When measuring recognition acuity in a research setting, the most widely used symbols are the Early Treatment of Diabetic Retinopathy Study (ETDRS) set of 10 Sloan letters. However, the symbols are not appropriate for patients unfamiliar with letters, and acuity for individual letters is variable. Alternative pictogram sets are available, but are generally comprised of fewer items. We set out to develop an open-access set of 10 pictograms that would elicit more consistent estimates of acuity across items than the ETDRS letters from visually normal adults. We measured monocular acuity for individual uncrowded optotypes within a newly designed set (The Auckland Optotype [TAO]), the ETDRS set, and Landolt Cs. Eleven visually normal adults were assessed on regular and vanishing formats of each set. Inter-optotype reliability and ability to detect subtle differences between participants were assessed using intraclass correlations (ICC) and fractional rank precision (FRP). The TAO vanishing set showed the strongest performance (ICC = 0.97, FRP = 0.90), followed by the other vanishing sets (Sloan ICC = 0.88, FRP = 0.74; Landolt ICC = 0.86, FRP = 0.80). Within the regular format, TAO again outperformed the existing sets (TAO ICC = 0.77, FRP = 0.75; Sloan ICC = 0.65, FRP = 0.64; Landolt ICC = 0.48, FRP = 0.63). For adults with normal visual acuity, the new optotypes (in both regular and vanishing formats) are more equally legible and sensitive to subtle individual differences than their Sloan counterparts. As this set does not require observers to be able to name Roman letters, and is freely available to use and modify, it may have wide application for measurement of acuity.

Prosthetic eyes are currently manufactured using Poly(methyl methacrylate) (PMMA) which is not an ideal material because it is hydrophobic. While significant research has investigated the benefits of hydrophilic materials for contact lenses, no such research has been carried out on hydrophilic materials for prosthetic eyes until now. In this study, different derivatives of Poly(ethylene glycol) (PEG) monomer and methyl methacrylate (MMA) monomer were grafted to PMMA using copolymerisation. The resulting matrixes were evaluated by water contact angle measurement, 24 h water absorption testing, and colour-difference measurement when exposed to ultraviolet light. The contact angle and water absorption results indicated that ethylene glycol dimethacrylate (EGDMA) grafted PMMA matrix had a better hydrophilic performance than the other matrixes tested. EGDMA is already a minor constituent of the PMMA matrix currently used for manufacturing prosthetic eyes but when the proportion of EGDMA monomer to MMA monomer used in the manufacturing process was increased to 50/50 the hydrophilicity of the matrix was significantly improved. EGDMA-grafted PMMA is inexpensive and comes as a liquid monomer that is easily mixed with the PMMA monomer that ocular prosthetists are familiar with. The mixture requires no special handling beyond the normal safety precautions that apply when using PMMA monomers. In-vitro testing shows that EGDMA-grafted PMMA significantly improves the wettability of PMMA currently used for the manufacture of prosthetic eyes and has the potential to significantly improve wearing comfort and socket health.

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