Lecture 1

Question 1

what can elevated iop result in

Answer 1

elevated iop can result in glaucoma

which can lead to visual field constriction and ultimnaltey blindness

chronic glaucoma may not be noticed until the optic nerve is permeantly damaged- therefore iop monitoring can be helpful in identifying asympotomatic patients ar risk

Question 2

what is 14mmhg in hpa

Answer 2

19hpa

Question 3

what is glaucoma

Answer 3

raised iop

impaired drainage of aqueous fluid from the anterior chamber

permeant damage to optic nerve leading to loss of ganglion cells can be considered a form of optic neuropathy

leads to a biararcuate field defect

Question 4

what are some example causes of glaucoma

Answer 4

obstruction of aqueous fluid drainage from the anterior compartment of the eye

in order to make clinical inferences from iop it is important to establish a normal range in addition measurements should be non traumatic and non invasive

Question 5

what is the definition of normal iop

Answer 5

pressure that dosnt lead to glaucomatous damage of the optic nerve - normal pressure is about 15mmhg with a standard deviation of 3mmhg

their is a overlap between non glaucomatous and glaucomatous which demonstrates that diagnosis cannot be purely reliant on iop - most studies would suggest a normal range should be between 10-20mmhg however individual differences cloud this + there is subtypes like low tension glaucoma

thus high iop isn’t necessarily glaucoma and low iop dosnt necaessairly rule it out -

iop= influenced by a number of factors e.g. blood prsessure / drugs etc

Question 6

what is the measurement of iop termed

Answer 6

the measurement of iop= termed tonomettry and is performed with tonometers - pressure within it can be measured by relating the deformation of the globe (unknown ) to an exrerannly applied force (known)

two types of tonometer- applanantizn and indentation

Question 7

what relationship do application tonometers rely on

Answer 7

applanation tonometer rely on the relationship between wall tension and pressure in a elastic sphere - the surface tension y (gamma) is related to the pressure difference triangle across the curved wall by the following equation

pressure difference = 2 x surface tension over radius

Question 8

how are pressure, force and area related

Answer 8

pressure= force / area (opthamologists call this the imbert fick law)

Question 9

when do the forces balance out when a piston is placed on a cornea

Answer 9

cornea has a central thickness of 0.55mm

in the literature forces balance out at about 3.06mm

Question 10

how does the Goldmann tonometer work

Answer 10

Goldman type application tonomter applies a force to the surface of the cornea and uses a optical system to determine when the applanated area is 3.06mm in diameter ]

the cornea is anthessied with a topical anaesthetic and the tear film is stained with sodium fluroscein

fluorescence allows visualisation of the meniscus surrounding the application area

which is split into two semicircles by biprisms

when the inner edges of the semicircles touch is when applantion is correct

the iop can then be measured directly from a scale on a tonometer

Question 11

what can errors be due to when using a tonomter

Answer 11

variations of thickness and curvature of cornea - e.g. keratoconus/ laser surgery

variations in tear film , age , epithelial oedema , bvlephorasm / poor coop , posture , drugs and blood pressure/ tight collar

Question 12

how do tonometers that use a puff of air work

Answer 12

tonometers are now available that use a puff of air to deform the surface of the cornea

by using a know velocity and volume of air and measuring the resulting deformation of the corneal surface it is possible to provide a reasonable accurate measurement of iop

Question 13

how much is 1mmhg in hpa

Answer 13

1mmhg= 1.33hpa

1hpa= 0.75mmhg

Question 14

what do we regard an electrode as

Answer 14

an electrode is a transducer - has to convert the ionic flow of current in the body to an electric flow along a wire to a recorder

Question 15

what are the different types of electrode

Answer 15

microelectrodes- electrodes which are used to measure the potential either inside or very close to a single cell

needle electrodes- electrodes used to pass through the skin and record potentials from a small area such as a motor unit within a muscle

surface electrodes - electrodes applied to the surface of the body and used to record signals such as the ecg and erg

Question 16

what are microelectrodes used for

Answer 16

microelectrodes are not routinely used in medical departments

they are electrodes with a tip small enough to penetrate single cell and can only be applied to samples of neural tissue - a very fine wire can be used

smallest electrodes are tube of glass stretched to give a tip size of 0.5um the tube is filled with electroplate kcl

special recording amplifiers used in order to allow for the very high impedence of tiny electrodes

Question 17

needle electrodes uses

Answer 17

used for routine needle electromyography as it allows for potentials from only a small group of motor units to be recorded

needle electrodes must be sterilised before use and they also must be kept clean in order for them to work satisfactorily

electrodes are suitable for sterilisation by autoclaving but others must be steralised in ethelynee oxide gas

this form of sterilisation requires needles to be pe placed in ethylene oxide gas at 20 psi 140kpa for 1.5hrs at a temperature of 55-55 degrees the needles must not be used for 48hrs following sterilisation this allows for spore tests to be completed

Question 18

what are the problems with surface electrodes

Answer 18

they are subject to movement artefacts

movement of the electrode - movement of the electrode disturbs the electrochemical equilibrium between the electrode and the skin and results in contact potential changes - that’s why electrolyte (gel) is placed between electrode and skin

a pool of electrolyte is placed between the silver chloride disc and the skin - movment of the electrolyte does not disturb the junction between metal and electrolyte and so does not change the electrode or contact potential

Question 19

what are other electrodes that can be used

Answer 19

e/..g conductive polymer electrodes can be used to make contact to the cornea and record electrical signals from the eye

Question 20

what is the largest electrical signal produced by the body

Answer 20

the largest signal produced by the body is the ecg

which has an amplitude of 1mv

this is too small to drive any recorder directly or too input into a computer hence any signal must be amplified before recording

amplification can be either of voltage or current- voltage amplification is required to supply sufficent to current to drive a recording device

Question 21

what is amplifier gain

Answer 21

if the signal to amplifiers is small then the amplifier gain will be large , an eeg amplifier will have a higher gain than an ecg amplifier

the gain of an amplifier is the ratio of the output and input voltages
in a ideal amplifier the gain is independent of frequency but in a real amplifier this sent the car

frequency response of amplifier must be matched to the frequency content of the signal

Question 22

what is frequency analysis

Answer 22

Fourier developed the concept of frequency analysis he demonstrated that any receptive signal can be considered a summation of sine waves

Question 23

what is the ecg

Answer 23

ecg is a perodic signal of which the lowest frequency component is the heart rate

if the heart rate = 60min the lowest frequency component is 1hz

Fourier analysis reveals that the complete ecg waveform can be produced by adding together the sine waves of 1hz 2hz 3hz and so on the. amplitude of components will determine the shape of the ecg
frequency analysis dictates that the largest component of the ecg has a frequency of 17hz and that the components above 100hz are of negligible amplitude an ecg amplifier must be able to handle frequency components between 1 hz and 100hz - it must amplify the components equally and preserve the relative phase of all the components

Question 24

what is bandwidth

Answer 24

bandwidth of an amplifier = the frequency over which the gain remains constant

in practice = -3db bandwidth - this = frequency range over which the gain is not less than 3db below the maximum gain - the bandwidth of an amplifier must be sufficent to handle all frequency components in the signal of interest

Question 25

what is sample rate

Answer 25

interfacing signals must be sampled and recorded at regular intervals this= a sample rate - the rate of sampling must be high enough to handle all the frequency components of the desired signal

Question 26

noise and electrical interference

Answer 26

electrophysiological signals such as the ecg , eeg and emg are susceptible to interference due to their small amplitude

lab instruments , nuclear medicine and computing equipment can be subject to interference from nearby electrical machinery such as lifts and air conditioners