This blog is long overdue. There has much written and spoken concerning our study over the last couple of years. Most has been accurate, but some not. In this blog I want to set the record straight concerning our study design, the results and even the consequences of solution-induced staining. I've listed 9 common misstatements or points of confusion and articulated what I hope is a common sense, clinically sound response. Throughout the blog I've placed hyperlinks referencing facts and study results, not just opinions. Also, especially relevant statements have been italicized for emphasis.

1) The vast majority of patients, even non-CL wearers, exhibit corneal staining.
This argument has been frequently proposed as proof that staining is "natural phenomenon" and is therefore not important. The answer lies in quantity.

Let's consider what is meant by "STAINING". At our baseline examination we examine all subjects who have abstained from lens wear for at least 12 hours. Within this group I often see some staining, typically a few dots. An analysis of our baseline data shows that the average population of subjects entering our study shows 0.6% staining area. Of course, this level of staining spread over an entire corneal is barely noticeable and most likely clinically insignificant, yet in the above argument it is still staining.

Our study shows that solution-induced staining can vary widely, ranging from a few insignificant dots to many thousands of dots spread densely over the cornea. For this reason on the Staining Grid we chose to report, not only the presence or absence of staining, but the amount of staining (i.e., percentage of corneal area covered with staining). Beyond that, the Staining Grid is color-coded so the user can easily identify which lens/solution combinations are inducing moderate (yellow) and high (red) amounts of staining. Finally, the web site includes photos of actual stained corneas observed in our study allowing the readers to apply their own criteria of clinical significance. While I agree that most people will exhibit a few dots of staining it is the goal of our study to identify cases where staining is severe enough to be a clinical concern.

2) Most staining is grade 1, micropunctate, and therefore clinically insignificant.
This statement tries to equate 3 different terms commonly used in ophthalmic practice; "grade 1", "micropunctate", and "clinically insignificant". Let's discuss each term.
The confusion starts with the term "Grade 1" which really has two meanings. To the eye care practitioner Grade 1 is a loosely used term to imply a condition which is minor, irrelevant and insignificant. On the other hand to researchers (including us) and the FDA Grade 1 denotes a type of staining, in this case "micropunctate" (i.e., individual dots). It says nothing about the quantity of that staining. These two, very different meanings of Grade 1 can create confusion. These photos from our study show that micropunctate (i.e., individual dots) staining can be either clinically insignificant or extremely significant depending upon the quantity of that staining. Again, that is why we report the quantity (i.e., staining area) versus a more simple, yet more confusing "Grade x" scale on the Staining Grid.

3) Solution-induced staining is asymptomatic and therefore not important.
Some (not all) early published reports of solution-induced staining described it as "asymptomatic". Our research has shown that low to moderate amounts of staining (i.e., less than 20% corneal area) are relatively asymptomatic, due in part to the bandage lens-effect. However, as staining becomes more widespread across the cornea subjective irritation is nearly universally experienced. This is conclusively shown in a chart of staining area versus subjective comfort. The trend line shows that, in general, as staining area (X-axis) increases subject comfort ratings (Y-axis) decreases. This difference is often more than 20 point (on a 100-point scale) for heavy staining.

4) Solution-induced staining is transient and therefore not important.
Fortunately, it is correct that the solution-induced staining which we observe is transient. But if you think about it, all staining eventually resolves. The real issue lies in the frequency of this staining and the time required for resolution.
We have measured this time to resolution over a 12-hour wearing period for one highly staining lens/solution combination, Renu Multiplus and Purevision. An analysis of staining area over time shows that staining peaks 2 hours after lens insertion and then begins to gradually resolve. However, the staining remains statistically greater than saline-induced staining for 12 hours. More clinically relevant is that fact that Renu/Purevision staining remains at or above 10% staining area for approximately 7 hours EACH DAY.

5) Solution-induced staining has not been definitely proven to be a direct risk factor in microbial keratitis and therefore is not important.
It is correct that there has been no definitive, peer-reviewed study proving that solution-induced staining directly increases the risk of corneal infection. On the other hand there has been no study showing that it doesn't. Realistically, there will probably never be such a prospective study since infection rates are so low (i.e., a few cases per 100,000 wearers per year) that a prohibitively large study would be required.
With our admittedly incomplete knowledge of the risk factors and mechanisms for corneal infection we, as highly trained professionals, are therefore required to rely on our ophthalmic education, clinical experiences, textbooks on corneal pathology, and common sense in determining how we view staining in the scheme of maintaining ocular health. Keep in mind that GPC, contact lens-induced dry eye, conjunctival injection, and excessive 3 to 9 o'clock staining are all conditions which do not appear to increase the risk for infections yet we try to minimize them whenever possible. How is solution-induced staining different?

6) Staining measured at 2 and 4 hours after lens insertion does not reflect long-term results.
Our study and several others have conclusively shown that solution-induced staining peaks around 2-hours after lens insertion. This early day timing is not surprising since the mechanism of this staining is irritation from preservatives released from the lens after overnight soaking. Previous published research by Jones (see Table 2) has shown that solution-induced staining is similar at day 1and day 14. Therefore, we chose to measure staining early in the wearing period and report 2-hour results on the Staining Grid.
Recently, a study was published by the Institute for Eye Research (IER) looking at staining induced by 16 lens/solution combinations used for 3 months. In the scatter plot comparison of the IER study with our study the relatively close alignment of the points to the trend line indicates that their study results correlate highly with ours. Based upon studies by both Jones and the IER group it has now been conclusively established that staining observed after 2-hour on the first day of lens wear is an excellent predictor of long-terms staining results.

7) Our study (sample size) is too small to be meaningful.
It has been occasionally misstated that our study includes 30 subjects. In reality our study tests 30 subjects for EACH lens/solution combination. To date, a total of 2,807 non-unique subjects have been tested over a 2-year period. Very few ocular studies include a sample size this large.

8) Our study population represents a cross-section of a typical practice.
At first glance one would think that a study of over 2,000 subjects would represent a good cross-section of a typical clinical practice. However, due to restrictions of the Institutional Review Board (IRB) which oversees our study, subjects experiencing several relatively common conditions must be excluded. Some of these conditions include:
a) baseline staining in two or more corneal regions
b) macropunctate staining anywhere on the cornea
c) active and/or clinically significant anterior segment conditions including dry eye, ocular allergies, GPC, conjunctival injection, blepharitis, iritis, etc.
d) hypersensitivity to any components of a multipurpose solution
e) evidence of active viral or bacterial infections
f) functionally monocular subjects
g) pregnant for lactating subjects
h) diabetic subjects.

Therefore, our subject population is indicative of the "healthiest" subset of patients in your practice. Due to these IRB restrictions our results probably represent a best case scenario of staining results. In clinical practice you do not have the luxury of pre-screening and excluding high-risk patients.

9) Bausch & Lomb sued Dr. Andrasko over this study.
In 2007 Bausch & Lomb sued Alcon Laboratories over their interpretation of our study results in their promotional materials. One of the main points of contention was the particular colors used to denote high amounts of staining. Alcon and B & L eventually settled the suit. For details of lawsuit and settlement click here.

I have not been sued over our study or its results. On our web site and in my lectures and writings I am careful to base any conclusions on results from either our study or other peer-reviewed publications. Eye care practitioners should consider our study results as well as the totality of their clinical experiences when prescribing an appropriate lens care products for each patient.

There will undoubted be more written concerning our study debating both sides of the issues. However, I hope that this admittedly lengthy blog will serve as reference conveying the facts about our study and a common sense approach to apply them.

It's been about 2 years since we began testing the biocompatibility of various lens/solution combinations. This web site just passed a milestone, 75,000 hits. We have just completed testing of the "relaunched" Complete MPS® Easy Rub. To-date we've tested 94 different combinations. More testing is planned for 2008.

Excluding saline and the recalled solutions, 67% of the combinations fell in the Green zone (<10% staining area), 11% fell in the Yellow zone (10% - 20% staining area), and 22% in the Red zone (>20% staining area). By observing the amount of green on the Staining Grid it is obvious that there are plenty of biocompatible choices available. My hope for the future is that the next generation of multipurpose solutions will entirely fall within the Green zone. We're already seeing that trend with AMO's recently launched Complete® EZ Rub solution showing better biocompatibility than its recalled predecessor.

At a recent seminar I presented our study results and was then followed by a speaker who mentioned that our work was "obviously suspect" since it was mainly sponsored by one company. That brings up an interesting question for discussion... In general, should industry-sponsored research be trusted?

In my opinion the short answer is... Yes, but understand all the variables. Over 27 years of performing industry-sponsored contact lens research I'm happy to report that I've never been asked to manufacture, skew, or in any way influence results of a study to make a product look favorable. However, each eye care practitioner should understand how industry-sponsored research works. When a company suspects that one of their products is superior in some area to its competitor's it commissions a study using "independent" (non-company employee) researchers. (Who would believe research done by company employees?) If the company's theory is true and the research is done correctly it will likely show the suspected results. (Sometimes it doesn't possibly because the original hypothesis was wrong, the research was not done correctly, or the effect was too small given the sample size.)

Should you believe industry-sponsored research? That is a question each reader needs to answer for themselves on a case-by-case basis. Here is how I analyze all research results:
1) First and most important.....Listen to comments from industry (both pro and con) while understanding their agenda. Each company wants to sell their products...period! Their comments and opinions of the research typically reflect how their own products performed in the study. Examples from our study
2) Evaluate the credibility of the researchers. What is their research background? How long have they done clinical research? Was their previous work credible? Relevance to our study
3) Evaluate the study design. Did it follow the accepted principles of good study design including (double) masking, randomization, adequate sample size, etc. Relevance to our study
4) Evaluate the results for yourself. Do they seem consistent with your own clinical experiences? Can you duplicate the results, even on a smaller scale, in your practice? An easy demonstration
5) Have similar results been previously shown? List of previous staining literature
6) Are the results clinically relevant in your practice? An improvement in comfort ratings of 3 points (on a 100-point scale) may be statistically significant but not clinically relevant. Clinical relevance explanation
7) Do the researchers offer a credible explanation for the results? Do the results and explanation make sense based upon of your knowledge of the topic? Explanation of staining mechanisms
8) Discuss the research with your colleagues. What is their "take" on the results? Are they arriving at similar conclusions as you?

I encourage you to scrutinize all research, including ours, following these simple principles. Hopefully our research has made your task as a contact lens fitter a little easier. Your input to our web site via the Contact Us page is always welcomed.

I want to bring your attention to an article on Solution-Induced Corneal Staining (SICS) published in the September 2007 issue of Contact Lens Spectrum. This article by 8 prominent researchers from the prestigious Institute for Eye Research (IER) in Australia reports on corneal staining found in 16 lens/solution combinations. The main differences between the IER study and ours are the time in which subjects wore lenses and the outcome reported. Our study looks for staining during the first day the lens/solution combination is worn. The IER study looks at staining various times during a 3-month wearing period. Another notable difference is that the IER study measures the percent of subjects experiencing solution-induced staining while ours reports average corneal staining area for each combination tested. Other differences including masking, control solution, criteria for color coding, the time of day subjects were examined and number of observers are summarized in a comparison table.

Even noting these many differences between the two studies the results are amazing similar. The peroxide solution tested in both studies induces very little staining.The multipurpose solutions tested in the IER study (Aquify, Opti-free Express, and Opti-free Replenish) induce various degrees of relatively low staining depending upon which lens they are paired.

Since the IER study reports percent of subjects while our study reports staining area the results of these two studies cannot be compared directly. In order to determine if our 2-hour staining observations correlate with the IER long-term (3 month) staining results I preformed a data conversion and analysis of our data. For the 16 combinations tested by IER I calculated the percent of subjects showing either yellow or red zone staining from our study. (This information is readily available on the "details page" of each combination by clicking on the percentage shown in any cell of the grid.) I then plotted the IER results versus our results for each of these 16 combinations.

In a scatter plot when the points are aligned close to a trend line then the two studies are highly correlated. In the scatter plot comparison of the IER study with our study the relatively close alignment of the points to the trend line indicates that staining observed at 2 hours after insertion on the first day of lens wear (our study) is highly predictive of long-term staining results (IER study). The abilixty of 2 hour staining observations to predict longer term staining results was also shown in a recent study by Jones, et al entitled, "The Impact Of Post-Insertion Time On Corneal Staining And Comfort With Group II Hydrogel Materials Disinfected With Various Lens Care Regimens". My sincere thanks to the researchers of the IER and (all study sponsors) for undertaking such a demanding and extensive study.

I've just returned from the AOA Congress. Upon speaking with many practitioners I was struck by a couple of things. Nearly every practicing optometrist (as opposed to industry-based optometrists) commented that the Staining Grid was a very useful tool in their practice. Many told me that it is bookmarked on their computer and they routinely show it to patients to emphasize compliance. As you might expect, industry-based optometrists are either the biggest advocates or the biggest critics of the Staining Grid depending on which company they work for...No surprise there! One topic which has been somewhat misunderstood is the origin and meaning of the green-yellow-red color coding employed on the Staining Grid.

Why color-code the Staining Grid?
There were essentially two purposes for using a color coded instead of a black-and-white grid. First, color allows the user to quickly determine how a particular lens/solution combination fares compared to other combinations tested. Secondly, the color coding reveals patterns in the amount of staining area observed across the grid. For example, Polyquad and peroxide-based solutions staining typically stain less than biguanide-based (PHMB) solutions. Another pattern is that surface-treated silicone/hydrogel lenses tend to staining more than non-surface-treated ones. These trends would not be as evident simply by looking at a table of numbers.

How were the color-coding ranges determined?
In the 29 years since graduation from optometry school I've been an instructor in the contact lens clinic at OSU, director of that clinic for a few years, and director of a contact lens research practice for the last 17 years. Over my career I've observed the corneas of tens of thousands of hydrogel lens wearers. The color coding employed on the Staining Grid is a general observation of staining severity based upon the totality of my teaching, practice and research experiences.

How is the color-coding relevant to the needs of your individual patients?
The color coding on the web site represents a starting point for assessing the various degrees of staining area for each lens/solution combination. The actual percentage of staining area for each combination is also displayed. Using this information the eye care practitioner should determine the clinical significance of various levels of corneal staining for their patients based upon the consideration of individual factors. Just as 120/80 is considered an overall guideline for blood pressure, most physicians would apply a different standard for a healthy 16-year old boy versus an 85-year old diabetic man with pre-existing vascular pathology. The same is true for staining. The Staining Grid provides initial guidelines. You, as the eye care practitioner legally and ethically responsible for rendering eye care services, should apply your own "mental color coding" for each individual patient after considering several factors such as general ocular health, lens care compliance history, wearing schedules, and other pertinent risk factors.

I've recently returned from the British Contact Lens Association (BCLA) meeting in Manchester, UK. This is reported to be the largest meeting in the world focusing only on contact lenses. Not surprisingly the hot topic was the recent recall of AMO Complete MoisturePlus solution and its link to a disproportionate number of acanthamoeba infections. Several questions and themes tended to recur in the various lectures. Are other multipurpose solutions going to be implicated? Is No Rub really a good idea? Should all patients be switched to a hydrogen peroxide-based disinfection system? What can practitioners do to protect their patients from all types of microbial keratitis? Based on what I have come to understand here are some answers to these questions.

Are other multipurpose solutions going to be implicated?
As of this time the U.S. Center for Disease Control and Prevention (CDC) has not released any evidence that other multipurpose solutions are deficient in their ability to control acanthamoeba. In their update of June 8, 2007 they state, The preliminary analysis of the reported use of other brands of contact lens solution did not reveal any significant associations.

Is No Rub really a good idea?
No Rub method of lens care was an interesting experiment. Results of several studies indicate that rubbing and rinsing the contact lens before storage effectively removes several log units of microorganisms from the lens surface. The remaining bugs are then effectively killed by the disinfecting solution. Based upon what we know today Rub and Rinse should undoubtedly be the standard.

Should all patients be switched to a hydrogen peroxide-based disinfection system?
Hydrogen peroxide is effective against acanthamoeba if the disinfecting solution is at full strength for a 4-hour soak. Current one-step systems begin to neutralize immediately upon contact with the disk. A two-step system where the patient delays inserting a neutralizing tablet for at least 4 hours would be ideal but probably not practical based upon the history of dubious patient compliance.

What can practitioners do to protect their patients from all types of microbial keratitis?
In short there are no procedures or lens care regimens which offer 100% assurance that a patient won't suffer a microbial infection. As with all aspects of medicine we are limited to minimizing the risk factors, both known and suspected. Review and emphasize with patients the necessity of strict adherence to all cleaning and disinfecting instructions. Also review the importance of hand washing, sticking to the prescribed wearing schedule (i.e., daily wear, flexible wear, etc.) and other known risk factors such as smoking and ocular exposure to contaminated water supplies. Finally, carefully examine contact lens wearers for corneal staining, infiltrates, chronic hyperemia, and tear film deficiencies.

The surprising infections and recalls of the last two years indicate there is still much we don't understand concerning contact lens care and effective disinfection. It is more crucial than ever that we adopt a cautious and conservative approach to lens care. Minimizing all risk factors, staining being an obvious one, is essential to maintaining happy, healthy patients.

A new web site was recently launched, www.StainingGrid-Japan.com. Dr. Itoi, a highly respected Japanese ophthalmologist and researcher, has published his own lens/solution biocompatibility research. He has tested 3 lens materials (O2 Optix, Acuvue Advance, Acuvue Oasys) with 8 multipurpose solutions available in Japan. He tests 15 subjects for each combination and reports a score representing Staining Area X Density. He also codes his results using the same colors as we use but adds BLUE representing very low, saline-like staining. The third tab on his site shows his actual staining grid.

Where identical products have been tested, Dr. Itoi's results basically mirror ours. The hydrogen peroxide solutions (Clear Care on our site, AOSept on his) induces very little staining with all lenses. The Optifree product which he tests (essentially Optifree Replenish without Aldox) also induces very little staining. The various PHMB (biguanide) results, like ours, show a range of staining.

With all due respect to Dr. Itoi, you may be reading this and thinking, "So what?" The true test of the validity of any research is whether it can be duplicated by independent researchers. Dr. Itoi's work was done on a different continent using a slightly different grading metric. Despite these differences the bottom line is...Where similar products were tested, similar results were found. Dr. Itoi and I may occasionally differ in a red or yellow zone (his color coding is stricter than mine) but the overall trends are very consistent.

Dr. Itoi's excellent work is the third independent study showing similar lens/solution biocompatibility results. (A paper entitled, Evaluation of Solution Toxicity with Lens Care Products During Silicone Hydrogel Lens Wear by Tilia, Jalbert, Keay, Naduvilath, Wilcox, Holden, Papas, and Carnt presented at the 2006 American Acad. Of Optometry was the second study.) It's becoming increasingly difficult for the few (companies) denying that solution-toxicity staining really exists to maintain credibility. Should solution manufacturers step up and actively warn users (practitioners and wearers) when significant red zone staining exists with their product and a particular lens?

In the last couple of months two articles have been published in Contact Lens Spectrum discussing our study and the specifics of the grading scales which we use. Not surprisingly both articles were either written or funded by solution manufacturers whose products induce various degrees of corneal staining with some lens materials.

In the first article (written based upon a grant from Bausch & Lomb, manufacturer of Renu Multiplus) Dr. Milton Hom proposes some unlikely scenarios. In one example he concludes that the location of staining on the cornea affects our final grading amount. He also states that 29 dots of staining would be graded completely differently than 30 dots. For the record, neither of these statements are true. Surprisingly, Dr. Hom has never asked me about the specifics of our grading scale criteria or if his assumptions were actually true. Even more interesting is Dr. Hom's attempt to divert attention to cases of insignificant staining (i.e., 30 dots) while leaving the real problem unmentioned.

In a second, more balanced article Drs. Lasswell, Huth, and Tran, all employees of AMO (manufacturer of Complete MoisturePlus), discuss the various corneal staining grading scales available to researchers. They correctly point out that our study uses a modified version of the CCLRU scale. Since the vast majority of solution-toxicity staining is micropunctate (type) and superficial epithelial (depth) we chosen to make this modification to better focus on staining AREA. Dr. Lasswell also correctly illustrates one of the major strengths of our study design. With only one observer throughout the entire study we eliminate all inter-observer variability, a major source of error in other studies.

Dr. Lasswell does point out one apparent inconsistency in our study which bears explanation. The first published version of the Staining Grid (April 2006) was based upon a pilot study with a sample size of 9-14 for each lens/solution combination. We quickly realized the significance of our work and decided, at major cost and time commitment, to redo the entire study using a sample size of 30 subjects per cell. Today's Staining Grid is completely based on that larger sample size, thus providing confidence in the results of each lens/solution combination tested. As we switched from the pilot study to the final study results some lens/solution staining area results changed slightly. For example, Purevision/Optifree Express changed from 6% to 4%, still insignificant staining.

Both articles cite studies showing little or no staining with use of their own multipurpose solution - an apparent contradiction to our results. How can this discrepancy be explained? The answer lies in the time of day which the subjects were examined for corneal staining. Solution toxicity-induced staining peaks at or soon after lens insertion. For this reason subjects in our study were examined after 2 and 4 hours of lens wear, thus ensuring that staining, if present, would be detected. Results of our 12-hour study show that corneal heal commences soon after the initial insult and, even in cases of severe staining, is nearly complete by the end of the wearing period. On the other hand studies, like the ones cited by Dr. Hom and Lasswell, which recommend corneal examination near the end of the wearing period, are not likely to detect solution-induced staining. This does NOT mean that staining was absent during most of the wearing period. Bottom line...when a study is presented as evidence of lack of solution toxicity staining be sure to ask WHEN the subjects were examined.

I am truly impressed that the Staining Grid study has attracted so much attention, even spurring back-to-back publications. Soon I'll be discussing another staining grid-like study carried out on another continent. Stay tuned.

It's been about a year since we first displayed our Staining Grid research during a poster session at ARVO. A lot has happened during that year. Poster sessions were also presented at AOA Congress (Las Vegas), BCLA (UK), AAO (Denver), and ARVO-Asia (Singapore). In addition this information has been presented by various speakers literally hundreds of times around the world. In March 2007 an article on our Staining Grid study was published in Review of Cornea & Contact Lenses. Sensing the enthusiasm which practitioners embraced our ongoing lens/solution compatibility research we decided to post the results on a web site for immediate access to practitioners around the world. Finally, the FDA is reassessing what criteria should be examined when approving multipurpose solution (MPS) products to be used with silicone hydrogel lenses.

Our work has also had many consequences. It's not surprising that several lens and solution manufacturers have pointed to our work as confirmation of the universal compatibility of their products. One company has continuously questioned our methodology, scales, and reliability in lectures and published articles...again not surprising. The consequence which I most like to hear is when a practitioner relates a story about a patient experiencing staining and symptoms which were solved by consulting the Staining Grid. I've heard dozens of those over the year.

My prediction for the future is this. Within the next one or two generations of MPS products we will be able to close this web site. By then all eye care practitioners will be aware of the issue and will favor using those products which offer the broadest biocompatibility. Sensing this (and the corresponding effect on sales of specific MPS) lens care manufacturers will have engineered ocular biocompatibility into all new products. Your voices will have been heard and another significant risk factor for patients will have been eliminated through sound scientific technique!

If you are a new or infrequent visitor to this web site please allow me to share some tips to maximize your experiences here. Obviously the initial page contains the Staining Grid which is fairly self explanatory. Only comments here are that each cell shows the average corneal AREA of staining found in a sample of 30 subjects tested in our study. It's NOT the percent of patients showing staining as some people mistakenly think. A lower number represents a more compatible lens/solution combination.

Clicking on any of the percentages within a cell opens what I call the details page. This page gives specific information about the selected lens/solution combination. The top of a detail page shows basic information about the lens and solution. The middle section shows the average staining area and its standard deviation. Next is a breakdown of the percentage of subjects in our study falling into each of the 3 staining zones (green=less than 10%, yellow=10-20%, red=greater than 20% staining area). This is useful in allowing you to predict how your patients might fare using the combination in question. Average comfort information (on a 100-point scale) of the lens/solution combination as well as averages of all lenses using this solution and all solutions using this lens is shown next. Finally, a representative staining photo from a subject in our study is shown, if available.

Other useful information on the web site is included under the FAQ and Learn More tabs. Check them frequently as we often add new info there. For example we recently completed a study measuring staining of one combination over 12 hours. This information is shown in the 12-hour study submenu under the Learn More tab. Also 3 short videos explaining various aspects of the web site are included in the Tutorials submenu.

Two other areas of the web site also provide useful information. The Comfort Analysis tab shows information about the overall effect of staining on subjective comfort. The Photo Gallery tab displays (in the slide show) a series of staining photos of many of the combinations tested. Clicking through this slide show will give you an idea of the appearance and extent of solution toxicity staining. If you want to receive free email updates when significant additions are made to the web site go to the Contact/Updates tab and fill in our name and email address in the form.

Since the staining grid study is an ongoing project this web site is constantly evolving and growing. Feel free to snoop around at your leisure.