bluuebunny/crossref_metadata_2025 huggingface dataset:
Light scattering in IOLs
Authors: Labuz Grzegorz
Published: December 2022

Intraocular lens (IOL) calcification is a rare, albeit severe condition that may degrade visual function. Although patients with the affected implants might preserve good visual acuity, they often complain about increased sensitivity to light sources, which may be bothersome enough to necessitate IOL explantation. Disability glare may also be a sign of glistenings (fluid‐filled microvacuoles) that form within the IOL matrix. In those IOL complications, photopic phenomena originate from the scattering of light that cannot be sufficiently quantified using an industry‐standard for IOL testing, namely the modulation transfer function. Instead, one may use the straylight parameter that has proven effective in detecting IOL pathology and also shown a clear correlation between clinical symptoms and optical effects assessed in the laboratory.
IOL glistenings and disability glare
Authors: Grzybowski Andrzej
Published: December 2022

Glistenings are small fluid‐filled microvacuoles that appear within the intraocular lens (IOL) optic when it is placed in an aqueous environment. Subsurface nanoglistenings are much smaller fluid‐filled gaps from the surface of the optic of the IOL and they may give the IOL surface whitish coloration when the light is directed at the IOL at the angle of incidence of 30° or greater. It has been proposed that the optical quality of an IOL is not significantly affected by the level of glistenings. However, glistening was shown to degrade vision by inducing glare symptoms (straylight) rather than by lowering visual acuity; straylight elevation demonstrates a proportional relationship with the number of glistenings. Retinal straylight, even presenting in low levels, can cause increase in halo size, elevation in luminance detection threshold, and reduction in contrast sensitivity, being a reason for persistent visual complaints. The magnitude of retinal straylight can be clinically determined by the level of disability glare. Moreover, glistenings are not unique to adults and have been reported in paediatric patients Thus, patients having undergone cataract surgery in childhood should undergo a periodical ophthalmic follow‐up for evaluating visual quality and disability glare, and subsequently as determined by grade of glistenings.
Retinal blood flow and oxygen metabolism in diabetes
Authors: Schmidl Doreen
Published: December 2022

Diabetic retinopathy is the leading cause for blindness in the Western countries and its prevalence is constantly increasing. In the last years, evidence has accumulated that alterations in the retinal microcirculation and changes in retinal oxygen metabolism play a key role in the disease process. In particular, tissue hypoxia seems to be a major trigger of neovascularization and macular edema in the retina of patients with diabetes.

Recently, new methods to assess the retinal vasculature, such as Doppler Optical Coherence Tomography (OCT) or OCT angiography have become available, providing valuable findings in patients with diabetes. Combining these methods with techniques such as the assessment of retinal oxygen saturation, more information about retinal oxygen metabolism can be obtained.

The present talk will summarize the current knowledge on retinal blood flow and oxygen metabolism in patients with diabetes.

Acknowledgements: Part of the work presented was funded by the Austrian Science Fund (FWF), Projects No. KLI 721 and P26157.
Structural and vascular retinal parameters in early onset type 2 diabetics
Authors: Heitmar Rebekka
Published: December 2022

The number of patients suffering from type 2 diabetes mellitus (T2DM) has been steadily increasing along with another worrying trend: while typically T2DM is diagnosed in individuals over the age of 40 years, more and more patients are diagnosed with the condition when they are much younger. Those diagnosed with T2DM at less than 40 years of age appear to have a particular high “disease burden” compared to those diagnosed older than 40 years.

Retinal vessel changes have been well documented to reflect systemic changes: i.e. arteriolar narrowing with increasing blood pressure and venular widening in diabetes. When it comes to patients with multi‐morbidities this can make it difficult to interpret ocular vascular changes in particular when it comes to establishing a causal relationship. This presentation seeks to discuss the findings of a sample of T2DM patients with such a complex disease profile.
Toxic optic neuropathies – Update on genetics and therapy
Authors: Barboni Piero
Published: December 2022

Toxic optic neuropathies are characterized by bilateral visual loss, papillomacular bundle damage, central or centrocecal scotoma and colour vision defect. Multifactor causes play a role in disease manifestation such as toxic, nutritional and genetic defects of mitochondrial DNA.

Toxic optic neuropathies are caused by defect to mitochondrial metabolism with consequent damage of retinal ganglion cells with higher energy (ATP) demand. Moreover, the interaction of the mtDNA genetic background with most common toxic exposure, tobacco, could explain the phenotypic expression of the disease. Finally, for a better prognosis an early diagnosis is necessary as is a faster therapeutic approach entailing the correction of toxic causes.
Is docosahexaenoic acid supplementation effective in non‐proliferative diabetic retinopathy?
Authors: Hernandez‐Martinez Francisco Javier
Published: December 2022

We evaluated the effect of 2‐year supplementation with a highly concentrated docosahexaenoic acid (DHA) product with antioxidant activity on nonproliferative diabetic retinopathy (NPDR). A prospective, randomized, double‐blind, placebo‐controlled study was performed. A total of 170 patients with diabetes were randomly assigned to the DHA group (n = 83) or the placebo group (n = 87). NPDR was diagnosed by biomicroscopic examination with a non‐contact slit lamp and classified into mild, moderate and severe stages, monitoring the macular status with oct spectral domain. Patients in the DHA group received a nutritional supplement rich in DHA triglycerides (1050 mg/day), and those in the placebo group received olive oil capsules Results: There were improvements in serum HbA1c levels in both groups, and the change to milder stages of the disease was greater in the DHA group, although not statistically significant.

Although in our study group, the protective role of nutraceutical supplementation with DHA in mild stages was less evident, the evidence is encouraging and allows us to speculate about the protective role of DHA supplementation in non‐early stages of diabetic retinopathy, in which the most relevant biomarkers of inflammatory stress can act as a more effective therapeutic target for nutraceutical supplementation.
Pros and cons of natural food and nutraceuticals for dry eyes
Authors: Duran Maria Dolores Pinazo
Published: December 2022

A healthy diet is a choice for help fighting against the most prevalent ocular disorders, among them the ocular surface disease, Getting adequate daily amounts of specific micronutrients, including carotenoids, omega‐3 fatty acids, vitamins, trace metals and others, may diminish the risk of dry eyes. For boosting eye and vision health the following natural food has to be considered: citrus fruits, dairy products, eggs, fish, leafy green vegetables, legumes, meat, nuts, olives‐olive oil, and also orange‐coloured fruits/vegetables. Furthermore, nutritional supplements are important coadyuvants for managing a wide spectrum of chronic‐degenerative ocular diseases. In this communication we will show the audience how to identify appropriate directions for implementing knowledge on the diet and nutrition on the eyes and vision, the potential antioxidant, anti‐inflammatory and neuroprotective effects of natural food (broccoli, tigernuts and walnuts), the role of the Mediterranean Diet, and the state of the art of nutraceutic supplements, that may constitute a promising and highly affordable tool for patients at risk of eye diseases and vision loss. Remember, good nutritional habits at any age are essential for maintaining healthy eyes.
Trabeculectomy indications – when to do it (Trab vs MIGS)
Authors: Besinis Dimitrios
Published: December 2022

Trabeculectomy still remains the gold standard in glaucoma surgery, being the only operation that can potentially lead to single digit IOP control. Indications for trabeculectomy have not changed throughout the years in glaucoma management and even with the new EGS guidelines, trabeculectomy still represents what is called “traditional glaucoma surgery”. With the evolution of MIGS (Minimally Invasive Glaucoma Surgery) there has been a broad debate between the use of trabecvulectomy and the gradual replacement by MIGS. In this presentation the indication of trabeculectomy and MIGS will be explained, with specific emphasis on how MIGS complement trabeculectomy and fill the gap between drops and traditional incisional glaucoma surgery. Clinical paradigms will also be presented.
Trabeculectomy techniques – Tips and pearls
Authors: Bloom Philip
Published: December 2022

For almost 50 years, trabeculectomy has been considered the ‘gold standard’ procedure in the surgical management of the Glaucoma patient. The operation undoubtedly works well in many surgeons' hands, and over the last 20 years small changes in surgical technique have improved the safety profile of guarded sclerostomy. This presentation will cover basic and more advanced techniques, with tips and pearls to augment success rates.
Current measures to prevent corneal transplant rejection
Authors: Pleyer Uwe
Published: December 2022

Despite the immune‐privilege of the cornea, transplant rejection remains the leading cause for graft failure following penetrating keratoplasty. This is particularly true in the high‐risk recipients, e.g. following previous graft failure due to rejection, infectious keratitis and vascularized corneas. Several strategies including local and systemic immune modulatory agents are currently used to increase the success rate of high‐risk corneal grafts. Although corticosteroids are still a major component of our immunopharmacological armentarium, they might be supplemented by other more specific immunomodulating agents. The spectrum includes agents such as methotrexate calcineurin inhibitors affecting T‐cells (cyclosporin A, FK506), mycophenolate mofetil and more selective monoclonal antibodies directed against T‐cell subpopulations and other targets. New options may include JAK kinase and anti‐Rho directed approaches that remain under investigation.

In addition, preoperative MHC and non‐MHC antigens matching have been investigated as strategy to reduce immune‐mediated graft rejection however, results still remain controversial. In order to better evaluate the risks and benefit of these approaches the properties of established and forthcoming options are presented.
New approaches to improving corneal transplant survival in a pre‐clinical model
Authors: Ritter Thomas
Published: December 2022

Cornea transplantation has been a target for mesenchymal stromal cell (MSC) therapy for several years with a number of publications highlighting the therapeutic potential and mechanism of action of these cells. It is widely known that MSC possess potent anti‐inflammatory capabilities and are able to modulate the activity of a wide array of immune cells including T cells, B cells, dendritic cells and macrophages. This modulation occurs through both cell–cell contact and the paracrine release of soluble factors such as nitric oxide and prostaglandin E2.

High risk cornea transplant recipients suffer from a much higher rate of rejection than the average patient. Factors which place patients at high risk of rejection include corneal ulcers, bullous keratopathy or a failed previous graft. These conditions frequently lead to increased blood and lymphatic vessel infiltration to the recipient graft bed and/or some pre‐existing high immunological risk. As outcomes for lower risk cornea transplant recipients, such as those who require a transplant as a result of keratoconus, improves the field is shifting its focus to improve outcomes for more complex cases.

In this presentation, I will discuss the therapeutic potential of MSC to promote corneal transplant survival in both low‐ and high‐risk pre‐clinical models and its pathway to potential clinical translation.

Funding received for this work.

This work was supported by Science Foundation Ireland (12/IA/1624), by a grant from the European Commission [FP7 Collaborative Health Project VISICORT (grant number 602470), www.visicort.eu], by infrastructural funds from the European Regional Development Fund and by the European Union's Horizon 2020 research and innovation programme under grant agreement no. 814439.

Keywords: corneal transplantation, high risk, mesenchymal stromal cells, immunomodulation, regulatory cells, tolerance.
New findings on the immune response following corneal transplantation
Authors: Murphy Conor
Published: December 2022

We performed a multi‐centre, cross‐sectional analysis of the current immunological status of human full thickness (FT) and posterior lamellar (PL) corneal transplant (CT) recipients and control subjects using multiple technology platforms. The primary goal of this study was to define pathways associated with adverse immune responses to corneal transplantation and to generate and compare comprehensive, pathway‐based profiles of immune activity in CT acute rejection (AR). The secondary goal was to identify a composite biomarker of CT AR. Clinical details, including a comprehensive clinical examination, and blood samples, enabling analysis of peripheral blood mononuclear cell (PBMC) DNA, RNA and phenotype, were collected from adults with clinically diagnosed AR of FL‐CT (n = 35) and PL‐CT (n = 21) along with Stable CT recipients (n = 177) and adults with non‐transplanted corneal disease (n = 40). For those with AR, additional samples were collected 3 months later. CT acute rejection was clinically diagnosed and defined as precipitates on the corneal graft but not on the peripheral recipient cornea, either scattered or in the form of a Khodadoust line along with an increase in central corneal thickness. Immune cell analysis was performed by whole‐genome microarrays (whole blood) and high dimensional multi‐colour flow cytometry (peripheral blood mononuclear cells). For both, no activation signature was identified within the B cell and T cell repertoire at the time of AR diagnosis. Nonetheless, in FT‐ but not PL‐CT recipients, AR was associated with differences in B cell maturity and regulatory CD4+ T‐cell frequency compared to stable allografts. Our results suggest that, in contrast to solid organ transplants, genetic or cellular assays of peripheral blood are unlikely to be clinically exploitable for prediction or diagnosis of AR. However, further investigation of circulating B cell and T cell subpopulations may provide insights into the regulation of anti‐donor immune response in human CT recipients with differing AR risk.
Microglia in the retina
Authors: Cordeiro Francesca
Published: December 2022

The role of microglia has been increasingly recognized as important in disease. No more so than in the retina, where neurodegeneration in diseases such as glaucoma, multiple sclerosis, Parkinson's Disease and Alzheimer's disease, can be seen. Establishing ways of assessing microglia in disease states will be discussed, and how there morphology can be used in characterizing activity.
Understanding the role of microglia in the onset of photoreceptor degeneration
Authors: García‐Ayuso Diego , Di Pierdomenico Johnny , Martínez‐Vacas Ana , Vidal‐Sanz Manuel , Villegas‐Pérez María Paz
Published: December 2022

Photoreceptor degenerative diseases are currently the leading cause of irreversible blindness in developed countries and a major cause of irreversible blindness in the world. The most common forms of these diseases are age‐related macular degeneration and retinitis pigmentosa, both diseases cause a profound visual impairment due to photoreceptor loss. In the early stages of photoreceptor degeneration, glial cells have a major role to play, presumably leading to extensive retinal remodelling. The mammalian retina contains three types of glial cells. Two types of macroglial cells: astrocytes and Müller cells, and microglial cells. Microglial cells are the major resident immune cells in the retina and, although these cells and neuroinflammation have been implicated in the pathology of many neurodegenerative diseases, their role and function in photoreceptor degenerations are not yet fully understood. During retinal degeneration, microglial cells change their morphology, become activated and travel from the inner to the outer layers of the retina to phagocytose the dying photoreceptors, while astrocytes and Müller cells become hypertrophic, and overexpress glial fibrillary acidic protein (GFAP) filling the space left by dead photoreceptors to form a glial seal. It is known that activated microglial cells can be either neuroprotective or neurodestructive during photoreceptor degenerations, and therefore it is not yet clear whether activated microglial cells may increase or decrease photoreceptor loss. Microglial cell activation, migration and proliferation occur simultaneously with the onset of photoreceptor degeneration, prior to the loss of the vast majority of photoreceptors. During photoreceptor loss, microglial cells reach the outer nuclear and outer segment layers. These events suggest that photoreceptor death is the trigger for the activation and migration of microglia to the outer retinal layers, where they phagocytose the dying photoreceptors and remove cellular debris. By carrying out these functions, microglial cells in the retina may affect photoreceptor survival or death, eventually phagocytizing stressed but still viable photoreceptors. Interestingly, inhibition of microglial cell activation and migration during photoreceptor degeneration results in improved cone outer segment morphology and increased photoreceptor survival, which suggest that the role of activated microglial cells may be more neurodestructive than neuroprotective and that treatments with anti‐inflammatory drugs that modulate microglial reactivity may be considered in the early stages of photoreceptor degenerations.
Microglia – An innocent bystander?
Authors: Salobrar‐Garcia Elena
Published: December 2022

Under normal conditions, microglia act as neuropathology sensors and are neuroprotective.

Microglia are spatially organized features as mosaic in the retina; distributed in the plexiform layers of the retina and in the retinal nerve fibre layer‐ganglion cell layer, in order to control the environment and detect changes that can cause neuronal damage. Microglial cells may undergo two different types of activation in response to injuries, being an important player in maintaining retinal balance to a stressful situation. The microglia phenotype called M2‐like, secrete anti‐inflammatory mediators and neurotrophic factors that act as neuroprotectors, while the M1‐like generates a massive inflammatory response, being neurotoxic. When a neurodegenerative process occurs, such as that caused by protein deposits in Alzheimer's Disease (AD), the microglia responds changing its phenotype, which will cause changes in its shape, promoting migration to the area of damage, changing the arrangement in the tissue that gives rise to cells that converge or form barriers, isolating damaged tissue or phagocytizing toxic aggregate proteins and cellular debris.

The migratory capacity of the microglia gives it the property of being able to move in its own layer and even between layers, remodelling the retina with areas of clustered cells and other areas with a shortage of cells. These movements lead to structural changes in the layers of the retinal that can be measured, with regions thickened versus other changes thinned over time as the disease progresses. All this changes can be detected by examining the retina in vivo with optical coherence tomography (OCT) in both animal experimental models and human. OCT allows the evaluation of cellular behaviour indirectly in neurodegeneration, in which at first a thickening can be observed that could be associated with protein deposits or cellular changes caused as a result of the inflammatory process, then in more advanced stages the tissue experiences a neurodegeneration, related to a thinning of the retina due to neuronal loss. These changes have been seen that are similar in both the experimental model, as in AD patients.

Therefore, the microglia is not an innocent bystander, but a key player, generating changes based on its dual form of activation.
Human retina – A history of biological research and the development of genetic engineering
Authors: Polak Agnieszka
Published: December 2022

The development of genetic engineering (also called genetic modification) started in the 40‐ties of the 19th c. After the Second World War the rapid process that used laboratory‐based technologies to conduct researches on cells, tissues, alter the DNA makeup of an organism and virus become the basis of modern paradigm of medical sciences. This was the culminating point of the process, which is sometimes called “the war against diseases”. One of the most successful moments was the creation of vaccines by combining genetic engineering research with research on viruses. It was a time of scientific optimism. For the first time in human history people could get the knowledge of aetiology of diseases, could fight them and protect themselves against infection. Its seems that the development of medical sciences could serve mankind, therefore there should be no limits as to its development. This optimism was not hindered by Nazists medical experimentations performed during the Second World War. However, The main ethical questions about the limits of medical science and human biological material research were left unanswered. The development of genetic engineering gave rise to questions on legalization of abortion, euthanasia, and transplantology. From 60‐ties to 90‐ties of the 20th century, large‐scale research began on diploid cells of fetal origin. All these events have called for discussion in the bioethics community and the question of the limits to which medical sciences can be pushed.

Key word: history of genetic engineering, cell biology, history of human biological material research.
Ethnobotanic history of ophthalmology
Authors: Polak Agnieszka
Published: December 2022

The history of plants in treatment and prophylactics of eyes diseases is an essential part of traditional medicine handed down since prehistoric times. Formulas written down in those days preserved the knowledge on medical cultivation of plants. Due to the fact that humanity has been searching for treatment options in nature since prehistoric times, it is now possible to distinguish the Chinese, Indian and Mediterranean region pharmacopoeia. Medical application of herbs and other plants began as a trial and error method; those plants that proved effective found their way to the collection of medicines. The best example of the “empirical pharmacopoeia” was Indian herb medicine, but also the Slavic medicine, based on the use of local plants. Superstitions and beliefs, especially symbolism (including biblical traditions), played a pivotal role in shaping knowledge about plants. In medieval Europe, Christians believed that God had placed plants and animals on the earth to serve humans. It was believed that the discovery of the secret of creation would make it possible to discover a panacea for all ills. This extremely fascinating journey through the history of herbal medicine and plants witch were used to treat eyes diseases leads us through the diversity of cultures whose customs, superstitions and beliefs strengthened faith in the effectiveness of plant medicine. Many of those plants are still used today.

Key words: etnobotanic, plant in treatment of eyes diseases.
Ocular references on ancient coins
Authors: Sanchez Juan Luis
Published: December 2022

According to the dictionary of the Royal Academy of the Spanish Language, numismatics is the discipline that studies coins and medals, mainly ancient ones. In other places, this definition includes the study and collection of paper money or banknotes. The information we can obtain from coins with a minimum study of the aspects that appear on them is surprising. In relation to vision and ophthalmology, they show us important figures in the field, ocular symbology, they tell us about mythology and religion and curious stories that we would hardly have known without looking at the coins. Finally, we will talk about an important 19th century Valencian ophthalmologist, Rafael Cervera y Royo, and the collection of ancient coins that bears his name. This work is not intended to be an exhaustive description of all the coins and medals that speak of vision, but rather a sample of the valuable information that numismatics contributes to our speciality and to stimulate the public's curiosity about this fascinating science.
The value of colour assessment in diagnostic dilemmas
Authors: Evans Benjamin
Published: December 2022

Background: When the goal of clinical assessment is to segment, divide, and classify cases into neat discrete boxes it can often be frustrating to encounter cases which do not fit standard diagnosis algorithms. However, such diagnostic dilemmas often provide a valuable insight into the boundaries of current clinical procedures and the potential value psychophysical assessment can provide when used in conjunction with standard diagnosis algorithms. We present such a case involving localized retinal dysfunction that is not fully consistent with signs of either autoimmune retinopathy or occult maculopathy.

Methods: Specific visual function loss was investigated in a health 32‐year‐old male with suspected localized retinal dysfunction, affecting the central retina. Blood tests and electro‐diagnostics were carried out after the patient presented with acute onset ‘foggy’ central vision. The working diagnosis from this initial visit was autoimmune retinopathy and oral steroids were prescribed. Following no change in symptoms a year after initially presenting, the patient was referred to City, University of London for bespoke assessments of specific visual functions. These included assessments of central and peripheral red / green (RG) and yellow / blue (YB) colour vision, mesopic visual acuity (VA), functional contrast sensitivity (FCS), rod‐ and cone‐mediated flicker sensitivity, and pupil responses measured using both rod‐ and cone‐enhanced stimuli.

Results: The loss of vision affected primarily the central 20° with a mean VA of 6/36 in each eye. Fundus images, fluorescein angiography, and full field electroretinograms (ERGs) were normal, but pattern and focal ERGs were undetectable indicating localized dysfunction in central vision with OCT images showing a disrupted ellipsoid zone in each eye. The patient's mean corpuscular volume was 69 femtoliters, with red cell indices suggestive of thalassemia. Testing at City, University of London confirmed a loss of VA and FCS in the central 10° field, although both VA and FCS depended strongly on light level and were less affected with negative contrast stimuli. A loss of RG and YB colour vision was also measured centrally. Outside the central 10° field EA had almost normal colour and spatial vision. Rod‐ and cone‐mediated, flicker thresholds were elevated, with cone thresholds 10‐fold higher than normal. Pre‐stimulus pupil size, constriction amplitudes and latencies were normal with both centrally presented and peripheral stimuli.

Conclusions: Psychophysical measurements in a patient with presumed autoimmune maculopathy showed atypical macular dysfunction that appears to preferentially affect negative contrast stimuli. Despite damage to the retinal mechanisms involved in spatial vision and light adaptation pupil responses remained unaffected. This unusual case highlights the importance of detailed phenotyping in understanding unknown aetiology.
Gut microbiome and Behcet's disease
Authors: Wallace Graham
Published: December 2022

Behcet's Disease (BD) is a multisystemic autoinflammatory condition characterized by mucosal ulceration breakdown of immune privileged sites and vasculitis. Several sites of mucosal inflammation, including the mouth, skin and genitals have a specific microbiome. Studies from different regions of the world have reported the composition of both the buccal and gut microbiomes from which similarities and differences will be discussed. Moreover, understanding potential mechanisms driving such changes other than disease are important in identifying the role of microbiome in BD. Finally recent studies on altering patient's diet, based on microbiome studies will be discussed.
In vivo corneal biopsy – OCT
Authors: Wylegala Edward
Published: December 2022

AS‐OCT has been a diagnostic device for corneal diseases for many years. The non‐contact examination enables obtaining morphological and morphometric data useful in clinical practice. AS‐OCT is used both for initial diagnosis and treatment monitoring in diseases of the eye's surface. Most often used in the diagnosis of corneal dystrophy and degeneration. The presentation will show the practical aspects of using AS‐OCT in the diagnosis of eye surface diseases.
Imaging of corneal nerves with in vivo confocal microscopy (IVCM)
Authors: Messmer Elisabeth M.
Published: December 2022

The subbasal corneal nerve plexus may serve as an important biomarker in ocular surface disease and ocular as well as systemic neuropathies. Changes in number and density of nerves, “beadings” and or tortuosity correlate to clinical signs of Dry Eye Disease. The same is true for atopic keratoconjunctivitis where – in addition – the number of perineural inflammatory cells was significantly increased. In patients with type 1 diabetes mellitus, the corneal subbasal nerve plexus was abnormal in 50% although classified as “normal” by the clinical and electrophysiological based tests for peripheral neuropathies. Although in vivo confocal microscopy is a wonderful tool to assess corneal nerves as reliable biomarkers, it is not generally available, the quality of different equipment may vary, and the analysis of nerves is still time‐consuming.
Twenty‐five years of acanthamoeba diagnostics in Austria
Authors: Walochnik Julia
Published: December 2022

Acanthamoeba spp. are ubiquitous free‐living amoebae and do not need a host. They can, however, cause disease upon accidental contact with a potential host. The most common Acanthamoeba infection in humans is the so‐called Acanthamoeba keratitis (AK), occurring mainly in contact lens wearers.

The first case of AK was reported in the early seventies and in the mid‐eighties the association between AK and contact lens wear was discovered. Today, acanthamoebae are among the most important causative agents of keratitis in contact lens wearers. AK often shows a severe progression, which is due to a lack of awareness but also to the lack of specific treatment. The dormant cysts pose a particular problem, often residing within the tissue and leading to reinfection after termination of treatment. In industrialized countries the annual incidence of AK lies between 0.1–1 cases per 100 000 inhabitants, with a marked regional variation depending on contact lens wear habits and mode of water supply.

Our institution is the Austrian reference laboratory for Acanthamoeba diagnostics. All samples from patients with suspected AK are screened for Acanthamoeba spp. by culture and PCR in parallel, and all detected amoebae are genotyped. We currently have an annual incidence of AK of around 0.2 cases per 100 000 inhabitants, with >90% of cases occurring in contact lens wearers. In contrast to other countries, we do not see any seasonality and in contrast to the early years, today, males and females are equally represented, the most affected group being the 21–30‐year‐olds. The vast majority of cases are unilateral and many cases have a prolonged progression, in some cases infections remain viable for >1 yr. The predominant genotype is Acanthamoeba T4, other common genotypes are T3, T5, T6, T10 and T11.
Morphogenesis of the optic vesicles – The roots of retinogenesis in amniote embryos
Authors: Grocott Timothy
Published: December 2022

Eye number varies dramatically across the animal kingdom. We recently discovered a self‐organizing gene network involving eye master control gene Pax6, which casts new light on eye number regulation. In amniote vertebrates, eye number variation manifests as cyclopia – the formation of a single eye in the centre of the head – caused by defects in midline Sonic hedgehog (Shh) signalling. In the developing embryo, the retinas derive from the optic vesicles of the primitive forebrain. Yet how the optic vesicles are themselves generated in amniote embryos, and the molecular pathways that regulate their morphogenesis, is a surprisingly neglected question. During healthy development a pair of vesicles grow either side of the anterior neural tube, contributing cells to the developing forebrain and retinas. In cyclopia a single vesicle grows at the ventral midline, which is widely attributed to a loss of Pax6 inhibition by Shh, yet paradoxically Pax6 is thought not to initiate optic vesicle outgrowth in amniotes. How then is optic vesicle outgrowth initiated and number regulated? Using chick as an experimental model, our recent data suggest that optic vesicles may normally grow from paired growth zones within the anterior neural folds of the amniote neural tube. We hypothesize that cyclopia occurs following ventral fusion of these growth zones in the absence of midline Shh signalling.
Myopia risk factors
Authors: Lanca Carla
Published: December 2022

There have been significant increases in the prevalence of childhood myopia in the past three decades. An earlier onset of myopia may predispose children to high myopia and potential blinding conditions in adulthood, such as myopic macular degeneration. A young child with a low hypermetropic refraction has a greater likelihood of developing myopia, thereby increasing the risk of blindness. Thus, it is important to understand risks factors for myopia to develop appropriate prevention plans, screening programs and treatment strategies to control myopia progression. Both genetic and environmental factors have been implicated in the development of myopia and its progression. Basic birth parameters, such as ethnicity, parental myopia, and gender have been identified as risk factors for myopia and myopia progression. Although, there is mix evidence on gender predilection and myopia. In populations of European ancestry, genetic variation accounts for about 12% of the variance in mean spherical equivalent (SE). Furthermore, the increases in myopia prevalence in the last years do not seem to be primarily due to genetic variation, but rather environmental changes. Strong evidence on the association between environmental factors and myopia has been provided by mendelian randomization studies, randomized clinical trials and meta‐analysis. Major environmental factors, include level of education and time spent outdoors. Other environmental factors include near work, screen time and urbanization. However, evidence on the associations between near work, screen time and myopia have been mixed. Modifiable environmental risk factors provide an important basis for the design of preventive interventions. Further research on the interactions between genetic and environmental factors is necessary to better understand the pathophysiology mechanisms of myopia.
Contrast polarity and myopia
Authors: Schaeffel Frank
Published: December 2022

To transmit the visual information detected by 125 Million photoreceptors in the retina through the optic nerve, with only about 1 Million ganglion cell axons, the retina has to compress information down to about 1 percent. Aside of receptor pooling, a major trick is to form receptive fields with ON/OFF structure which compare brightness in the center with the brightness in the periphery and reduce the information to spatial–temporal differences, while absolute luminances largely ignored. Two major types are found: ON center, which are activated by light in the center and inhibited by light in the periphery and OFF center with the inverse response patterns. Such receptive fields are perfectly suited to detect defocus which represents low pass filtering of the spatial frequencies in the image. It was found in animal models that suppression of ON pathways is generally related to more axial eye growth and can enhance deprivation myopia while suppression of OFF has little or an inverted effect. Analysing the ON and OFF input strength in our visual environment, we found that reading text with conventional contrast overstimulates OFF channels while reading with inverted contrast strongly stimulates ON channels. After reading for one hour, we found that the choroid becomes thinner with conventional text, but thicker with contrast‐inverted text. Since there is considerable published evidence that choroidal thickening is a precursor of myopia inhibition, reading text with inverted contrast may be beneficial against myopia progression. We have also tested different text sizes. The effect was not observed with a letter height of 0.25 deg (like on a smart phone) but prominent at 0.5 deg (like in a book). Interestingly, choroidal thickening was induced both in emmetropic and myopic subjects, suggesting that the approach should also work in myopes. We have previously found that myopic subjects show a reduced choroidal response, compared to emmetropes, when positive defocus was imposed for 30 min. The functional deficit in the myopic retina appears limited to the detection of defocus while the activity of ON and OFF pathways is not affected. A major question for future research is whether and how ON/OFF processing may be linked to the detection of the sign of defocus by the retina.

Research supported by IOB.

No proprietary interest.
Benefits and limitations of the low dose atropine use
Authors: Grzybowski Andrzej
Published: December 2022

Atropine is an anti‐muscarinic agent and can be used as a monotherapy or as a combination to slow the progression of myopia. It has been advocated as the first line of treatment in children with lower cost compared with other therapies, and it is a good option for children intolerant to contact lenses and when other treatment options are rejected by parents. The major limitations of topical atropine therapy include the adverse effects with higher concentrations (0.1% and higher), such as reduced amplitude of accommodation and photophobia, and the need for daily dosing. Efficacy of low‐dose atropine treatment has been confirmed by several meta‐analysis showing reduced SE progression and decreased axial elongation. The results from the Low‐Concentration Atropine for Myopia Progression (LAMP) study (3‐year RCT results) in Chinese children showed that 0.05% atropine conferred the best efficacy compared with 0.025% and 0.01%. However, it was postulated that the use of 0.05% topical atropine in Caucasian children may lead to more side effects compared to 0.01%, which can compromise parent's acceptance or children's compliance. The efficacy and safety of 8 atropine concentrations for myopia control in children was reported in a recent network meta‐analysis, in which the 0.05% was found the most beneficial for control of overall myopia progression. It is generally believed that the atropine dose should be adjusted based on the risk factors and progression.
Optical methods in myopia control
Authors: Bremond‐Gignac Dominique
Published: December 2022

As myopia increased dramatically in Asia and all over the world, the use of myopia control devices is proposed in evolutive forms. An initial ocular check‐up is performed to adapt the best system to control myopia evolution. Optical correction are based on defocus system to control myopia. Defocus glasses with different systems (DIMS, HALT…), defocus soft contact lenses with systems (dual concentric ring, EDOF), and orthokeratology are proposed to treat myopia and must be customized to children and parent needs.
Alternatives for corneal endothelial tissue engineering
Authors: Thuret Gilles
Published: December 2022

Corneal endothelial diseases are common almost everywhere in the world and have 3 main origins: primary diseases, largely dominated by Fuchs' endothelial corneal dystrophy (FECD), iatrogenic diseases which mainly complicate lens surgery, whether cataract or clear lens, but also other surgeries. The frequency of these complications is very low but the number of these surgeries being gigantic (probably around 50 million cases/year/worlwide), the number of post‐surgical bullous keratopathy remains important. Post‐keratoplasty endothelial failure (early or late) is the 3rd cause.

All these diseases “consume” 50% of corneal grafts in the world and a large part of the population does not have access to any graft. The number of corneal donors is absolutely insufficient to meet the world demand and corneal bioengineering appears to be a realistic solution to complete the offer. Because of its relative simplicity and the demonstrated effectiveness of endothelial keratoplasty, endothelial bioengineering is logically the first to be developed. The Japanese team of 2 Kyoto universities (Prof. S. Kinoshita, N. Koizumi and N. Okumura) is a pioneer in this field and has demonstrated the effectiveness of injection therapy, which consists of cultivating mature endothelial cells from a small number of corneas from young donors, then injecting them into the anterior chamber of patients. The industrialization of the process is underway in 2 different start‐ups, one in the United States, the other in Japan. In addition to injection therapy, the bioengineering of endothelial grafts (Tissue engineered endothelial keratoplasty, TEEK), which consists of cultivating endothelial cells on a “corneo‐compatible” carrier to exactly reproduce a DMEK or a DSAEK, has passed the preclinical stage. This presentation will detail these different processes, their current limitations and the short, medium and long term perspectives. These Advanced Therapy Medicinal products (ATMP) are clearly revolutionizing corneal transplantation. By offering a new treatment for endothelial diseases, they will make it possible to redirect donor corneas to other corneal diseases that have no therapeutic alternative. Finally, this paper will also discuss the prospects of medical and medico‐surgical treatments for FECD, which are at the frontier of endothelial bioengineering.
Acanthamoeba keratitis – Specific conservative treatment or surgery?
Authors: Szentmary Nora
Published: December 2022

Clinical signs of acanthamoeba keratitis are in early stages grey‐dirty epithelium, pseudodendritiformic epitheliopathy, perineuritis, multifocal stromal infiltrates, ring infiltrate and in later stages scleritis, iris atrophy, anterior synechiae, secondary glaucoma, mature cataract, and chorioretinitis. Our finding emphasizes that pre‐testing the in vitro susceptibility of the AK isolate with the non‐nutrient E. coli agar plate assay against the anti‐amoebic drug intended for treatment will give valuable information on whether the drug is likely to be active on the Acanthamoeba isolate in vivo. In therapy resistant cases, surgical treatment options such as corneal cryotherapy, amniotic membrane transplantation, riboflavin‐UVA cross‐linking, and penetrating keratoplasty are applied.
Mycotic keratitis – Experience in Europe
Authors: Daas Loay , Hamon C. Sourlis L. , Seitz B.
Published: December 2022

Mycotic keratitis is a rare but severe ophthalmological illness, which has to be taken very seriously with a potentially sight‐threatening outcome. Over the last two decades, an increase of cases with mycotic keratitis has been noticed, which has possibly caused an increased use of soft contact lenses. Therapy is often lengthy and difficult. In a lot of cases, surgical therapy, i.e. corneal transplantation is indicated. For this reason, it is essential to discuss during the clarification process the necessity of a keratoplasty during the course of treatment. In this talk, we would like to give an overview on the typical clinical signs, symptoms, diagnostics and therapy options as well as confocal microscopy for diagnosis of mycotic keratitis.
Epidemiology and risk factors for myopia development
Authors: Grzybowski Andrzej
Published: December 2022

Myopia due to high prevalence in recent years gained importance in epidemiological studies. It is estimated that 1.4 billion people were myopic in 2000, and it has been predicted that by 2050 the number will reach 4.8 billion. It is known that children with early onset and/or rapid progression are at risk of complications associated with high myopia in the future, including retinal detachment, glaucoma, cataract, optic disk changes and maculopathy.

The myopia prevalence ranges from 0.7% in Saudi Arabia to 65.5% in the Haidian district of Beijing; with the highest prevalence in schoolchildren in East Asia and Singapore, urban areas of China, Taiwan and South Korea. In Europe the prevalence rates reached 42.7% in a 10–19‐year French cohort. Interestingly, the majority of the studies reporting on myopia prevalence with non‐cycloplegic measurements compared with cycloplegic measurements reported much higher prevalence rates.

The major risk factors for myopia onset and progression include parental myopia, ethnic differences, less time outdoors, increased near work and reading distance less than 30 cm, population density and socioeconomic status.
Work up of paediatric uveitis
Authors: Willermain Francois
Published: December 2022

Although children represent a minority of uveitis patients, their management represent a clinical challenge. Indeed, their visual prognosis is poorer, their examinations and investigations more difficult and there are more idiopathic cases. Some etiologies are specific of childhood uveitis, others are common between adult and paediatric uveitis, but differently distributed in these two groups. Certain, like birdshot, are never found in children (or exceptionally). The work up of uveitis in children is thus relatively different that the one performed in adults patients. These particularities of paediatric uveitis work up will be illustrate in this presentation.
TINU syndrome
Authors: Makhoul Dorine
Published: December 2022

Tubulointerstitial nephritis and uveitis (TINU) syndrome is defined as the association of tubulointerstitial nephritis (TIN) and uveitis in a patient without any other systemic disease that can cause this overlap of ocular and renal inflammation. Commonly, ocular involvement consists in a sudden‐onset bilateral non‐granulomatous anterior uveitis. However, it is becoming clear that non‐granulomatous anterior uveitis is not the only uveitis phenotype associated with TINU syndrome. It is likely that this uveitis aetiology is underestimated as nephritis is most of the time self‐limited. Although a reliable diagnosis of TIN can be made from clinical and laboratory findings, renal biopsy is required for its definitive diagnosis. On the other hand, the increase of urinary β‐2 microglobulin and serum creatine level has been proposed as a potential tool to screen and follow nephritis in TINU syndrome. The main purpose of this presentation is to clarify the assessment in case of TINU syndrome suspicion, to describe the associated uveitis as well as the management.