Loteprednol Etabonate 0.2% in the Possible Treatment of Dry Eye Syndrome

Poster Presentations questionable. Reasonable alterations in the structure of the laboratory should be considered to maximize its educational benefit in future years.

Poster 68 Emphasis Techniques in Presentations: Effectiveness and Recall Adam M. Preston, B.S., John R. Hayes, Ph.D., Yu-Chi Tai, Ph.D., and James E. Sheedy, O.D., PhD, Pacific University College of Optometry, Forest Grove, Oregon Background: The use of computer presentation software, such as Microsoft PowerPoint or Apple’s Keynote, is widespread across every discipline. When used effectively, well-designed computer presentations are excellent aids to lectures and presentations. When poorly designed, computer presentations have the potential to lessen the value of the presentation. To date, little has been studied on the effectiveness of various typographical emphasis techniques used in such presentations. The purpose of this study was to compare the effectiveness of common chromatic and achromatic typographical emphasis techniques used in computer presentations in terms of response time and recall. Method: In the first of 2 experiments, subjects were presented with a series of computer presentation slides in which one of 49 words was emphasized in one of the following ways: bold, italic, underline, all capital letters, red, yellow, green, or blue text. The subject was asked to locate and speak the emphasized target word, and a computer recorded the subjects’ reaction times. These conditions were tested across 3 different backgrounds common to computer presentations: white, black, and dark blue. In the second experiment, subjects were asked to judge which of 2 words (only one had been emphasized, but both had appeared only once) had occurred most frequently in the first study. Results: Generally, chromatic emphasis techniques resulted in significantly faster reaction times than achromatic emphasis techniques. Underline and italic emphasis techniques were consistently the least effective means of emphasizing text across all background conditions. Using all capital letters elicited nearly the same reaction time regardless of the background and was the quickest achromatic emphasis response time on the most backgrounds. There was no significant difference in recall when analyzed for emphasis technique, background color, or chromaticity. Conclusion: Chromatic emphasis techniques result in faster reaction times than achromatic ones, and all-capitalization has the fastest reaction times among achromatic emphasis techniques. The recall measure used in this study showed no differences among emphasis techniques. Further research is needed to determine optimum text/background combinations and to evaluate emphasis effectiveness on cognition and learning.

299 Poster 69 Dissolution Rates of Multivitamin Supplements in Different pH Environments Kimberly Reed, O.D., and Storm R. Berman, Nova Southeastern University, Ft. Lauderdale, Florida Background: More than half of U.S. adults take a daily multivitamin. Speculation abounds as to the necessity of supplementation and the preferred formulation of supplements if they are taken. Many experts believe that some multivitamin pills may be passed through the gastrointestinal track largely undigested. Liquid vitamin supplements are designed to eliminate this potential problem. Still other experts believe that the acidity of the stomach neutralizes many nutrients that are contained in multivitamin pills. Delayed-release or extended release formulations are designed to remain intact in the acidic pH of the stomach and to rapidly dissolve when encountering the more alkaline environment of the small intestine. A potential additional benefit of delayed release tablets is that they are often associated with fewer side effects; however, dissolution and absorption within the small intestine is more difficult to predict. Method: For this pilot study, a modified protocol based on the U.S. Pharmacopeia (USP) simplified disintegration technique was performed on several multivitamin pills, some of which were ‘‘rapid release’’ and others ‘‘delayed release.’’ Pills were submerged in liquids with pH of 4.0 (trial 1, to simulate the acidity of a stomach with food and/or drink) and 2.0 (to approximate the acidity of an empty stomach), and were allowed to remain undisturbed at room temperature for 4 hours. Pills that were not indicated to be ‘‘delayed release’’ or ‘‘extended release’’ formulations that were not dissolved within 60 minutes were considered failures. Delayed release pills that did not dissolve after 4 hours were gently bathed in tap water and then submerged in a liquid with pH of 8.0. These pills that did not dissolve within 60 minutes of exposure to an alkaline environment were considered failures using this protocol. Results: Some supplements failed to meet the dissolution timeframes indicated by the study protocol. Conclusion: The findings of this pilot study suggest that there is wide variability in commonly available multivitamin supplements with respect to dissolution, potentially affecting absorption of nutrients.

Poster 70 Loteprednol Etabonate 0.2% in the Possible Treatment of Dry Eye Syndrome Candace Acord, O.D., Amanda Gonzales, O.D., and Alan G. McKee, M.S., O.D., NSU Oklahoma College of Optometry, Tahlequah, Oklahoma Background: Dry eye syndrome (DES) is a multifactorial disease, the etiology, diagnosis, and management of which are controversial. Tear film instability is the most widely

300 accepted cause of DES. However, ocular inflammation is now considered an underlying cause, making steroid treatment an alternative option for dry eye. This study explores the use of the low-dose soft steroids in the treatment of DES. Specifically, is loteprednol etabonate 0.2% effective in the treatment of DES compared with higher dosed steroids and artificial tears? Methods: In a randomized masked clinical trial, 8 subjects were divided into 3 treatment groups and given different drops for each eye to take over 2 weeks. After a 1-week rest period, the treatments were rotated, giving 3 treatment periods and 2 rest periods with examinations and surveys at the end of each period. Results: Using t-test analysis, data from examinations were analyzed regarding visual acuity, tear volume, corneal staining, grade, and intraocular pressure. Additionally, questionnaires were used to evaluate comfort, dryness, itchiness, grittiness, wateriness, and blurry vision. Minimal statistical significance was found among these categories. Conclusion: Although this study cannot claim a significant difference in the relief of dry eye with loteprednol etabonate 0.2% compared with loteprednol etabonate 0.5% and an artificial tear, the performance of loteprednol was comparable to that of the traditional treatment modalities, suggesting loteprednol etabonate 0.2% is a plausible alternative treatment for DES.

Poster 71 Hyperbaric Oxygen Therapy and the Eye Lynn Ueshiro, O.D., Spark Matsunaga VA Medical Center, Honolulu, Hawaii Background: Hyperbaric oxygen therapy (HBOT) is well known for its treatment of decompression sickness and arterial gas embolism. It is less well known for its ocular side effects and potential for ocular treatment. It is hypothesized that hyperoxygenation increases the refractive index of the lens, which increases myopia without causing an increase in axial length, forward movement of the lens, accommodative spasm, or change in corneal curvature. It is also hypothesized that hyperoxygenation of the retina via the choroid can aid in treating ischemic diseases like CRAO. Though it is expensive, not widely available, time consuming, and not extensively studied, it is important for optometrists to be aware of the side effects and possibility for treatment. Case Report: A 65-year-old white man patient presented for a refraction check. He had undergone 2 hyperbaric oxygen treatments for a nonhealing rectal vault. The first treatment lasted 3 months for 2 hours a day, 5 days a week. The second treatment 5 months later was for 10 days. His ocular history included a ganciclovir implant OD in 2001 for CMV retinitis and cataract OU. His medical history included HIV, multiple malignancies, CKD, HTN, HLP, and pulmonary disease. His medications included HAART and others. Visual acuities were 20/20 for each eye. Entrance

Optometry, Vol 81, No 6, June 2010 testing, biomicroscopy, intraocular pressure, and dilated fundus examination were unremarkable. After his first treatment, he had a myopic shift of 1.75 D in both eyes and an increase in astigmatism of 1.25 D OS. Two months after his first treatment, his refraction returned to baseline. Ten days after his second treatment, he had a similar refractive shift, which continued for 4 months. Visual acuities were 20/20 for each eye at each visit. At last follow-up, the myopic shift increased, and visual acuities decreased because of cataract progression. Conclusion: A myopic shift should be expected after HBOT. This case reminds us to educate our patients and other physicians about the possible side effects of HBOT and to consider it for certain sight-threatening diseases such as CRAO. Though HBOT is currently an off-label use for ocular conditions, it appears to be gaining acceptance because of its safety and efficacy.

Poster 72 Oral Tetracycline–Induced Bulbar Conjunctival Pigmentation Matthew Rhodes, O.D., and Carla Engelke, O.D., Southern Arizona VA Healthcare System, Tampa, Florida Background: Ocular, cutaneous, dental, osseous, and thyroid pigmentation are well documented side effects of the tetracycline class of drugs, especially with long-term use. Scleral and palpebral conjunctival pigmentation in both minocycline and combination minocycline/tetracycline therapy have been suggested by numerous reports. Clinically visible ocular tissue pigmentation with tetracycline therapy alone, however, is rare. Only 2 reports of tetracycline-induced bulbar conjuntival pigmentation were found in a literature search. Westin et al. reported bilateral, elevated, brownish-gray lesions near the limbus in a 24-year-old after 5 years of oral tetracycline use. Morrison et al. reported bilateral discrete, green, crystalline deposits adjacent to the temporal limbus after 2.5 years of tetracycline use. We present a case of bulbar conjunctival pigmentation in a patient whose clinical presentation closely resembled the latter report. Case Summary: A 57-year-old white man presented for a routine eye examination. His medical history included acne vulgaris, hypercholesterolemia, airway obstruction, and kidney and heart transplants. His medications included atenolol, albuterol, niacin, prednisone, sirolimus, simvastatin, warfarin, and tetracycline 500 mg orally daily. He reported 6 years of tetracycline therapy but denied previous minocycline therapy. He also denied recent use of topical ophthalmic medications or any unusual pigmentation of skin or body parts. His best-corrected visual acuities were 20/20 OD and OS. Entrance testing was unremarkable. Biomicroscopy found numerous green, discrete, refractile deposits within the temporal bulbar conjuntiva adjacent to the limbus OU. No corneal or conjunctival staining was observed. Goldmann intraocular pressures were 13 mmHg