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M K Smolek

Publications and source records attributed to M K Smolek.

At least 19 recordsLinked to original sources
PubMed1998

Topographic assessment of irregular astigmatism after photorefractive keratectomy.

OBJECTIVE: To correlate new quantitative topographic indexes of corneal irregular astigmatism to best spectacle-corrected visual acuity (BSCVA) following excimer laser photorefractive keratectomy (PRK). SETTING: Department of Ophthalmology, LSU Eye Center, and Refractive Surgery Center of the South, Ear, Nose & Throat Hospital, New Orleans, Louisiana; Manhattan Eye, Ear and Throat Hospital, New York, New York, USA. METHODS: Videokeratography data (TMS-1) were obtained preoperatively and 1, 3, 6, 12, 18, and 24 months postoperatively from 100 eyes having PRK for low to mild myopia. Algorithms measured fine local irregularity with the surface regularity index (SRIp), varifocality with the coefficient of variation of corneal power (CVPp), and central islands with the elevation/depression magnitude (EDM). RESULTS: The SRIp and CVPp increased after surgery and remained significantly higher than the preoperative levels throughout the 24 month follow-up (P < .05). The increase in EDM was significant from 1 to 6 months (P < .05) but not thereafter. Multiple regression analysis revealed that variables having a statistically significant relationship with postoperative BSCVA were CVPp and EDM at 1 month, CVPp at 3 months, and CVPp, haze, and age at 6 months. No statistically significant correlation between any measures of irregular astigmatism and BSCVA was found after 1 year of follow-up. CONCLUSION: The quantitative measures used in this study are sensitive methods by which irregular astigmatism after keratorefractive procedures can be classified, evaluated, and compared.

Algorithms↗
PubMed1998

Corneal hydration and central islands after excimer laser photorefractive keratectomy.

PURPOSE: To determine whether uneven corneal surface hydration during excimer laser photorefractive keratectomy (PRK) is related to postoperative occurrence of central islands. SETTING: LSU Eye Center, New Orleans, Louisiana, USA. METHODS: A retrospective study reviewed intraoperative videotapes and postoperative videokeratography of 49 eyes of 49 patients who had excimer laser PRK for myopia. The uniformity of corneal hydration within the photoablation zone, particularly the frosty appearance of the ablated zone, was characterized. The presence or absence of a topographic central island (steepening of at least 3.0 diopters and 1.5 mm in diameter) was determined from the 1 month postoperative videokeratographs. RESULTS: Twelve eyes (24.5%) developed central islands postoperatively. A statistically significant association was observed between the uneven surface hydration (central accumulation of fluid) within the ablation zone intraoperatively and the formation of central islands postoperatively (P < .001, Kruskal-Wallis test; Kendall tau rank correlation = 0.534; P < .001). CONCLUSION: Nonuniform fluid distribution during photoablation was a risk factor for central island formation after PRK. Intraoperatively, the presence of excess fluid in the central cornea appeared as a shiny area. This mirror-like surface layer may reduce the rate of central ablation by reflecting and absorbing a significant amount of the incident excimer laser light.

Adult↗
PubMed1997

Cinemakeratography using computer morphing.

PURPOSE: TMS-1 videokeratography (Tomey Technologies, Inc.) was animated using computer morphing to visualize corneal shape change over time. METHODS: Morphing was performed using keratoconus (8 examinations/76 months) and postoperative photorefractive keratectomy (PRK) corneas (8 examinations/37 months; LSU PRK Phase IIa). RESULTS: In the keratoconus animation, the inferior cone increased curvature, but not equally in all directions, nor at a constant rate. The cone apex did not drift over time. Periodic flattening and steepening was observed superiorly, as well as cone regression at month 76. The Keratoconus Prediction Index (KPI) at month 0 was 0.18, plateaued at 0.36 at month 46, and dropped to 0.33 at month 76. In the post-PRK animation there was continuous corneal remodeling out to 30 months. Fluctuating steep and flat regions of the ablation zone correlated with the Surface Regularity Index (SRI). CONCLUSION: Cinemakeratography (Cinema-K) enhanced our appreciation of subtle changes in corneal topography.

Cornea↗
PubMed1997

Disparity between keratometry-style readings and corneal power within the pupil after refractive surgery for myopia.

PURPOSE: Because keratometry readings may no accurately reflect the refractive changes after keratorefractive surgery for myopia, better methods for the assessment of corneal curvature in the postsurgical cornea are needed. METHODS: We developed a procedure to calculate the average central power (ACP) of the cornea within the entrance pupil from videokeratography. Videokeratograph-derived keratometry-style readings (average K; K) and calculated ACPs, as well as the differences between the two values, were compared in four groups: normal corneas (n = 30), corneas with regular astigmatism (n = 30); post-radial keratotomy corneas (RK, n = 85), and post-excimer laser photorefractive keratectomy corneas (PRK, n = 63). Intraocular lens (IOL) powers calculated by using K or ACP in the Sanders-Retzlaff-Kraff formula were compared. RESULTS: In the groups with normal corneas or regular astigmatism, none of the eyes showed a difference between K and ACP > 0.25 D. However, six (7%) of the RK eyes and 16 (25%) of the PRK eyes had differences > 0.55 D; in these eyes, the disparity between IOL powers calculated by using K and IOL powers calculated by using ACP was > 0.5 D. CONCLUSION: These results suggest that basing the calculation of IOL powers on keratometry readings in patients who have undergone RK. PRK, or possibly other refractive procedures may result in a residual refractive error in some eyes. In particular, patients undergoing surgery involving a small optical zone or large attempted correction or both, as well as those with low postoperative keratometry readings, may be at risk for this problem if IOL placement becomes necessary in later years.

Cornea↗
PubMed1997

Current keratoconus detection methods compared with a neural network approach.

PURPOSE: Four videokeratographic methods for keratoconus detection were compared with a neural network approach. METHODS: A classification neural network for keratoconus screening was designed to detect the presence of keratoconus (KC) or keratoconus suspects (KCS); a separate cone severity network graded the severity of conelike topography patterns consistent with KC or KCS. Three hundred TMS-1 examinations (Tomey) were randomly divided into training and test sets. Ten topographic indexes were network inputs. Nine categories were used: normal, astigmatism, KC, KCS, contact lens-induced warpage, pellucid marginal degeneration, photorefractive keratectomy, radial keratotomy, and penetrating keratoplasty. KC was subdivided into KC1 (mild), KC2 (moderate), and KC3 (advanced). There were three outputs for the classification network (KC, KCS, and OTHER); target output values of 0 = OTHER, 0.25 = KCS, 0.5 = KC1, 0.75 = KC2, and 1.0 = KC3 were used for the severity network. RESULTS: The best-trained classification network had 100% accuracy, specificity, and sensitivity for the test set. The severity network had mean outputs (+/-standard deviation) of OTHER = 0.02+/-0.02, KCS = 0.21+/-0.05, KC1 = 0.52+/-0.17, KC2 = 0.74+/-0.12, and KC3 = 0.91+/-0.15. The severity network output for all categories was well correlated to the keratoconus prediction index (R = 0.892, P < 0.0001). The classification network had an overall accuracy and specificity significantly better (P < or = 0.005) than the Klyce/Maeda keratoconus index (KCI) test, the Rabinowitz test (K & I-S), and simulated keratometry (average Sim K). However, there were no significant differences in keratoconus sensitivity between the classification network, KCI, and K & I-S. The sensitivity and specificity of average Sim K were significantly worse than those of the other tests. The classification network had significantly better sensitivity (P < 0.001) and specificity (P = 0.025) for KCS detection than the K & I-S. CONCLUSIONS: The neural networks completely distinguished KC from KCS and from topographies that resembled KC. The network approach equaled the sensitivity of currently used tests for keratoconus detection and outperformed them in terms of accuracy and specificity.

Cornea↗
PubMed1995

Comparison of methods for detecting keratoconus using videokeratography.

BACKGROUND: The detection of keratoconus patterns on videokeratography is important for screening candidates for refractive surgery and for studying the genetic basis of keratoconus. OBJECTIVE: We compared three quantitative approaches to identifying keratoconus from videokeratographic information to examine the limitations and capabilities of each test and to determine their suitability for use in the clinical setting. METHODS: Videokeratographs typical of clinically diagnosed keratoconus (n = 44) and of various non-keratoconus conditions (n = 132, including normal, with-the-rule astigmatism, contact lens-induced corneal warpage, photorefractive keratectomy, keratoplasty, and pellucid marginal degeneration) were selected. Three methods for detecting keratoconus were used: keratometry (average Simulated Keratometry [SimK] readings > 45.7 diopters [D]); the modified Rabinowitz-McDonnell test (central corneal power > 47.2 D and/or Inferosuperior Asymmetry [I-S] value > 1.4 D); and an expert system classifier (classification based on discriminant analysis and classification tree with eight topographic indexes). Sensitivity and specificity were calculated for each test. RESULTS: Sensitivities were 84% for keratometry, 96% for the modified Rabinowitz-McDonnell test, and 98% for the expert system classifier. Specificities for the three methods were 86%, 85%, and 99%, respectively. In terms of sensitivity, the expert system classifier was significantly better than keratometry (P = .04). In terms of specificity, the expert system classifier was significantly better than either of the other methods (P = .001). CONCLUSIONS: For screening candidates for refractive surgery, where high sensitivity is needed, either the modified Rabinowitz-McDonnell test or the expert system classifier is suitable. For diagnosing keratoconus, where high specificity is more useful, the expert system classifier is more appropriate than the other two methods.

Cornea↗
PubMed1995

Neural network classification of corneal topography. Preliminary demonstration.

PURPOSE: Videokeratography is a powerful tool for the diagnosis of corneal shape abnormalities. However, interpretation of the topographic map is sometimes difficult, especially when pathologies with similar topographic patterns are suspected. The neural networks model, an artificial intelligence approach, was applied for automated pattern interpretation in corneal topography, and its usefulness was assessed. METHODS: One hundred eighty-three topographic maps were selected and classified by human experts into seven categories: normal, with-the-rule astigmatism, keratoconus (mild, moderate, advanced), postphotorefractive keratectomy, and postkeratoplasty. The maps were divided into a training set (108 maps) and a test set (75 maps). For each map, 11 topography-characterizing indices calculated from the data provided by the TMS-1 videokeratoscope, plus the corresponding diagnosis category, were used to train a neural network. RESULTS: The correct classification was achieved by a trained neural network for all 108 maps in the training set. In the test set, the neural network correctly classified 60 of 75 maps (80%). For every category, accuracy and specificity were greater than 90%, whereas sensitivity ranged from 44% to 100%. CONCLUSIONS: With further testing and refinement, the neural networks paradigm for computer-assisted interpretation or objective classification of videokeratography may become a useful tool to aid the clinician in the diagnosis of corneal topographic abnormalities.

Cornea↗
PubMed1994

Holographic interferometry of intact and radially incised human eye-bank corneas.

Many methods to measure corneal elasticity destroy the tissue and thereby produce erroneous results. Holographic interferometry, a highly precise nondestructive optical comparison technique, was used to evaluate corneal elasticity of intact eye-bank eyes. A double-pulse holographic interferometer operating at 632.8 nm was used to measure corneal deformation in 20 whole-globe eyes from donors 45 to 83 years of age for intraocular pressures from 16 mm Hg to 21 mm Hg. Stress was computed from LaPlace's law, and arc length strain was derived from z-axis distention of the central cornea. The stress-strain relationship in the normal physiological range of intraocular pressure was linear with a Young's elastic modulus of 1.03 gigapascals for the central cornea (r = 0.999). During interferometry of radial keratotomy of the cornea, interference fringe patterns developed in association with each incision as it was made. When four incisions were placed deep along each of the primary semimeridians, the fringe pattern developed as expected, based on current keratotomy models. When incisions were shallow (approximately 50% depth) and placed asymmetrically along the nasal, temporal, and superior semimeridians, the resulting surface strain was symmetrical about the central cornea, forming an annular pattern of interference fringes. These results indicate that when the cornea was stressed at physiological pressures as part of the intact whole globe, it was less elastic than excised corneal tissue tested by strip extensiometry. Radially incised corneas demonstrated strain patterns suggestive of inherent structural anisotropy with a possible inferior quadrant weakness.

Adult↗
PubMed1994

Keratoconus and contact lens-induced corneal warpage analysis using the keratomorphic diagram.

PURPOSE: Videokeratography of early keratoconus may be difficult to distinguish from contact lens-induced corneal warpage, even by experienced examiners. Furthermore, topographic irregularity may be judged inconsistently if quantitative standards are not applied. Quantitative measures based on videokeratographic data were developed and evaluated to determine if improved corneal topographic classification can be achieved. METHODS: The Corneal Irregularity Coefficient (CIC) and Corneal Power Coefficient (CPC) were derived from multiple measures of mean corneal power and its variance for 207 videokeratographs of normal, warped, keratoconus, and keratoconus-suspect corneas. CIC was plotted against CPC, creating a distribution of points representing all maps that tended to be grouped according to surface conditions (the Keratomorphic Diagram). Normal, steep, abnormal, and warped zones were defined by CIC and CPC cutoff values chosen to distinguish normal from keratoconus corneas graphically. RESULTS: Seventy of 76 normal corneas were grouped in the normal zone and 6 in the steep zone; 84 of 84 keratoconus corneas were grouped in the abnormal zone; 35 of 35 contact lens-induced warpage cases were grouped in the warped zone; and 10 of 12 keratoconus-suspect corneas were grouped in the warped zone, with 2 in the abnormal zone. Serially plotted data of keratoconus progression and warpage regression demonstrated that the vector displacement of CIC and CPC values may provide a potentially useful means of distinguishing contact lens-induced warpage from keratoconus-suspect corneas. CONCLUSION: The Keratomorphic Diagram aids in classifying and comparing corneal shape by plotting indices along axes with easily recalled scales. The diagram may become a useful tool to assess presurgical corneal surface instability and postoperative progression of corneal shape change due to healing.

Contact Lenses↗
PubMed1994

Automated keratoconus screening with corneal topography analysis.

PURPOSE: Although visual inspection of corneal topography maps by trained experts can be powerful, this method is inherently subjective. Quantitative classification methods that can detect and classify abnormal topographic patterns would be useful. An automated system was developed to differentiate keratoconus patterns from other conditions using computer-assisted videokeratoscopy. METHODS: This system combined a classification tree with a linear discriminant function derived from discriminant analysis of eight indices obtained from TMS-1 videokeratoscope data. One hundred corneas with a variety of diagnoses (keratoconus, normal, keratoplasty, epikeratophakia, excimer laser photorefractive keratectomy, radical keratotomy, contact lens-induced warpage, and others) were used for training, and a validation set of 100 additional corneas was used to evaluate the results. RESULTS: In the training set, all 22 cases of clinically diagnosed keratoconus were detected with three-false-positive cases (sensitivity 100%, specificity 96%, and accuracy 97%). With the validation set, 25 out of 28 keratoconus cases were detected with one false-positive case, which was a transplanted cornea (sensitivity 89%, specificity 99%, and accuracy 96%). CONCLUSIONS: This system can be used as a screening procedure to distinguish clinical keratoconus from other corneal topographies. This quantitative classification method may also aid in refining the clinical interpretation of topographic maps.

Cornea↗
PubMed1993

Corneal topography of excimer laser photorefractive keratectomy.

The application of the 193 nm excimer laser for keratorefractive surgery promises to deliver a higher degree of precision and predictability than traditional procedures such as radial keratotomy. The development and evaluation of keratorefractive surgery have benefited from the parallel advances made in the field of corneal topography analysis. We used the Computed Anatomy Topography Modeling System (TMS-1) to analyze a Louisiana State University (LSU) Eye Center series of patients who had photorefractive keratectomy for the treatment of myopia with the VISX Twenty/Twenty excimer laser system. The excimer ablations were characterized by a relatively uniform distribution of surface powers within the treated zone. In the few cases that exhibited marked refractive regression, corneal topography analysis showed correlative changes. With topographical analysis, centration of the ablations relative to the center of the pupil could be evaluated. Marked improvement in centration occurred in the patients of LSU Series IIB in which the procedure to locate the point on the cornea directly over the pupil's center during surgery was refined. Corneal topographical analysis provides objective measures of keratorefractive surgical results and is able to measure the precise tissue removal effect of excimer laser ablation without the uncertainties caused by measuring visual acuity alone. Our observations forecast the need for improved aids to center the laser ablations and for the development of a course of treatment to prevent post-ablation stromal remodeling.

Cornea↗
PubMed1993

Interlamellar cohesive strength in the vertical meridian of human eye bank corneas.

PURPOSE: Previously, human corneal stromal interlamellar cohesive strength in the horizontal meridian was shown to be twice as strong peripherally as centrally (approximately 2.90 x 10(-1) versus 1.40 x 10(-1) N/mm). In the current study, stromal samples excised from the vertical meridian were studied to determine if meridional differences also exist. Precise knowledge about corneal stromal structure is warranted, because anisotropy can influence postoperative healing strength and corneal shape. METHODS: Limbus-to-limbus stromal strips with a constant 2.2-mm width were obtained from the vertical meridians of 52 eyebank corneas (8 single, 22 pairs). Cohesive strength was recorded as samples were split at a constant 1.6 mm/s at 50% stromal depth. RESULTS: The mean cohesive strength in the inferior periphery was found to be only two thirds the strength observed in the nasal or temporal periphery (1.96 x 10(-1) N/mm versus approximately 2.94 x 10(-1) N/mm @ 5 mm). The mean cohesive strength in the inferior periphery was also significantly less than the strength of the superior periphery (1.85 x 10(-1) N/mm +/- 8.83 x 10(-3) SEM versus 2.34 x 10(-1) +/- 1.37 x 10(-2) @ 4 mm from the central cornea; P = 0.0027). Unlike the samples from the horizontal meridian, which could be described by a profile symmetric about the central cornea, force profiles for the vertical data could be characterized with distinct, classifiable patterns that were generally asymmetric. Fellow corneas from a single donor tended to have strength profiles belonging to the same class (P = 0.035; chi-square), although some paired eyes exhibited profiles from distinctly different classes. CONCLUSIONS: These data strongly support the concept of an anisotropic collagen macrostructure that is more complex than previously believed. This inherent structural anisotropy may become a significant determinant of corneal shape during ectatic disease and some forms of keratorefractive surgery.

Adult↗
PubMed1992

A biomechanical evaluation of rabbit corneas in M-K and Dexsol.

We compared the average force required to separate normal corneas at a 50% stromal depth, with the force required to separate corneas stored for 2, 5, 7, 10, and 14 days in either McCarey-Kaufman or Dexsol corneal storage medium. The required interlamellar separation force was calculated by standardizing the width of the test strips. The average required force for 35 fresh rabbit corneas (no storage) was 9.1 +/- 1.5 g/mm. There was no significant change in the required separation force after storage in either medium for up to 14 days.

Animals↗
PubMed1990

Interlamellar adhesive strength in human eyebank corneas.

The interlamellar biomechanical properties of stromal collagen are relatively unknown, yet may be highly significant with respect to wound healing and the efficacy of certain keratorefractive surgical procedures. Interlamellar adhesive strength was measured as the tearing force required to separate corneal lamellae at a 50% stromal depth in 16 human eyebank corneas. The mean value for the central cornea was found to be 14.2 (+/- 0.5 SEM) g-wt/mm of tissue width. Histology showed a smooth separation between the lamellae along the tearing plane in the central cornea. We believe that the adhesive strength measured in the central cornea may be primarily the force needed to break interlamellar proteoglycan bonds between collagen lamellae, because no torn lamellae were found in this region. The mean adhesive strength and the SEM increased toward the periphery in a symmetrical fashion. The mean adhesive strength in the far periphery was 31.6 (+/- 3.7 SEM) g-wt/mm at 5 mm nasally, and 28.4 (+/- 3.2 SEM) g-wt/mm at 5 mm temporally, and was approximately twice the mean central value. The rising value of the mean adhesive strength with increasing distance from the central cornea was believed to be due to a more highly disorganized collagen network in which greater numbers of lamellae passed obliquely in depth through the tearing plane. These lamellae would contribute their tensile strength to the adhesive strength measurement along the tearing plane. Histology from the peripheral cornea confirmed the existence of depth-varying collagen lamellae and the torn ends of lamellae that passed across the tearing plane.

Adhesiveness↗
PubMed1986

Nonius horopter in projected viewing.

Nonius horopter measurements were made on three normal subjects using both physically displaced (real viewing) and stereogrammetrically displaced (projected viewing) test objects. Three subjects with ocular anomalies were tested using the projected viewing arrangement with and without 5% overall magnifier before the right eye, and seven complete measurements of the projected viewing horopter were made on a fourth subject with an ocular anomaly over the period of 1 month. These latter individual plots showed large irregularities that changed location from day to day. Plotting the mean and standard error of the means of these seven sets of data produced a smoothing out of the horopter locus. Plotting each individual horopter setting in the sequence of measurement and monitoring eye position indicated that all of the irregularities and regional horopter changes found are most likely introduced by changes in fixation disparity (vergence eye movements).

Depth Perception↗
PubMed1983

A comparison of two horopter criteria.

Both the binocular nonius and classical nonius criteria were applied to a group of subjects in order to compare the resulting horopters. Results indicated that monocular visual directions shifted along with changing binocular disparities when using the binocular nonius technique. This method constitutes a modification of the frontal plane criterion, since binocular portions still can be set equidistant to the fixation object. Comparing equidistance (binocular nonius) with equidirection (nonius) indicated that the 2 loci were essentially the same. Shifts in the nonius horopter induced by a small overall magnifier could not be predicted for 2 out of 7 subjects; one of these with aniseikonia and the other with intermittent exotropia. Irregularities in all horopter data could be accounted for by shifts in the vergence angles during the experiment.

Aniseikonia↗