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Purpose: This investigation compared 2 commonly used care systems, Boston Advance(R) care system and Boston Simplus (Bausch & Lomb, Rochester, New York) multipurpose solution, and the effects of these solutions on unaided daytime vision, care, and handling and comfort with Paragon corneal refractive therapy (CRT)(R) (Paragon Vision Sciences, Mesa, Arizona) lenses., Methods: Eighteen subjects wearing CRT lenses were recruited. Three evaluations were conducted over 2 months. Subjects were randomly assigned a solution and returned for a follow-up visit after 1 month. At the conclusion of the 1-month visit, each patient was reassigned the other solution for the second month. The final visit included an additional questionnaire regarding which solution was deemed the best and worst for unaided daytime vision, comfort, care, and handling., Results: From the responses of the 18 patients, a trend is evident that patients favor Boston Simplus over Boston Advance for comfort, unaided daytime vision, and care and handling. However, the sample size is small in this study; therefore, most of the differences are not significant at the 0.05 level except the preference for care and handling (P = 0.03)., Conclusions: Patients preferred Boston Simplus to Boston Advance with corneal reshaping lens wear when evaluated for comfort, unaided daytime vision, and care and handling. The preference of Boston Simplus to Boston Advance for care and handling is very strong and statistically significant, whereas other such advantages of Boston Simplus were not found to be statistically significant in this study. Further confirmation of these results as well as a better understanding of other visual and ocular interactions of Boston Simplus versus conventional solutions, will require using a larger sample in further studies.

Background: The Illinois College of Optometry's (ICO) Pediatric Outreach Program (POP) provides comprehensive vision care for high-risk children from birth to approximately 5 years of age in partnership with early intervention programs throughout the city of Chicago. Grant funds assisted in the ability to deliver vision services and spectacles to uninsured children. This report describes the structure and organization of the POP and presents the visual data., Methods: Comprehensive eye examinations were performed on 4,298 children ages birth to approximately 5 years at 76 early intervention program sites. All of the children evaluated were enrolled from early intervention/Head Start programs. Visual acuity determination (by Lea method), assessment of binocular status, stereopsis evaluation, cycloplegic retinoscopy, and ocular health evaluations were performed. As necessary, eyeglasses were prescribed. Amblyogenic risk factors, strabismus, and ocular pathology were identified., Results: Of the 4,298 children examined, 49% were boys and 51% were girls. Two percent were younger than 12 months old, 6% were 1.1 to 2 years old, 12% were 2.1 to 3 years, 30% were 3.1 to 4 years, 35% were 4.1 to 5 years, 14% were 5.1 to 6 years, and 1% were older than 6 years. Hyperopia and emmetropia were the most common refractive classifications among the children examined. Approximately 6.5% had risk factors for isometropic amblyopia, and 2.3% had risk factors for anisometropic amblyopia. Approximately 1% of the children had strabismus. Less than 1% of the children examined were identified with ocular pathology. Spectacles were dispensed to 16.6% of the children examined., Conclusions: The Pediatric Outreach Program provides early identification and treatment of abnormal visual conditions, ensuring that children have maximal visual acuity and visual function. The educational aspects of the program have also contributed to its successes. Education for parents and early intervention agency staff promote the importance of comprehensive vision examinations for children 5 years of age and younger.

Background: Assessment of ocular responses associated with lens and contact lens solution combinations was undertaken to address recent reports of toxicity caused by lens solutions resulting in high levels of corneal staining., Methods: Double-masked, randomized, crossover, clinical studies were conducted at one research site. Before wear, new lenses were soaked at least 12 hours in marketed lens care solutions. Unisol 4 Preservative Free Saline (Alcon Labs, Fort Worth, Texas) was also assessed and served as a control. Corneal staining [severity (0-4) and area (0-100%)] and comfort were evaluated., Results: The majority of observed staining was micropunctate. PureVision lenses in combination with the biguanide-preserved solutions resulted in excessive staining area at 2 hours (ReNu MultiPlus, 73%; Complete MoisturePlus, 48%; AQuify, 21%). Staining tended to decrease throughout the wearing day, but several biguanide solution/lens combinations continued to exhibit excessive staining at 4 hours. Similar to saline, Opti-Free Express and RepleniSH as well as Clear Care exhibited minimal staining area, averaging 7% or less at 2 hours across all lens brands. Subjective comfort tended to decrease with higher levels of corneal staining area., Conclusion: Some solution/lens combinations may cause excessive corneal staining 2 to 4 hours after lens insertion. Patients with high levels of corneal staining may experience decreased comfort.

Background: The purpose of this study was to quantify the outcome from a humanitarian eye care clinic providing refractive correction., Methods: Entering versus exiting binocular visual acuities at distance and near were measured to evaluate the overall change in the prevalence of visual impairment (20/70 to 20/180) and blindness (20/200 or worse) in 882 patients ages 8 to 89 (mean age 49) in San Blas, Mexico., Results: A total of 413 distance spectacle corrections and 670 near corrections were dispensed within the study sample of 813 subjects. Those entering the clinic with distance visual acuity of 20/200 or worse caused by refractive error and/or ocular disease totaled 78 (9.6%), whereas those exiting with this level of acuity totaled 32 (3.9%). Those who entered with distance acuity constituting visual impairment totaled 105 (12.9%), whereas those exiting with distance visual impairment totaled 31 (3.8%). Those entering with near visual acuity of 20/70 or worse totaled 403 (49.6%), whereas only 27 (3.3%) exited the clinic with visual impairment at near. Of 86 patients with cataracts, 74 showed improved visual acuity with refractive correction., Conclusion: Spectacle correction, especially for near, significantly reduced the burden of visual impairment in this patient sample, even in the presence of ocular disease.

Background: ANSI Z80.1 (American National Standards Institute) is a voluntary standard that provides tolerance guidelines for ophthalmic lens parameters. The recently approved ANSI Z80.1-2005 changes tolerances for cylinder axis for all ophthalmic lenses and for distance power for progressive addition lenses (PALs)., Methods: The ANSI Z80.1 committee analyzed the amount of unwanted residual cylinder created by rotating a cylinder axis away from its desired orientation for a range of cylinder powers. The limits of axis orientation error that keep the residual unwanted cylinder error within the tolerances for cylinder power were determined. For PALs, a tolerance for distance power error was sought that considers the currently followed standards for front surface power error and the tooling steps used for the rear surface., Results: Tolerances for cylinder axis error were changed to +/-14 degrees for 0.25 diopter (D) cylinders and to +/-7 degrees for 0.50 D cylinders. Tolerance for error in back vertex power of PALs was changed to +/-0.16 D for both sphere and cylinder., Conclusion: Tolerances for cylinder axis for low cylinders have been made in ANSI Z80.1-2005 to be consistent with tolerances in cylinder power. Changes in tolerance for power errors in PALs have been made to recognize fabrication challenges.

Background: This study is a followup to a previous study in which the optics of several progressive addition lens (PALs) designs were measured and analyzed. The objective was to provide information about various PAL designs to enable eye care practitioners to select designs based on the particular viewing requirements of the patient., Methods: The optical properties of 12 lenses of the same power for each of 23 different PAL designs were measured with a Rotlex Class Plus lens analyzer. Lenses were ordered through optical laboratories and specified to be plano with a +2.00 diopters add. Measurements were normalized to plano at the manufacturer-assigned location for the distance power to eliminate laboratory tolerance errors. The magnitude of unwanted astigmatism and the widths and areas of the distance, intermediate, and near viewing zones were calculated from the measured data according to the same criteria used in a previous study., Results: The optical characteristics of the different PAL designs were significantly different from one another. The differences were significant in terms of the sizes and widths of the viewing zones, the amount of unwanted astigmatism, and the minimum fitting height. Ratings of the distance, intermediate, and near viewing areas were calculated for each PAL design based on the widths and sizes of those zones. Ratings for unwanted astigmatism and recommended minimum fitting heights were also determined. Ratings based on combinations of viewing zone ratings are also reported., Conclusions: The ratings are intended to be used to select a PAL design that matches the particular visual needs of the patient and to evaluate the success and performance of currently worn PALs. Reasoning and task analyses suggest that these differences can be used to select a PAL design to meet the individual visual needs of the patient; clinical trials studies are required to test this hypothesis.

Background: The objective of this research was to investigate the possibility of predicting the retention or discontinuation of contact lenses on the basis of their effect on the quality of life of the wearer. While most studies of discontinuation of assistive technology devices have focused on other than psychosocial causes of discontinuation, there is reason to believe that a major cause is the psychosocial effect of the device on the user., Methods: Participants were 418 adult volunteers who had been fitted with contact lenses. One hundred eighty of the participants had discontinued wearing their lenses, while 238 were still wearing their lenses. The participants were asked to complete a recently developed questionnaire, the Psychosocial Impact of Assistive Devices Scales (PIADS), which measures the psychosocial impact of assistive devices, and is used also to predict retention and discontinuation of other assistive devices., Results: Overall correct prediction of the 418 respondents was 68.9%. The PIADS was better at predicting discontinuation than retention among males, while the reverse was true for females., Conclusions: The PIADS was shown to be a valid instrument to predict retention and discontinuation of contact lenses.

Background: Despite the fact that more than 50% of multifocal lenses dispensed in the United States are progressive addition lenses, adequate methods for clinical verification of these lenses have been lacking. Using automated lens meter techniques, the author describes a simplified method for verification of these complex lenses., Methods: Thirty pairs of progressive lenses were measured in a modified method using a Humphrey 330 Lens Analyzer. Fifteen pairs were "premium-quality" progressive lenses: fifteen pairs were "non-premium-quality" progressives. Five criteria were assessed on each lens: Distance Zone Width (DZW). Intermediate Zone Width (IZW), Near Zone Width (NZW), Drop Distance (DD), and Maximum Astigmatic Distortion (MAD)., Results: "Premium-quality" progressive lenses failed to demonstrate clear-cut superiority over "non-premium-quality" progressive lenses in the five specified criteria. Individual measurements indicate considerable product inconsistency affected every brand tested., Conclusions: Premium- and non-premium-quality progressive lenses demonstrated similar performance characteristics in this study. Zone size variation in these lenses was found to be considerable, a characteristic that seemed to cut across brand lines. The AO Compact lens seemed to demonstrate a shorter drop distance than other lenses, which does enhance its suitability for use with small frames. A comparison of the Essilor Natural PAL to the Younger Image lens showed little difference in the categories measured, although peripheral distortions seemed closer to the reading zone in the image. A comparison of the MAD of lenses in this study to lenses tested in 1986 indicates a considerable improvement has been made in that important characteristic.

Background: The pediatric clinic of the State College of Optometry/University Optometric Center develops a yearly quality management plan to monitor patient care. One of the areas retrospectively reviewed for all outcomes is refractive amblyopia., Methods: A retrospective review of records was performed on patients diagnosed with refractive amblyopia. With the use of a prescribed protocol, each patient's progress was tracked for a period of 6 months. Major emphasis was placed on outcome as related to treatment modality. Treatment alternatives were optical correction alone, optical correction in conjunction with patching, and optical correction and patching with vision therapy., Results: Improvement criteria included a 2-line increase in visual acuity on the Snellen chart and an increase of 20 seconds of arc of stereopsis, as measured by the Wirt circles. The groups that patched with correction and those that received vision therapy had similar visual acuity improvement's; however, the latter group had a significantly greater improvement in stereopsis. Both groups performed significantly better in both categories when compared to the group receiving optical correction alone., Conclusions: Though patching alone may be sufficient for improvement of visual acuity, binocular performance is significantly better when vision therapy is included in the treatment regimen.

Background: Contact lenses may be a useful, even essential, treatment modality for children with a variety of optometric needs. Many clinicians who are experienced and capable contact lens practitioners but do not specialize in the care of children may refrain from considering contact lenses as a treatment option because of a host of perceived problems. Most of these concerns can be readily overcome with patience, planning, and education., Case Reports: Five cases are presented to illustrate specific clinical problems and the clinical application of contact lenses in the pediatric population., Conclusion: The case reports illustrate the clinical application of contact lens fitting in children with a variety of clinical needs. The use of contact lenses in children is an ongoing process, requiring great flexibility and creativity on the part of the optometrist. Educating the child and the family is an integral part of the treatment. The use of contact lenses in children is both an opportunity and a challenge that may result in great satisfaction for the child, the family, and the optometrist.

Background: Marfan syndrome, a genetic connective tissue disorder, manifests many problems: high myopia, astigmatism, crystalline lens subluxation, and cataracts. No published studies have described the contact lens corrections that can be used with Marfan syndrome patients. This report describes the variety of contact lens modalities used for a subpopulation of patients with Marfan syndrome., Methods: The clinical records of eight patients with Marfan syndrome (16 eyes) from two hospital-based contact lens practices were retrospectively reviewed. Seven different contact lens modalities were used for this subpopulation., Results: Mean unaided visual acuities were 20/296, while mean best-corrected optimal spectacle refraction visual acuities were 20/33. Contact lenses improved the mean visual acuity to 20/27. Patients wore the contact lenses for an average of 12 hours per day. Complications of contact lens wear occurred in approximately 70% of eyes and included neovascularization, giant papillary conjunctivitis, 3 and 9 o'clock staining, and central superficial punctate staining. Additionally, ocular non-contact lens-related complications occurred in 50% of patients., Conclusions: A variety of contact lens designs may be used during the care of patients with Marfan syndrome. However, patients may experience an increased rate of complications associated with contact lens wear or unrelated to lens wear, and thus they deserve more intensive follow-up care than non-Marfan syndrome patients.

Background: Corneal distortion in contact lens wear can be produced by epithelial wrinkles, compression rings, and anterior corneal surface mosaic. True corneal wrinkling can also occur but is an extremely rare phenomenon. These conditions can be manifested as alterations in keratometry and corneal topography., Methods: A case report is presented of a 17-year-old patient with Marfan syndrome. Central corneal wrinkling developed in his right eye while he was wearing low-water-content hydrogel contact lenses. No visual discomfort or distortions were noted., Results: The patient was refitted with a non-HEMA hydrogel polymer contact lens, with no further episodes of corneal wrinkling observed during subsequent care of the patient., Conclusions: This case represents an example of corneal wrinkling in a patient wearing hydrogel contact lenses. It is unlikely this finding is related to Marfan syndrome.

Background: The superposition of thin sphero-cylindrical lenses with arbitrary angles between cylindrical axes is sometimes required in a clinical setting. For example, it may be useful in some instances to perform an overrefraction which, added to the spectacle or toric contact lens in place on the eye, yields a final correcting lens., Methods: Computer calculations have been used to create contour graphs allowing a graphical solution to the problem of combining sphero-cylindrical lenses. Although conceptually strightforward, the method has not been presented before., Results: The use of contour graphs to superpose sphero-cylindrical lenses is shown by examples to be accurate and much simpler than calculational methods., Conclusions: Lacking a pre-programmed computer, the method of contour graphs offers a practical method of combining sphero-cylindrical lenses.

Background: Due to the renewed attention given to reduction of myopia, interest in orthokeratology has dramatically increased. This study was performed to determine whether or not a predictor for orthokeratologic changes can be identified., Methods: Fifteen subjects enrolled in the study. For each subject, corneal eccentricity (e) was measured, subjective refraction and autorefraction were performed, and intraocular pressures were taken. Each subject was then fitted with a rigid contact lens for orthokeratology and followed for a minimum of 16 weeks. Eleven subjects completed the study., Results: No correlation between corneal eccentricity and improvement in visual acuity was found. Correlations were found between e and changes in subjective refraction, and between e and changes in autorefraction. There was also correlation between lower intraocular pressure and changes in subjective refraction, and between lower intraocular pressure and changes in autorefraction., Conclusions: These findings suggest that corneal eccentricity and lower intraocular pressures may be predictors of orthokeratologic changes. A longitudinal study with a larger subject size will be needed to conclusively determine if these two measurements are predictors of orthokeratologic changes.

Background: Optometric services in many parts of the world are unavailable with a resultant lack of information on the epidemiology of visual problems in those countries as well., Methods: A retrospective analysis was conducted on the records of 3,281 patients seen on a VOSH mission to Nicaragua., Results: The mean spherical correction for each eye was a low hyperopic correction. For eyes having an astigmatism the mean cylinder correction was -1.00 and was usually oriented against the rule., Conclusion: There was a lower incidence of myopia in this population than for many others that have been studied. There was also a need for a presbyopic correction at an earlier age than for Mid-European populations. A very large number of spectacles must be donated in order to get a sufficient supply for a successful VOSH mission.

To determine the differences between prescribing a trial fitted vs. nomogram (System 10) selected rigid gas permeable contact lens, 42 subjects were fit with one lens design on one eye and the other lens design on the opposite eye. Subjective responses for comfort and vision, objective signs of central corneal clouding, conjunctival injection, post keratometry readings, 3-9 staining, over-refraction, post refraction and lens position were ranked and assigned to success levels for each eye. Subjects were evaluated at 1 week, 1 month, and 3 months. The first fit success rates were 92 percent for the trial fit and 86 percent for the nomogram fit. The trial fit lens attained significantly better outcomes in individual categories of comfort and over-refraction. It was noted that the lens diameters differed significantly and a large percentage of both types of lenses benefited from a slight blend and edge modification. Although trial fitting remains the method of highest success, nomogram fitting (using System 10) appears consistent enough to consider it an option for certain practice situations.

Multiple pinhole discs are being promoted as part of systems claimed capable of correcting refractive error. Attempts to mitigate refractive error utilize training attributable to the systems of Bates, Peppard, and Huxley. The pinhole discs provide an array of 0.9mm apertures separated by 3mm horizontally and vertically. Because of the small aperture size, some of the optical advantages of the pinhole are offset by diffraction effects. The discs can produce multiple images and the visual experience of individuals will be a function of the user's pupil size and refractive error. These are discussed both theoretically and based on the author's observations wearing the spectacles.

Throughout the first quarter of 1989, 14 professionals field-tested Varilux Infinity prior to its launching. The study was conducted to determine the following factors: the level of ability to adapt, length of the adaptation process, ratings of distortion and head movements, and level of satisfaction. Varilux Infinity was systematically offered to each potential user whatever the prescription requirement. Among the 720 persons who were fitted in the course of the experiment, only 8 (1.1 percent) could not adapt. After a 6-week trial period, 168 answered a survey as to their level of satisfaction with the new progressive lenses. The results show that the parameters of the prescription (ametropia, cylinder, axis, addition) are not related to either the length of the adaptation process or the other ratings of the Multi-Design progressive lens. Experienced wearers of progressive lenses adapt more quickly and are the most favorable in their evaluation of the new lens. On the other hand, first-time users of progressive lenses offer the same response as did new wearers of Varilux 2. However, wearers of Varilux Infinity do not notice as much the need for head movements. This improvement can be considered as a point in favor of the wider visual field provided by Varilux Infinity. On the whole, the most active and the least active patients respond similarly in their evaluation of the new lens. The ametropia, add power, or level of activity cannot be held as risk factors in the adaptation to Varilux Infinity.

Using the commercially available shell programs NeuroShell and EXSYS, example-based and rule-based expert computer systems were developed to explore how such systems could be applied in an optometric environment. To demonstrate such an application, the example-based NeuroShell system was taught to prescribe sphere and cylinder powers for low refractive error myopes. When the system learned with only the chief complaint, habitual prescription and acuity through the habitual, and best refraction with resulting acuity, it predicted the sphere and cylinder powers prescribed by human optometrists within 0.25 diopter 97 and 98 percent of the time, respectively, for 60 test eyes. With a set of only three rules, the rule-based EXSYS system predicted sphere powers within 0.25 diopter of the prescribed powers for 100 percent of the 60 test eyes. Results with these very simple refractive problems suggest that teaching expert computer systems to prescribe ophthalmic lens corrections is possible, and further suggest that the concept could be extended to more complex and challenging patient populations.

Aviation systems incorporating sophisticated electro-optical displays frequently are designed without provision for use by spectacle-wearing pilots. Contact lenses offer a solution to the compatibility problems experienced by Army aviators, approximately 18% of whom wear corrective lenses. Under a waiver from The Surgeon General, 44 helicopter pilots performed flying duties while wearing extended-wear soft and rigid lenses. Pilots remained in the study for a minimum of 6 months and a maximum of 24 months. Six experienced temporary discontinuance of wear (4-19 days); and six withdrew from the study. An overall wearing success rate of 86% was achieved. No pilot was grounded due to contact lens-related problems. Subjectively, extended wear contact lenses favorably affected job performance. This is the first major field evaluation of contact lens use by U.S. Army aviators while flying military aircraft.

Toric soft contact lenses of a double slab-off design were fitted to 72 patients (128 days) with varying refractive requirements. Rotational characteristics and lens stability were studied as related to sphere power, cylinder power, and axis orientation. The patients were followed over a 1-month period. Although rotation of all lenses was skewed nasally, the total number of all lenses showing no rotation or temporal was somewhat greater than those with nasal rotation. In addition lenses of oblique axis displayed the least amount of rotational instability. Finally this study suggests some differences when comparing the rotational characteristics between with-the-rule and against-the-rule astigmatism correction, low vs. high myopia, and myopia vs. hyperopia.

This study examined flexure of contact lenses while varying the base curve corneal relationship. Identical 9.5 mm lens designs of Polycon I, Polycon II and PMMA and Polycon I 9.0 mm lenses were fitted to corneas with toricities of between 0.75 and 5.00 D. It was found that the amount and direction of the flexure were determined by the base curve fitting relationship. As lenses were fitted steeper than K, with-the-rule flexure occurred, and flatter than K, against-the-rule flexure. If the upper lid covers the superior portion of the lens, an against-the-rule flexure component is usually introduced.

A case is presented in which a sudden refractive change and its subsequent recovery is documented by keratometry and subjective refraction measurements. Appropriate examination techniques demonstrate that the cornea and by inference other structures such as the lens are are the structures which have been affected. Various possible etiologies are discussed.

This history of orthokeratology includes contributions made by Jessen, Ziff, Nolan, Paige, Gates, May, Grant, Fontana, Tabb, Freeman, Shed, Kerns, and Binder to the use of contact lenses for myopia reduction. It reviews the early use of extremely flat lenses to flatten corneas and the more recent use of lenses fit with apical clearance to reduce myopia. The controlled studies of Kerns and Binder are described and the need for further research is indicated.

Changes in unaided visual acuity, corneal integrity and lens position are differentially affected by contact lens fitting procedures. The effects on these parameters, from contact lenses fitted by defined conventional and orthokeratological techniques, are given and compared to each other and to a group of non-contact lens wearers. General trends and variability of data are discussed in conjunction with pertinent clinical observations for the three groups.

Accommodative spasm (AS) is rarely reported in the literature. We studied 17 patients with accommodative spasm. Most patients were clinically emmetropic. Ten patients also manifested a spasm of the near reflex (SNR). The probable etiology of the accommodative disorder for most patients was psychogenic as revealed by case histories and visual field analysis. Treatment consisted primarily of plus reading lenses and, in some instances, orthoptic training. Some patients also underwent psychological counseling. Follow-up ranged from 2 months to 30 months. Although visual symptoms improved for most patients, only four patients had complete resolution of the spasm.

Rigid lenses may flex on the eye, particularly when the center thickness is less than 0.12 mm. Rigid oxygen permeable materials are less rigid than PMMA and can be expected to flex more easily.

Nine studies are presented illustrating how operant conditioning techniques can be used to facilitate the acquisition of task-relevant skills of young vision training patients. Four cases describe how behaviors considered prerequisite for visual skill training can be improved; task attention and motivation. Five cases show how special operant learning procedures, directly applied to visual skill performance, can facilitate the acquisition of such skills. It was suggested that all attempts at effective visual training recognize the role of scientifically based principles of learning and motivation in improving visual skills.

Care of children at risk of developing strabismus is discussed. Recommended care consists of parental counseling combined with early and periodic examinations. Examinations should begin by age 3 weeks and continue at 3-6 month intervals until the child reaches age 5. Treatment of strabismus or amblyopia should begin as soon as these conditions exist. Using recent electrophysiological research as a background, a model care for infants with congenital strabismus is presented. Care reports are presented describing results of orthoptic treatment of non-congenital strabismus.

Hunters and marksmen have some unusual seeing problems and they differ depending upon the type of gun--shotgun, rifle or pistol. A number of suggestions are made concerning prescribing for these individuals, especially presbyopes. Sighting techniques are discussed, including possible solutions to the difficulty created by crossed dominance.

It is contended that the Keller/Amos review is based upon a serious misapplication of statistics or misinterpretation of statistical results, which do not support their conclusions. Proper evaluation supports conclusions diametrically opposed to theirs when based upon the original data of the experiment.

Forty-two university students participated in a study of reading with +0.50 sphere or yokes prism base down for overconvergence and base up for underconvergence. Sixty-four percent of the group improved with a mean of +10.79 wpm. The level of coffee consumption of each student was recorded. A negative correlation existed between the intake of caffeine and reading improvement, r = -.81, p less than .001. Two students reduced their coffee consumption and transformed their loss in words per minute to a significant gain. A double-blind protocol was used in this study. A placebo lens (plano) controlled for subject and investigator bias. The relationship between caffeine and accommodation was investigated by means of a monocular test through a +4.D sphere. The location of the blur point was indicative of the state of tonicity of the ciliary system. Pre- and post-tests of the blur point for 14 subjects who were tested before and after consuming 150 mg of caffeine showed a significant change. The experimental group showed an increase of -0.52D while the control group showed a change of +0.36D. r = .781, p less than .01.

This study consists of clinical experience with the recently produced lathe cut Bausch & lomb SOFTLENS. Sixteen patients were fitted with the spin cast and then lathe cut lens. Visual acuities were better with the lathe cut lens. Comfort was good with both lenses. Some degree of circum-corneal injection was noted with the larger lathe cut design.

This is a case of latent nystagmus with a significant improvement in acuity with both eyes open rather than with either eye alone. If this patient's visual acuity was tested only O.D. alone and O.S. alone, the best visual acuity obtainable would have been 20/60. This might have had serious implications for A.F.'s work since a minimum visual acuity of 20/40 is needed to keep a driver's license in New York State. Since binocular acuity was 20/20, I assured him that driving is safe.

In this paper, the results, discussions and conclusions concerning selected variables relative to orthokeratological effects and procedures are presented. The data, clinical observations and subsequent analyses suggest that corneal modification with contact lenses is not clearly understood. Hypothesis are offered to explain certain results obtained, to account for observed discrepancies and to collectively assemble a rational understanding for the effects of contact lenses on purposeful corneal modification.

Treatment of amblyopia has been relatively ignored in the adult population. In a retrospective study at the University of Michigan Health Service, 10 patients with refractive amblyopia showed visual acuity improvement in their amblyopic eye after completing simple vision therapies.