Dynamic Purkinje Meter as a Tool for Intraocular Lens Position Measurement

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

It's crucial to emphasize that while the technical content demonstrates significant merit, enhancing the linguistic precision could substantially improve the manuscript's overall clarity and impact. Here are some detailed suggestions for revision:

1. The manuscript occasionally fluctuates between past and present tense, which may confuse readers regarding the timeline of events or the current state of knowledge. For instance, sentences like "The IOL tilt was defined with a formula (1) for the magnitude α and with a formula (2) for the direction β described in section 2.4." juxtapose past tense ("was defined") with present tense ("described"). A consistent use of the past tense for completed actions and present tense for general facts or ongoing actions is recommended.

2. There are instances where the sentence structure could be streamlined for better readability. For example, complex sentences with multiple clauses may benefit from being broken down into simpler, more concise sentences. This would aid in conveying the technical details more clearly and make the manuscript accessible to a broader readership.

3. Certain sections could benefit from more precise language to accurately convey technical details. For instance, terms like "the device was based on the work of Phillips et al." could be more explicitly connected to the specific methodologies or findings from the cited work that influenced the device's development.

4. The frequent use of passive voice ("a method was developed", "the device was based") makes some sections less engaging and more difficult to follow. Where appropriate, transitioning to an active voice could make the narrative more dynamic and clear.

5. It's essential to maintain consistency in the use of technical terms and abbreviations throughout the manuscript. This includes the consistent use of either the full term or its abbreviation after the first instance where it is defined.

6. The manuscript offers an insightful exploration into the dynamic Purkinje-meter's application. Nonetheless, the technical exposition of the device's operational mechanics warrants further elaboration. Specifically, a more granular breakdown of the device's components, their interplay, and the underpinning optical principles would enrich the reader's comprehension. Incorporating schematic diagrams or enhanced visual aids could substantially aid in demystifying the complex interactions within the device.

7. The comparative assessment of the dynamic Purkinje-meter against static variants provides valuable insights. However, this comparison could be expanded to encompass a broader spectrum of existing methodologies, such as those outlined in "Heterogeneous Network Representation Learning Approach for Ethereum Identity Identification" and "Online Policy Learning-Based Output-Feedback Optimal Control of Continuous-Time Systems." These references, while seemingly disparate, touch upon the principles of dynamic system analysis and optimization, which are tangentially relevant to the manuscript's core focus on dynamic measurement systems.

8. While the manuscript delineates the novel aspects of the dynamic Purkinje-meter, it stops short of a comprehensive discourse on its practical implications within the field of ophthalmology. An in-depth discussion regarding how this innovation propels the current state-of-the-art forward, particularly in addressing extant challenges in IOL positioning accuracy and patient outcomes, would significantly bolster the manuscript's impact narrative.

9. The experimental section detailing the device's calibration and operational protocol is well-articulated. However, the manuscript would benefit from a more robust statistical analysis segment, delineating the precision, repeatability, and potential sources of error inherent in the measurement process. Such an enhancement would lend greater credence to the findings and facilitate their applicability in clinical settings.

10. Given the device's direct interaction with patients, a more thorough discourse on the safety protocols, patient consent processes, and ethical considerations undertaken during the device's development and testing phases is imperative. This is particularly pertinent in light of the increasing regulatory scrutiny and ethical mandates governing medical device innovation.

11. The manuscript concludes with a succinct summary of the findings and their implications. Augmenting this section with a forward-looking perspective on potential device iterations, scalability issues, and integration into existing diagnostic frameworks would provide a holistic view of the dynamic Purkinje-meter's trajectory within the biomedical engineering domain.

Author Response

To Inventions’ editor and the reviewers:

Dear reviewers,

 

We extend our heartfelt gratitude to you for your stimulating comments and suggestions, which have enhanced the validity of our invention.

Thorough evaluations and insightful feedback reflect a deep understanding and dedication to advancing knowledge in our field. We sincerely appreciate the time and your effort to invest in reviewing our work, and we honour the critical role they play in refining and improving academic discourse. Their contributions have been indispensable to the quality of our publication.

Please see below the responses and notes to the comments:

 

Review Report n°1

It's crucial to emphasize that while the technical content demonstrates significant merit, enhancing the linguistic precision could substantially improve the manuscript's overall clarity and impact. Here are some detailed suggestions for revision:

1. The manuscript occasionally fluctuates between past and present tense, which may confuse readers regarding the timeline of events or the current state of knowledge. For instance, sentences like "The IOL tilt was defined with a formula (1) for the magnitude α and with a formula (2) for the direction β described in section 2.4." juxtapose past tense ("was defined") with present tense ("described"). A consistent use of the past tense for completed actions and present tense for general facts or ongoing actions is recommended.
   --- Thank you for letting us know. Based on the reviewer's recommendations, the text has been changed. Please see the highlighted linguistic corrections(Yellow) in the text.
2. There are instances where the sentence structure could be streamlined for better readability. For example, complex sentences with multiple clauses may benefit from being broken down into simpler, more concise sentences. This would aid in conveying the technical details more clearly and make the manuscript accessible to a broader readership.
   --- Thank you for the notice. Based on the reviewer's recommendations, the text has been changed. Please see the highlighted linguistic corrections(Yellow) in the text.
3. Certain sections could benefit from more precise language to accurately convey technical details. For instance, terms like "the device was based on the work of Phillips et al." could be more explicitly connected to the specific methodologies or findings from the cited work that influenced the device's development.
   --- Thank you for your thought-provoking comment. The texts have been corrected. Please, see the changes in section 2.1 (lines 93-95)
4. The frequent use of passive voice ("a method was developed", "the device was based") makes some sections less engaging and more difficult to follow. Where appropriate, transitioning to an active voice could make the narrative more dynamic and clear.
   --- Thank you for your thought-provoking comment. Please see the highlighted linguistic corrections(Yellow) in the text.
5. It's essential to maintain consistency in the use of technical terms and abbreviations throughout the manuscript. This includes the consistent use of either the full term or its abbreviation after the first instance where it is defined.
   --- Thank you for this important point. Changes are highlighted in green colour in the manuscript. For the abbreviation „IOL“, I kept the explanation of the full term in the Abstract, in the Keywords and in first use in the main text.
6. The manuscript offers an insightful exploration into the dynamic Purkinje-meter's application. Nonetheless, the technical exposition of the device's operational mechanics warrants further elaboration. Specifically, a more granular breakdown of the device's components, their interplay, and the underpinning optical principles would enrich the reader's comprehension. Incorporating schematic diagrams or enhanced visual aids could substantially aid in demystifying the complex interactions within the device.
   --- Thank you for your feedback. The description of the system has been completed and improved to increase the meaningfulness of the whole text. Please, see the edited (coloured) text in section 2.2 (lines 130-133) and the added figure 4 in section 2.4.
7. The comparative assessment of the dynamic Purkinje-meter against static variants provides valuable insights. However, this comparison could be expanded to encompass a broader spectrum of existing methodologies, such as those outlined in "Heterogeneous Network Representation Learning Approach for Ethereum Identity Identification" and "Online Policy Learning-Based Output-Feedback Optimal Control of Continuous-Time Systems." These references, while seemingly disparate, touch upon the principles of dynamic system analysis and optimization, which are tangentially relevant to the manuscript's core focus on dynamic measurement systems.

--- Thank you for the interesting suggestion. The main aim of the communication is to present the innovative Dynamic Purkinje-meter as a tool for intraocular lens position measurement. The leading target group of users are healthcare professionals, opticians and optometrists. With respect, the proposed suggestions would complicate the overall concept of written communication at this point.

8. While the manuscript delineates the novel aspects of the dynamic Purkinje-meter, it stops short of a comprehensive discourse on its practical implications within the field of ophthalmology. An in-depth discussion regarding how this innovation propels the current state-of-the-art forward, particularly in addressing extant challenges in IOL positioning accuracy and patient outcomes, would significantly bolster the manuscript's impact narrative.
   --- Yes, we agree with your comment. We have expanded this area. Please, see the edited discussion and especially the added section 5. Conclusion. Changes are marked in colour.
9. The experimental section detailing the device's calibration and operational protocol is well-articulated. However, the manuscript would benefit from a more robust statistical analysis segment, delineating the precision, repeatability, and potential sources of error inherent in the measurement process. Such an enhancement would lend greater credence to the findings and facilitate their applicability in clinical settings.
   --- Please, see the answer for the comment n°7 of the Reviewer n°2.

--- The concept of the results was changed. Instead of a largely detailed case report, a group containing 24 pseudophakic eyes with spherical IOL was analysed, and one outlier was commented more in detail. Please, see the added section 2.6. (Methods) + a whole revised section of Results + partially edited discussion (lines 366-369, 377-391).

 

10. Given the device's direct interaction with patients, a more thorough discourse on the safety protocols, patient consent processes, and ethical considerations undertaken during the device's development and testing phases is imperative. This is particularly pertinent in light of the increasing regulatory scrutiny and ethical mandates governing medical device Innovation.
    --- The study was approved by the Ethics Committee for Multi-Centric Clinical Trials of the University Hospital Motol and Second Faculty of Medicine, Charles University in Prague, Czech Republic (reference No. EK – 1019/23). All patients were informed about the nature of the study and signed an informed consent to participate in this study. (Mentioned in the 2nd paragraph of the section 2.6.)

--- The Dynamic Purkinje-meter is a noninvasive device, and its design has taken into account all safety aspects relevant to devices of the same category. To ensure the safety of the examinees, the instrument was powered from a galvanically isolated system to minimize the risk from leakage currents, etc. 

11. The manuscript concludes with a succinct summary of the findings and their implications. Augmenting this section with a forward-looking perspective on potential device iterations, scalability issues, and integration into existing diagnostic frameworks would provide a holistic view of the dynamic Purkinje-meter's trajectory within the biomedical engineering domain.
    --- Thank you for your comment. Please, see the added and extended section 5. Conclusion.

I believe that the message of the paper is now clear and appropriate for publication in Inventions.

 

Kind regards,

 

Eliška Palkovičová

Petr Kudrna

Reviewer 2 Report

Comments and Suggestions for Authors

The current manuscript aims to report the development of dynamic Purkinje-meter as a tool for intraocular lens position measurement. Although the topic is interesting in its scientific field, there are some issues that require the authors’ attention to improve the quality of this particular manuscript before further consideration for publication in a high-quality journal “Inventions”.

 

Specific comments:

 

1.      In 1993, Cendelin and colleagues introduced the concept of the Purkinje-meter. However, I wonder whether any enhancements of this technology are proposed since then. Over such an extended period, why no advancements are made in the dynamic Purkinje-meter? This reviewer suggests a deeper exploration of the challenges and opportunities in developing and updating diagnostic instruments like the Purkinje-meter to balance scientific viewpoint.

2.      How to validate the accuracy of the dynamic Purkinje-meter’s measurements according to other established methods? Please specify.

3.      What were the specific reasons for choosing the particular dimensions and configurations (i.e., the 44 cm diameter rotatable disc) in the upgraded device design? Please clarify.

4.      Whether the dynamic Purkinje-meter can exhibit advantages than other IOL position measurement techniques in terms of precision, ease of use, and cost? The authors’ motivation for upgrading the Purkinje gauge is unclear. Please clarify.

5.      Please directly mark A, B, C, and D on the images in Figures 3a and 4a.

6.      Please describe the statistical methods used to analyze the data collected with the dynamic Purkinje-meter. Ho were outliers handled?

7.      The study gives the results from a single case to demonstrate the capabilities of the dynamic Purkinje-meter. But, it is indeed a shortcoming to include only one patient in this report. Could you please provide the evidences from a larger cohort of patients to validate the reproducibility of the measurement technique across diverse patient demographics and IOL types?

8.      As mentioned in the Introduction section, in most cases, it is an age-related, physiological process causing a progressive deterioration of visual acuity, which can lead to a complete vision loss. If possible, the authors are highly recommended to consider the inclusion of the following example case study (DOI: 10.1016/j.jcrs.2005.12.071) in the reference list to support this important claim.

Author Response

To Inventions’ editor and the reviewers:

Dear reviewers,

We extend our heartfelt gratitude to you for your stimulating comments and suggestions, which have enhanced the validity of our invention.

Thorough evaluations and insightful feedback reflect a deep understanding and dedication to advancing knowledge in our field. We sincerely appreciate the time and your effort to invest in reviewing our work, and we honour the critical role they play in refining and improving academic discourse. Their contributions have been indispensable to the quality of our publication.

Please see below the responses and notes to the comments:

The current manuscript aims to report the development of dynamic Purkinje-meter as a tool for intraocular lens position measurement. Although the topic is interesting in its scientific field, there are some issues that require the authors’ attention to improve the quality of this particular manuscript before further consideration for publication in a high-quality journal “Inventions”.

1. In 1993, Cendelin and colleagues introduced the concept of the Purkinje-meter. However, I wonder whether any enhancements of this technology are proposed since then. Over such an extended period, why no advancements are made in the dynamic Purkinje-meter? This reviewer suggests a deeper exploration of the challenges and opportunities in developing and updating diagnostic instruments like the Purkinje-meter to balance scientific viewpoint.
   --- Thank you for asking the right question. After the first publication of the Purkinje meter, Dr. Cendelin started to deal with other topics and changed workplaces, which is why there were no advancements in the dynamic Purkinje meter for such a long period. It is well known that it is easier to use commercially available devices than to develop new devices for clinical practice. Only years later, E. Palkovicova started her doctoral studies, which was an opportunity to reopen this issue. The result is presented in this paper.
2. How to validate the accuracy of the dynamic Purkinje-meter’s measurements according to other established methods? Please specify.
   --- The accuracy of the dynamic Purkinje-meter’s measurements according to other established methods is mentioned in the Results while dealing with the “outlier”. It is possible to compare the values measured by Purkinje-meter with the values from a commercially available AS OCT CASIA2. There are some other established methods for IOL position determination, such as Scheimpflug systems (Pentacam), OCT (IOL Master = biometry), UBM, but the verification is questionable as the reference structures are not universal. Only CASIA2 uses the visual axis as reference, as well as in case of the dynamic Purkinje-meter. An example of comparing CASIA2 and Dynamic Purkinje meter is shown in Table. 2
3. What were the specific reasons for choosing the particular dimensions and configurations (i.e., the 44 cm diameter rotatable disc) in the upgraded device design? Please clarify.
   --- Please see the edited beginning of section 2.2 (lines 137-141), where the explanation is.
4. Whether the dynamic Purkinje-meter can exhibit advantages than other IOL position measurement techniques in terms of precision, ease of use, and cost? The authors’ motivation for upgrading the Purkinje gauge is unclear. Please clarify.
   --- Apart from so-called Purkinje-meters, the commercially available methods are associated with expensive instrumentation, as mentioned in the 3rd paragraph of the Introduction. So, the motivation for upgrading the dynamic Purkinje-meter was to assemble a device that, with its favourable price, would be available for more workplaces, e.g. for research purposes.
   --- The advantage of commercially available methods is undoubtedly the “friendliness” of the user interface – commercially available instruments are largely automated, and the measurements tend to be fast. With Purkinje-meters, the device operation is not so intuitive and requires a certain experience of the examiner, moreover, the examination is more time-consuming than with commercial devices. However, the advantages of commercially available devices come at the cost of instrumentation.
   --- As for the post-processing of the image, CASIA2 is the only device that can detect and evaluate the position of the IOL automatically, however, it is always necessary to check the IOL border detected by the device in all 16 cross-sections of the anterior segment and, if necessary, adjust it manually, which in our case was necessary in most cross-sections, and this editing also takes some time. For other methods, the resulting data on the IOL position needs to be calculated manually or with the help of additional software.
5. Please directly mark A, B, C, and D on the images in Figures 3a and 4a.
   --- Please, see the edited figures.
6. Please describe the statistical methods used to analyze the data collected with the dynamic Purkinje-meter. Ho were outliers handled?
   --- Please, see the comment n°7 – the answers for the comments n°6 a 7 are merged.
7. The study gives the results from a single case to demonstrate the capabilities of the dynamic Purkinje-meter. But, it is indeed a shortcoming to include only one patient in this report. Could you please provide the evidences from a larger cohort of patients to validate the reproducibility of the measurement technique across diverse patient demographics and IOL types?
   --- The concept of the results was changed. Instead of a largely detailed case report, a group containing 24 pseudophakic eyes with spherical IOL was analysed, and one outlier was commented more in detail. Please, see the added section 2.6. (Methods) + a whole revised section of Results + partially edited discussion (lines 366-369, 377-391).
8. As mentioned in the Introduction section, in most cases, it is an age-related, physiological process causing a progressive deterioration of visual acuity, which can lead to a complete vision loss. If possible, the authors are highly recommended to consider the inclusion of the following example case study (DOI: 10.1016/j.jcrs.2005.12.071) in the reference list to support this important claim.
   --- I apologize, but is this really the correct article link? From my point of view, I do not see a connection here between cataract as a physiological process causing a progressive deterioration of visual acuity and endophthalmitis as a postoperative complication after cataract surgery.

 

Note: The references n°17 and n°18 were edited (in the text and in the reference list).

 

I believe that the message of the paper is now clear and appropriate for publication in Inventions.

 

Kind regards,

 

Eliška Palkovičová

Petr Kudrna

 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

It can be accpted. 

Reviewer 2 Report

Comments and Suggestions for Authors

The revised version has adequately addressed most of the critiques raised by this reviewer