroid hormones. Also, after 2 weeks of treatment with negative or positive lens/goggles, the tilapia retina becomes thinner or thicker, respectively. When the goggles are removed, the thickness of the retina changes within hours and gradually returns to normal. However, the circadian retinomotor movement is a complicating factor since it affects the retinal thickness measurement with OCT at some time points. In conclusion, tilapia represent a good lower vertebrate model for myopia research, suggesting a universal mechanism of myopia development, which may involve systemic hormones and immediate, short term retinal responses.

Introduction Contact lenses suffer from the same problems of deposition that other biomaterials exhibit, being rapidly coated with a variety of proteins, lipids and mucins. The first event observed at the interface between a contact lens and tear fluid is protein adsorption. Protein deposits on contact lenses are associated with diminished visual acuity, dryness and discomfort and lid-related inflammatory changes. The aim of this thesis was to determine the quantity and the conformational state of lysozyme deposited on contact lens materials over various time periods and also to determine the clinical relevance of protein deposits on contact lenses. The specific aims of each chapter of this thesis were as follows: • Chapter 4: To determine the total lysozyme deposition on conventional and silicone hydrogel contact lens materials as a function of time by artificially doping lenses with 125I-labeled lysozyme. • Chapter 5: To determine the conformational state of lysozyme deposited on conventional and silicone hydrogel contact lens materials as a function of time using an in vitro model. • Chapter 6: To quantify the total protein, total lysozyme and the conformational state of lysozyme deposited on a novel, lathe-cut silicone hydrogel contact lens material after three-months of wear. • Chapter 7: To determine the relationship between protein deposition and clinical signs & symptoms after one-day wear of etafilcon lenses in a group of symptomatic and asymptomatic lens wearers. • Chapter 8: To determine the influence of individual tear proteins (lysozyme, lactoferrin and albumin) on the adhesion of Gram positive and Gram negative bacteria to conventional and silicone hydrogel contact lens materials. Methods • Chapter 4: Conventional hydrogel FDA group I (polymacon), group II (alphafilcon A and omafilcon A), group IV (etafilcon A and vifilcon A), polymethyl methacrylate and silicone hydrogel lens materials (lotrafilcon A, lotrafilcon B, balafilcon A, galyfilcon A and senofilcon A) were incubated in a lysozyme solution containing 125I-labeled lysozyme for time periods ranging from 1 hour to 28 days. After each time period, lysozyme deposited on contact lens materials was determined using a Gamma Counter. • Chapter 5: Conventional hydrogel FDA groups I, II, IV and silicone hydrogel lens materials were incubated in lysozyme solution for time periods ranging from 1 hour to 28 days. After each time period, the lysozyme deposited on the lenses was extracted and the sample extracts were assessed for lysozyme activity and total lysozyme. • Chapter 6: 24 subjects completed a prospective, bilateral, daily-wear, nine month clinical evaluation in which the subjects were fitted with a novel, custom-made, lathe-cut silicone hydrogel lens material (sifilcon A). After 3 months of wear, the lenses were collected and total protein, total lysozyme and active lysozyme deposition were assessed. • Chapter 7: 30 adapted soft contact lens wearers (16 symptomatic and 14 asymptomatic) were fitted with etafilcon lenses. Objective measures and subjective symptoms were assessed at baseline and after hours 2, 4, 6 and 8. After 2, 4, 6 and 8 hour time points, lenses were collected and total protein, total lysozyme and active lysozyme deposition were assessed. • Chapter 8: Three silicone hydrogel (balafilcon A, lotrafilcon B & senofilcon A) and one conventional hydrogel (etafilcon A) lens materials were coated with lysozyme, lactoferrin and albumin. Uncoated and protein-coated contact lens samples were incubated in a bacterial suspension of Staphylococcus aureus 31 and two strains of Pseudomonas aeruginosa (6294 & 6206). The total counts and the viable counts of the adhered bacteria were assayed. Results • Chapter 4: Lysozyme accumulated rapidly on conventional hydrogel FDA group IV lenses, reached a maximum on day 7 and then plateaued with no further increase. PMMA showed a deposition pattern similar to that seen on lotrafilcon A and lotrafilcon B silicone hydrogel lenses. After 28 days, conventional hydrogel FDA group IV lenses deposited the most lysozyme. • Chapter 5: After 28 days, lysozyme deposited on group IV lenses exhibited the greatest activity. Lysozyme deposited on polymacon, lotrafilcon A and lotrafilcon B exhibited the lowest activity. Lysozyme deposited on omafilcon, galyfilcon, senofilcon, and balafilcon exhibited intermediate activity. • Chapter 6: The total protein recovered from the custom-made lenses was 5.3±2.3 µg/lens and the total lysozyme was 2.4±1.2 µg/lens. The denatured lysozyme found on the lenses was 1.9±1.0 µg/lens and the percentage of lysozyme denatured was 80±10%. • Chapter 7: Correlations between subjective symptoms and protein deposition showed poor correlations for total protein/ lysozyme and any subjective factor, and only weak correlations between dryness and active lysozyme. However, stronger correlations were found between active lysozyme and subjective comfort. • Chapter 8: Different tear proteins had varying effects on the adhesion of bacteria to contact lens materials. Lysozyme deposits on contact lenses increased the adhesion of Gram positive Staphyloccocus aureus 31 strain, while albumin deposits increased the adhesion of both the Gram positive Staphyloccocus aureus and Gram negative Pseudomonas aeruginosa 6206 & 6294 strains. Lactoferrin deposits increased the total counts of both the Gram positive and Gram negative strains, while they reduce the viable counts of the Gram negative strains. Conclusions • Chapter 4: Lysozyme deposition is driven by both the bulk chemistry and also the surface properties of conventional and silicone hydrogel contact lens materials. The surface modification processes or surface-active monomers on silicone hydrogel lens materials also play a significant role in lysozyme deposition. • Chapter 5: The reduction in the activity of lysozyme deposited on contact lens materials is time dependent and the rate of reduction varies between lens materials. This variation in activity recovered from lenses could be due to the differences in surface/ bulk material properties or the location of lysozyme on these lenses. • Chapter 6: Even after three-months of wear, the quantity of protein and the conformational state of lysozyme deposited on these novel lens materials was very similar to that found on similar surface-coated silicone hydrogel lenses after two to four weeks of wear. These results indicate that extended use of the sifilcon A material is not deleterious in terms of the quantity and quality of protein deposited on the lens. • Chapter 7: In addition to investigating the total protein deposited on contact lenses, it is of significant clinical relevance to determine the conformational state of the deposited protein. • Chapter 8: Uncoated silicone hydrogel lens materials bind more Gram positive and Gram negative bacteria than uncoated conventional hydrogel lens materials. Lysozyme deposited on contact lens materials does not possess antibacterial activity against all bacterial strains tested, while lactoferrin possess an antibacterial effect against certain Gram negative strains tested in this study. This thesis has provided hitherto unavailable information on contact lens deposition and its influence on subjective symptoms and bacterial binding. These results suggest that protein deposition has a significant potential to cause problems. Therefore, it is important that practitioners advise their patients regarding the importance of lens disinfection and cleaning and appropriate lens replacement schedules. These results will also be useful for the contact lens industry and the general field of biomaterials research.