bluuebunny/crossref_metadata_2025 huggingface dataset:
Autonomic nervous system and endothelial peripheral dysfunction in normal tension glaucoma patients
Authors: WIERZBOWSKA J , WIERZBOWSKI R , ZBIEć A , WOJTAś K , STANKIEWICZ A , MANIEWSKI R , LIEBERT A , SIERDZIńSKI J
Published: November 2010

Purpose To define parameters of autonomic nervous system activity and peripheral vascular reactive hyperemia in normal tension glaucoma patients.

Methods Ambulatory 24‐hour electrocardiogram and blood pressure (BP) monitoring by using Lifecard CF and SpaceLab 90207‐30 combined with occlusion provocation test were carried out in 54 NTG patients (44 women, mean age 59.7) and 43 matched control subjects (34 women, mean age 57.0). Heart rate variability (HRV) time and frequency domain parameters [low‐frequency (LF), high‐frequency (HR) and LF/HF ratio], and blood pressure variability (BPV) were calculated and analyzed for both study groups. Postocclusive hyperemia response parameters (TM ‐ time to peak flow, TH –half‐time hyperaemia, TR –time to rest flow, BZ‐biological zero and MAX – maximum hyperemic response) were compared for patients with a nocturnal fall in mean BP (MPB) of less than 10% (non‐dippers), of 10‐20% (dippers) and of more than 20% (over‐dippers)

Results NTG patients demonstrated higher LF and LF/HF values for 24‐hour period, day‐time and night time than control subjects. There was no difference in BPV between study groups (10.4 ± 1.9 vs. 10.5 ± 2.1, p=0.790). In NTG patients, TH was significantly higher (79.0 ± 80.9 s vs. 51.5 ± 35.3 s, p=0.028) and BZ was significantly lower (2.3 ± 1.0 vs. 3.1 ± 2.0, p=0.009) as compared to the control group. There was statistically significant difference between NTG non‐dippers, dippers and over–dippers in the BZ parameter (2.3 ± 0.9 vs. 2.7 ± 1.3 vs. 1.4 ± 0.4 p=0.024).

Conclusion NTG patients exhibit abnormal ANS system activity and a different systemic hyperemia response as compared with healthy subjects.
Glaucoma‐like optic neuropathy in patients with intracranial tumors
Authors: JONAS JB , WANG Y , XU L , WANG J , QU Y
Published: November 2010

Purpose To examine frequency and associated factors of a glaucoma‐like appearance of the optic nerve head in patients with intrasellar, suprasellar or parasellar tumors.

Methods The study included patients who were consectutively treated for intrasellar tumors (n=143), suprasellar tumors (n=321), parasellar tumors (n=36), or retrosellar tumor (n=1), and all of whom had undergone fundus photography and full‐threshold visual field examination. An age‐matched control group was formed from the population‐based Beijing Eye Study. Glaucoma was defined by neuroretinal rim shape plus glaucoma‐like visual field defects.

Results Five‐hundred and one patients fulfilled the inclusion criteria. Disc‐Glaucoma and Field Glaucoma were detected significantly more frequently in the study population (34 (6.8±1.1%) patients and 31 (6.3±1.1%) patients, respectively) than in the population‐based control group of the same ethnicity (1.3% ± 0.5% (0.3%‐2.3%); P<0.001). In multivariate analysis, presence of Disc‐Glaucoma and Field‐Glaucoma was significantly associated with tumor location (suprasellar > parasellar > intrasellar (OR=2.64; P=0.016; and OR=3.01; P=0.027, resp.)) and tumor width (OR=1.08; P=0.002; and OR=1.08; P=0.003, resp.).

Conclusion Large perisellar tumors were associated with a glaucoma‐like appearance of the optic nerve head in eyes. It may diagnostically and pathogenetically be of importance and may give insight into the pathogenesis of normal‐pressure glaucoma.
Application of 3D biomechanical eye model for concomitant strabismus diagnostics and treatment
Authors: BUSHUYEVA N , ROMANENKO D
Published: November 2010

Purpose Due to inaccuracy of diagnostic tests, prevalence of orthotropy after the first strabismus surgery varies in the range of 40 to 90%, and frequency of repeated surgeries comprises 10–50%. The purpose of the study was to investigate the efficacy of using of 3D biomechanical eye model (TBEM) in diagnostics and treatment of patients with concomitant strabismus (CS).

Methods 30 CS patients were examined and underwent standard strabometric tests (Hirschberg test, Krymskiy test, Maddox scale, synoptophore with fusion reserves). Hyperfunction and hypofunction of one muscle or another was measured by coordimetry according to Hess‐Lancaster; modeling of eye positions was performed using SEE‐KID 3D biomechanical model (RISC Software GmbH, Hagenberg, Austria). Standard surgeries were performed on the basis of their pre‐surgical modeling in SEE‐KID TBEM. Exclusion criteria: patients with high and moderate amblyopia were excluded from the study. Follow‐up period comprised 1 – 3 months.

Results Virtual pathological models created using SEE‐KID TBEM for all examined patients conformed to their actual strabismologic status. Surgeries conducted on the basis of preliminary TBEM modeling have resulted in achievement of orthotropy in 20 patients (66.7%) and its preservation at last visit in follow‐up period. Residual strabismus angle (5‐8°) was detected in 10 patients, including hypocorrection (9 patients), and hypercorrection (1 patient).

Conclusion The use of existing strabometric methods in complex with TBEM is a promising diagnostic algorithm for assessment of the state of concomitant strabismus patients, which requires further studies.
Dysthyroid optic neuropathy (DON): diagnosis and associated features
Authors: KLYSIK AB , BIENKIEWICZ M , GUMINSKA M
Published: November 2010

Purpose To determine the frequency of occurence and severity of dysthyroid optic neuropathy (DON), in relation to the degree of inflammatory signs, exophthalmos, asymetrical disease and diplopia, among patients with newly diagnosed inflammatory thyroid related ophthalmopathy (TAO) or suffering from the recurrence of the inflammatory phase of previously inactive/fibrotic stage of the disease.

Methods 400 subjects with TAO, 76% women and 24% men aged 29.0 to 88.0 (mean 55.5 +/‐ 9.8) years with Clinical activity scores between 2 and 9 ( mean 4.6 +/‐ 2.3) were included into the study. 30 healthy age and sex matched patients served as control. Diagnosis of DON was based on the presence of at least two features related to the optic nerve involvement, different than reduction of visual acuity.

Results Two or more clinical features of DON werefound in 27 patients with inflammatory TAO. 20 of whom displayed asymmetrical involvement ( > 2mm difference in exophthalmos and > 2 in CAS scale). There was slight statistical association between neuropathy and diplopia with neuropathy patients being more likely to suffer from constant double vision. There was no correlation between CAS and DON. Visual acuity was reduced from 2 to 7 Snellen lines in patients with DON and from 2 to 6 lines in TAO and not DON.

Conclusion Clinical features of DON occour in 6.75% of patients with inflammatory TAO. There is no correlation between the degree of inflammatory involvement and DON, therefore it must be carefully excluded in all patients even with apparently mild ophthalmopathy. Thera numerous other, than DON,causes of visual loss related to TAO. Majority of patients present with mild and moderate visual loss only, which is reversible on immunomodulatory treatment.
Input of Ksawery Gałęzowski (1832‐1907) to international ophthalmology
Authors: GRZYBOWSKI A
Published: November 2010

Purpose Gałęzowski was one of the most distinguished Polish ophthalmologists of the 19th century. He was the author of hundreds of articles and 12 books, on nearly every aspect of ophthalmology, including his major interests in ophthalmoscopy, retinal chromatoscopy, treatment of glaucoma, cataract and retinal detachment. Despite his many activities, a high professional position in his times and an important influence on the European ophthalmology, his private life and ophthalmic achievements have not yet been studied and analysed in detail.

Methods The original works and articles written by Gałezowski in Russian, Polish and French (courtesy of Dr. A. Franceschetti) were translated, analysed and summarised. The published information about his life was supplemented with information collected form Polish medical libraries, including Jagiellonian Library and French libraries, among them Polish Institute in Paris, Polish Libarary in Paris, and National French Library. The information collected was additionally verified by the grandson of Ksawery, Nicolas Gałęzowski.

Results His major interests were focused in ophthalmoscopy and retinal detachment. Due to his co‐operation with Jean‐Martin Charcot at the Salpetriere, he gained a great deal of experience with neurological diseases and he became the pioneer of the use of ophthalmoscopy in the diagnosis of central nervous system diseases (cerebroscopy). He founded the first French monthly ophthalmic journal “Journal d’ophtalmologie” in 1872.

Conclusion Gałęzowski did many pioneer studies in different fields of ophthalmology and certainly he was a great practitioner and tutor. His studies in ophthalmoscopy, retinal detachment and glaucoma surgery belong to the best of the 19th century ophthalmology.
Scene perception in macular degeneration: the effect of contrast
Authors: THI HA CHAU THC , DESPRETZ P , BOUCART M
Published: November 2010

Purpose To access performance of AMD patients in an animal/non‐animal categorization task using achromatic natural scenes with large reductions in contrast, and to study the relation between visual acuity, lesion size and the performance of categorization.

Methods Eighteen patients with neovascular AMD and visual acuity less than 20/50 were included. Seventeen age‐matched healthy subjects were used as controls. Complete ophthalmologic examination were performed in all participants. The stimuli were photographs of animal (targets) and natural scenes (distractors) , displayed on a screen, with four level of contrast N, N/2, N/4 and N/8. Participants were asked to press a key when they saw an animal. Accuracy, false alarms, correct rejections were recorded.

Results Percentage of correct detections was lower in AMD patients compared to control. Larger decrease of performance was observed in AMD patients than in controls when the contrast condition was reduced. No correlation was found between performance and lesion size. Correlation was found between visual acuity and performance when contrast level was reduced to N/2, N/4 and N/8.

Conclusion The results of the present study may be considered for adaptation of luminance and contrast in the environment of AMD subjects, in order to improve to improve their mobility and to prevent falls.
Clinical effect of retinal photocoagulation
Authors: BANDELLO F
Published: November 2010

Abstract not provided
Metallic proteases and laser
Authors: MARSHALL J
Published: November 2010

Abstract not provided
Laser and vitrectomy
Authors: STEFANSSON E
Published: November 2010

Purpose Modern vitreous surgery involves a variety of treatment options in addition to vitrectomy itself, such as photocoagulation, anti‐VEGF drugs, intravitreal steroids and release of vitreoretinal traction. A full understanding of these treatment modalities allows sensible combination of treatment options.

Methods Vitrectomy reduces the risk of retinal neovascularization, while increasing the risk of iris neovascularization, reduces macular edema and stimulates cataract formation. These clinical consequences may be understood with the help of classical laws of physics and physiology. The laws of Fick, Stokes‐Einstein and Hagen‐Poiseuille state that molecular transport by diffusion or convection is inversely related to the viscosity of the medium. When the vitreous gel is replaced with less viscous saline, the transport of all molecules, including oxygen and cytokines, is facilitated. Oxygen transport to ischemic retinal areas is improved, as is clearance of VEGF and other cytokines from these areas, thus reducing edema and neovascularization. At the same time, oxygen is transported faster down a concentration gradient from the anterior to the posterior segment, while VEGF moves in the opposite direction, making the anterior segment less oxygenated and with more VEGF, stimulating iris neovascularization.

Results Retinal photocoagulation has also repeatedly been shown to improve retinal oxygenation. Oxygen naturally reduces VEGF production and improves retinal hemodynamics. The VEGF‐lowering effect of photocoagulation and vitrectomy can be augmented with anti‐VEGF drugs and the permeability effect of VEGF reduced with corticosteroids

Conclusion Vitrectomy and laser retinal treatment both improve oxygenation of the ischemic retina, reduce VEGF formation and thereby reduce neovascularisation and edema.
Wall‐to‐lumen ratio of retinal vessels in patients with cerebrovascular damage
Authors: MICHELSON G , BALEANU D
Published: November 2010

Purpose There is evidence that generalized retinal arteriolar narrowing, which can be measured by the arteriole‐to‐venule ratio (AVR) of retinal vessels, predicts cerebrovascular events. The wall‐to‐lumen ratio (WLR) and wall cross‐sectional area (WCSA) of retinal arterioles reflect structural arteriolar parameters. The primary objective was to test the association between WLR and AVR in patients with cerebrovascular damage.

Methods In this cross‐sectional study, 23 patients (57.5 +/‐ 9.4 years) with acute transitory ischemic attack or lacunar cerebral infarct were compared with two age‐matched control groups: 83 subjects with essential hypertension (53.7 +/‐ 5.5 years) and 16 normotensive subjects (52.2 +/‐ 8.3 years). Retinal arteriolar parameters (WLR, WTH, and WCSA) were assessed in vivo with scanning laser Doppler flowmetry (SLDF). AVR and a qualitative evaluation of retinal vessels were obtained from digital retinal color photographs. The intima‐media thickness (IMT) of the carotid artery was measured.

Results WLR (0.44 +/‐ 0.1 vs. 0.34 +/‐ 0.1 vs. 0.30 +/‐ 0.1, P < 0.001) and carotid IMT (P < 0.05) were significantly greater in the cerebrovascular event group compared with normotensive subjects. WLR and WCSA were significantly higher in the cerebrovascular event group compared with subjects with mild arterial hypertension. AVR was similar in all three study groups.

Conclusion The increase in WLR and WCSA of retinal arterioles, as well as in IMT in patients with cerebrovascular damage suggests vascular hypertrophy in the microvascular and macrovascular bed. The lack of association between AVR of retinal vessels and WLR of retinal arterioles
Ocular blood flow in diabetes
Authors: GARHOFER G
Published: November 2010

Diabetes is among the most prominent reasons for developing blindness in industrialized nations. In the recent years there is cumulating evidence that a dysfunctional ocular microcirculation is involved in the pathogenesis of the disease. Although ocular blood flow in diabetic retinopathy has been thoroughly investigated, the reported results are inconsistent. This may be at least partially be related to the fact that blood flow is dependent on the severity of the disease. In particular, most of the studies, but not all report an increased ocular blood flow in early stages of diabetic retinopathy whereas blood flow seems to be decreased in the proliferative form of the disease. More importantly, it has been shown that beside changes in baseline flow, endothelial dysfunction is present even in very early stages of the disease. Based on this observation it has been hypothesized that endothelial dysfunction may precede other diabetes related complications. In this talk our current knowledge about blood flow regulation in patients with diabetes will be summarized.
Relationship between macular pigment and mesopic visual function in early age‐related maculopathy
Authors: PUELL MC , BARRIO AR , PEREZ‐CARRASCO MJ , GOMEZ‐SANZ FJ , LOZANO‐ESCOBAR I , PALOMO‐ALVAREZ C
Published: November 2010

Purpose Psychophysical studies have demonstrated that several parameters of visual function deteriorate in the early stages of age‐related maculopathy (ARM). This study was performed to analyze whether the variability in high (HC) and low (LC) ‐contrast visual acuity (VA) and contrast sensitivity (CS) at mesopic light level is attributable to differences in macular pigment optical density (MPOD) in early ARM patients.

Methods Measurements were obtained from 40 eyes of adults (65 ± 7 years) with early ARM and 34 age‐matched healthy control eyes (67 ± 6 years). MPOD was estimated at the fovea using the Metropsis Test (Cambridge Research System). Visual acuity (VA) was measured with the best spectacle correction using high‐contrast (96%) and low‐contrast (10%) logMAR letter charts under mesopic luminance conditions (0.1 to 0.2 cd/m2). Mesopic contrast sensitivity (CS) was determined using the Pelli‐Robson chart.

Results Foveal MPOD was 0.25 ± 0.14 in eyes without ARM and 0.29 ± 0.22 in eyes with early ARM. Mean mesopic high and low contrast logMAR VA and log CS were significantly worse in the ARM group than in the control group. There was no significant relationship between high HC‐VA and MPOD, LC‐VA and MPOD and between log CS and MPOD in both early ARM and control group.

Conclusion No differences in MP optical density were found between eyes with and without early ARM. Mesopic visual function was unrelated to foveal macular pigment optical density in early age‐related maculopathy.
The eyelid margin: an underestimated contributor to ocular surface health and disease
Authors: KNOP E , KNOP N
Published: November 2010

Purpose The eyelid margin is frequently underestimated in the consideration of factors in ocular surface health and disease. Clinically the whole free end of the lid margin is often addressed simply as “margin” without further differentiation. It is attempted to review the structure, embryology and function of the lid margin as well as its involvement in ocular surface pathology.

Methods A review based on the available literature on the lid margin is prepared together with own findings on the histology of normal and pathological tissues.

Results The human lid margin is divided into distinct zones that consist, coming from the skin side, of a rounded outer lid border, a free lid margin (between the eye lashes and the opening of the meibomian glands), the muco‐cutaneous junction and a sharp inner lid border. The embryological development of the eye lids and their tissue components (loose connective tissue, lid muscles, ciliary hairs, Meibomian glands and vascular and neural components) takes place during the period of sealed lids. During this time the development of the Meibomian glands shows considerable similarity to that of the ciliary hairs. The sealing of the mesodermal lid folds and their eventual separation is dependent on several factors that may be involved in pathology. Various disease states, as well as the aging process, can lead to destruction of the lid margin and, conversely, this can lead to deterioration of the cornea and conjunctiva.

Conclusion The eyelid margin is an underestimated contributor to ocular surface health and disease. Increased awareness of the anatomy, embryology, physiology and pathophysiology of the lid margin and it tissue components appears important for the preservation of ocular surface integrity. Support DFG KN317/11
Histological characteristics of the posterior lid margin
Authors: KNOP N , KNOP E
Published: November 2010

Purpose The structure of the lid margin is insufficiently understood and defined although it is of obvious importance for ocular surface integrity. In particular the histological structure of the tissues of the normal lid margin and their zonal differentiation is partly unclear.

Methods The structure and function of the different zones at the posterior lid margin are explained with a focus on dry eye disease, based on the available literature on the lid margin together with own findings on the histology of normal and pathological tissues from the human lid margin.

Results The Meibomian glands (MG) that are of particular significance for the integrity of the ocular surface open still within the cornified epidermis. Their obstructive dysfunction (MGD) is a main cause for dry eye disease. The orifice is followed by the mucocutaneous junction (MCJ) that extends from the abrupt termination of the epidermis to the crest of the inner lid border. The physiological vital stainable line of Marx represents its surface and can be used as a diagnostic tool for the location and functionality of the MG orifices and lacrimal puncta. The marginal conjunctiva starts at the crest of the inner lid border and forms a thickened epithelial cushion. This is the point in closest apposition to the globe, represents the zone that wipes the bulbar surface and distributes the thin pre‐ocular tear film. It is hence termed as the lid wiper and pathological alterations that result in a vital staining are a sensitive early indicator of dry eye disease.

Conclusion The margin of the eyelid is an important but yet underestimated structure for the maintenance of the pre‐ocular tear film and of utmost importance for the preservation of ocular surface integrity and for development of dry eye disease. Support DFG KN317/11
A revolutionary hypothesis to explain Marx's line and progressive disease at the lid margin
Authors: BRON AJ , GAFFNEY EA , YOKOI N , TIFFANY JM
Published: November 2010

Purpose The conjunctiva of the lid margin is protected from direct exposure to the atmosphere, by the tear meniscus. We examine the pathophysiological consequences of evaporation from this compartment.

Methods A consideration of empirical data.

Results The concave meniscus thins progressively to the point where it is pinned at the mucocutaneous junction (MCJ). We predict that, as a result, over the interblink period, evaporation generates a solute gradient which peaks behind the MCJ and is amplified over multiple cycles of the blink. We hypothesise that this creates a hyperosmolar state here which: i. stresses epithelial cells behind the MCJ, ii. stimulates a high cell turnover and iii. leads to immaturity of the surface cells and their glycocalyx. This is considered to explain an increased permeability to dyes at this site (rose bengal, lissamine green and fluorescein) and the stainability with dyes which is termed Marx’s line.This gradient mechanism could also concentrate proteins, such as inflammatory mediators, at this location.

Conclusion Since Marx’s line lies directly behind the terminal Meibomian ducts and acini, chronic stress in this region is further invoked to explain forward migration of Marx's line and the MCJ which occurs with age and the induction of primary Meibomian gland dysfunction. Arguments are put forward to explain how this mechanism might be accentuated in dry eye and how the globe might be protected from this gradient effect in the region of the ‘black line’, where the tear film is segregated from the meniscus after the blink. Factors pro and con the hypothesis are discussed.
Control of the Meibomian gland in health and disease
Authors: SULLIVAN DA , KAM W , KHANDELWAL P , LIU S
Published: November 2010

Purpose The meibomian gland is extremely important in maintaining the health and integrity of the ocular surface. This gland, through its lipid synthesis and secretion, promotes the stability and prevents the evaporation of the tear film. Conversely, meibomian gland dysfunction (MGD) leads to a decreased stability and increased evaporation of the tear film. Indeed, meibomian gland dysfunction is thought to be the major cause of dry eye syndromes throughout the world. Our goal is to advance understanding of the regulation of meibomian gland function and the mechanisms underlying MGD.

Methods Procedures included the immortalization of human meibomian gland epithelial cells with human telomerase reverse transcriptase, the evaluation of cellular responsiveness, and the identification of glandular gene expression changes in MGD. Gene analyses were conducted with Illumina HumanHT‐12 v3 Expression BeadChips and Geospiza bioinformatics software.

Results To date we have [a] immortalized human meibomian gland epithelial cells that respond to secretagogue, growth factor, neurotransmitter and hormone exposure with alterations in proliferation, differentiation, signaling, gene expression and/or lipogenesis; [b] discovered human meibomian gland genes that may facilitate the development and/or progression of MGD. These genes encode proteins that promote keratinization and amplify inflammation.

Conclusion Our findings advance our understanding of the control of the meibomian gland in both health and disease. [Acknowledgments: S.M. Richards, M. Hatton, A.M. Fay and K. Lo; Supported by grants from NIH (R01EY05612) and Alcon]

Commercial interest
Is foveal thickness correlated with macular pigment optical density and with Intraocular light scatter in early age‐related maculopathy?
Authors: PALOMO‐ALVAREZ C , PUELL MC , GOMEZ‐SANZ FJ , BARRIO AR , CLEMENT‐CORRAL A , PEREZ‐CARRASCO MJ
Published: November 2010

Purpose The purpose of this study was to investigate the relationship of foveal thickness with macular pigment optical density (MPOD) and intraocular light scatter (IOLS) in Early Age Related Maculopathy (ARM) subjects.

Methods Forty eyes of adults (age mean: 65 ± 7 years) with early Age Related Maculopathy (ARM) were investigated. All patients had undergone a complete ophthalmic examination to select the subjects. Foveal thickness parameters were obtained using optical coherence tomography (OCT: Topcon 3D OCT‐1000). Macular pigment optical density at the fovea was measured with the Metropsis Test (Cambridge Research Systems. Ltd. UK) and intraocular light scatter was measured using the C‐Quant straylight meter (Oculus AG, Germany).

Results Mean foveal thickness was 226.44 ± 22.56 microns, mean MPOD was 0.22 ± 0.29 log units and mean IOLS was 1.14 ± 0.18 log units. With the regression analysis of linear model, we did not find a significant correlation between foveal thickness and MPOD and neither between foveal thickness and IOLS in early ARM subjects.

Conclusion No correlation was found between foveal thickness and macular pigment optical density and between foveal thickness and intraocular light scatter in early ARM subjects.
Gene‐environment interactions shape myopia development
Authors: GUGGENHEIM JA , CHEN YP , ERICHSEN JT
Published: November 2010

Purpose Refractive development is highly heritable, yet also known to be regulated by visual experience during childhood. Recent genome‐wide association studies for refractive error have identified very few variants, which together explain only a small fraction of the population attributable risk. Gene‐environment interactions represent an attractive explanation for the paradoxical evidence supporting both genetic and environmental determination of refractive error, but to date their influence in complex disorders such as myopia is almost entirely unknown.

Methods We carried out a selective breeding experiment in chicks monocularly deprived of sharp vision for 4 days, starting when they were 4 days old. Chicks in the extremes of the myopia susceptibility frequency distribution were retained for breeding. Heritability was estimated using variance components analysis with the SOLAR package.

Results After 2 rounds of selection, chicks bred for low susceptibility developed less than half the treatment‐induced myopia of those bred for high susceptibility ("Low line" = ‐6.88 ± 3.35 D; "High line" = 15.27 ± 3.47 D; mean ± SD; N = 392; P ~10e‐80). Susceptibility to induced myopia was highly heritable (heritability = 0.53; N = 891; p ~10e‐122). Furthermore, the Low line developed only half the myopia of the High line in response to a second type of environmentally‐induced myopia, minus lens wear. The genetic variants that determined myopia susceptibility were found to be distinct from those controlling natural variations in eye size.

Conclusion This work reveals that genetic variants determine susceptibility to myopia triggered by cues from the visual environment, implicating a potentially major role for gene‐environment interactions in human myopia development.
Visual‐related quality of life in patients with inherited retinal dystrophies ‐ a baseline for assessing clinical trial efficacy
Authors: PROKOFYEVA E , BERND A , WILKE R , ZRENNER E
Published: November 2010

Purpose To analyze visual‐related quality of life (VRQL) in patients with inherited retinal dystrophies.

Methods The National Eye Institute Visual Functioning Questionnaire (NEI‐VFQ‐25), using a German validated version, was administered to patients with macular dystrophy (8), retinitis pigmentosa (34), Stargardt disease (31), Usher I and II types (10), central areolar choroidal dystrophy (3), cone (4) and cone‐rod dystrophies (13), choroideremia (2), Leber congenital amaurosis (1) and CSNB (2). Visual field (VF) data and BCVA in logMAR were obtained. The mean and standard deviations were calculated.

Results 108 patients (62 men/46 women) were studied. The mean age was 39,5 (SD=1,5). The mean composite score was 59 (SD=13,7). The most reduced subscales were role limitations (35,9; SD=18,8), mental health (30,3; SD=15,6) and dependence on others (26,12; SD=20,7). Social functioning (69,2; SD=22,6), ocular pain (79,3; SD=19,96), and color vision (82,5; SD=26,2) were least reduced. The peripheral vision score was significantly lower in patients with concentric VF constriction (p<0,0076). Those with a lower BCVA had decreased general (p<0,0251), near (p<0,003), distance vision (p<0,03), and social functioning (p<0,0069) scores.

Conclusion The composite score, role limitations, mental health, and dependence subscales were the most reduced. The lower peripheral vision score was associated with concentric VF constriction. Lower general, near, distance vision, and social functioning scores were linked to BCVA decrease. The results of this study can be used as a baseline for the assessment of clinical trials efficacy. Supported by Kerstan Foundation and EuroVisionNet EU Grant Health‐F2‐2008‐200641.
Expression of stem cell factor/c‐kit signaling pathway components in diabetic fibrovascular epiretinal membranes
Authors: ABU EL ASRAR A , STRUYF S , OPDENAKKER G , VAN DAMME J , GEBOES K
Published: November 2010

Purpose Stem cell factor (SCF)/c‐kit signaling promotes recruitment of endothelial progenitor cells and contributes to ischemia‐induced new vessel formation. We investigated the expression of the components of this pathway including c‐kit, SCF, granulocyte colony‐stimulating factor (G‐CSF), endothelial nitric oxide synthase (eNOS), and the chemokine receptor CXCR4 in proliferative diabetic retinopathy (PDR) epiretinal membranes.

Methods Membranes from 8 patients with active PDR and 12 patients with inactive PDR were studied by immunohistochemistry.

Results Blood vessels expressed c‐kit, SCF, G‐CSF, eNOS, and CXCR4 in 18, 15, 19, 20 and 20 out of 20 membranes, respectively. Significant correlations were detected between number of blood vessels expressing CD34 and number of blood vessels expressing SCF (r=0.463; p=0.04), G‐CSF (r=0.87; p<0.001), eNOS (r=0.864; p<0.001), and CXCR4 (r=0.864; p<0.001). Stromal cells expressed c‐kit, SCF, eNOS, and CXCR4 in 19, 15, 20, and 20 membranes, respectively. The numbers of blood vessels expressing CD34 (p=0.005), c‐kit (p=0.03), G‐CSF (p=0.007), eNOS (p=0.001), and CXCR4 (p=0.018), and stromal cells expressing c‐kit (p=0.013), SCF (p<0.001), eNOS (p=0.048), and CXCR4 (p=0.003) were significantly higher in active membranes than in inactive membranes.

Conclusion SCF/c‐kit signaling might contribute to neovascularization in PDR.
No retinal apoptosis in mouse model of Opa1 dominant optic atrophy despite visual loss
Authors: VOTRUBA M , PIECHOTA M , TAYLOR E , POWELL K , DAVIES V
Published: November 2010

Purpose Autosomal dominant optic atrophy (ADOA) due to mutations in OPA1 is a slowly progressive optic neuropathy. OPA1 is ubiquitously expressed and plays a key role in mitochondrial fusion. Heterozygous Opa1 mutant mice (B6;C3‐Opa1Q285STOP), with previously reported visual defects and optic nerve changes on EM, were assessed for evidence of cellular effects and retinal sequelae.

Methods The level and processing of Opa1 were studied by Western blot. Membrane potential was assessed by JC‐1 in isolated mitochondria. Mitochondrial morphology was investigated using Mitotracker staining on E13.5 mouse embryonic fibroblasts (MEFS). End‐organ evidence for apoptosis was explored on TUNEL stained retinal sections.

Results The heterozygous mutation leads to ca. 50% reduction in Opa1 protein in mitochondria. Despite this there is no statistically significant reduction in the average mitochondrial membrane potential in the retina and brain by 5 months of age. Although Opa1 +/‐ MEFS demonstrate a 15% increase in the number of cells showing mitochondrial fragmentation their growth and survival characteristics after oxidative stress were not significantly affected. There was no increased apoptosis in retinal sections from mutant animals.

Conclusion A 50% reduction in Opa1 protein, capable of causing a defect in mitochondrial morphology in MEFS, in the presence of visual dysfunction and morphological changes on electron microscopy in the optic nerve, nevertheless does not appear to lead to a significant increase in apoptosis in retina. This suggests that dysfunction of RGCs rather than overt loss may be important in the pathophysiology of the disease.
Legal blindness in Rethymnon: causes and prevalence
Authors: CHRISTODOULAKIS EMM , VRACHNIDIS ST , KRIKONIS TH , GODOLIAS ST , CHLIVEROS K , TROULI N
Published: November 2010

Purpose To report all cases with legal blindness in the prefecture of Rethymnon Crete, in the period of February 2009 – May 2010. Legal blindness in Greece is defined as best corrected visual acuity in both eyes less than 1/20 and has several social and economical issues.

Methods Retrospective analysis of all cases presented at the external office of department of Ophthalmology of the General Hospital of Rethymnon, Crete, Greece. Social Services in Greece, accept certificates of blindness only from hospitals of the same prefecture, so our cases presented here, are all the cases of the Rethymnon prefecture for this period of time.

Results In the period 2/2/2009 ‐ 30/5/2010 presented 107 patients asked for certificate of blindness, in the external Office of Ophthalmology department. 60 patients had best corrected visual acuity less than 1/20, 36 women and 24 men, with average age 82.6 years (std 12.7 years, 9 ‐ 95 years). Age‐related macular degeneration (ARMD) was the cause of blindness in 21 patients, glaucoma in 13 patients, diabetic retinopathy combined with ARMD in 4 patients; other causes were degenerative myopia, retinal occlusive disease, ocular trauma, retinoblastoma, endophthalmitis, optic nerve head atrophy or combinations of previous diseases.

Conclusion Age‐related macular degeneration followed by glaucoma are the most common causes of legal blindness in the population of prefecture of Rethymnon
What's new in neuroprotection
Authors: WHEELER L , BURKE J
Published: November 2010

Purpose Vision loss is a an important patient concern in glaucoma and retinal diseases. This talk will update recent findings with alpha‐2 agonists and NMDA antagonists in light of recent clinical experience in neuroprotection. Alpha‐2 agonists have been shown to be neuroprotective in many animal models by mechanisms thought to enhance neuronal survival. The physiological role of alpha‐2 receptors is still an emerging area of research in the retina and optic nerve.

Methods Recent experiments suggest that alpha‐2 agonists can improve retinal performance in laboratory animals. The new methods to demonstrate this will be presented. How is this different than neuroprotection? Or is it?

Results A number of ideas are being pursued to explain the observation of improved retinal performance: increased axonal transport in rats; changes in down stream receptor signalling, etc.

Conclusion Understanding the mechanism(s)of action for how alpha‐2 agonists affect neuroportection and retinal performance may lead to new medical therapies and the role of these receptors in the physiology and function of the eye.

Commercial interest
Phenotype/genotype evolution in corneal embryologic malformations
Authors: NISCHAL KK
Published: November 2010

Purpose To describe the evolution of a clinically useful classification of corneal developmental anomalies which has also allowed more accurate phenotype/genotype correlation.

Methods The use of clinical documentation using anterior segment photography, normal ultrasound of the eyeball, and high frequency ultrasound and where available histology of host tissue has allowed detailed phenotypes to be developed . Intraoperative recordings of phenotype have also been noted. Genotyping of specific patterns groupings of corneal developmental anomaly phenotypes. Retrospective analysis of clnical outcome with or without surgical intervention.

Results Corneal developmental anomalies are best considered in terms of primary corneal disease and secondary corneal disease. The former includes dystophies ( CHED, PPCD and X‐L ECD) , corneal dermoids and isolated sclerocornea ( CNA 1 and 2 ).Secondary corneal disease includes secondary to, iridotrabecular anomalies ( eg congenital glaucoma, aniridia, axenfeld ‐rieger anomaly), kerato‐irido‐lenticular dysgenesis ( iridolenticular adhesions( Peters type I), failure of lens to form,separate or move away from the cornea).

Conclusion Using this classification prognosis for intervention can be shown to be mor successful in primary corneal developmental anomalies. Also by considering groups of patients with similar disease eg primary aphakia, appropriate genotyping can be done eg FOXE3 analysis for children with primary aphakia . More acccurate phenotype allows better clinical classification and ultimately better genotyping of corneal developmental anomalies
Optical coherence tomography image grading agreement between observers in neovascular age‐related macular degeneration
Authors: MENKE MN , KORDIC H , KURZ‐LEVIN M , STURM V , KNECHT PB
Published: November 2010

Purpose Time‐domain optical coherence tomography (TD‐OCT) became an important tool for the management of neovascular age‐related macular degeneration (AMD). Recently, spectral‐domain OCT (SD‐OCT) became available with improved image resolution and scanning speed. The purpose of this study was to compare inter‐observer agreement of SD‐OCT versus TD‐OCT image grading in patients with exudative AMD.

Methods Thirty eyes with neovascular AMD were examined with 2 different OCT models. Three observers graded fast macular scans (FMS), cross hair scans (CHS) (both Stratus™ OCT), volume scans (VS), and radial line scans (RLS) (both Spectralis™ OCT) for the presence of various morphologic pathologies. Inter‐observer agreement between OCT models was assessed by calculating intra‐class correlation coefficients (ICC).

Results In Stratus™ OCT highest agreement was found for subretinal fluid (ICC: 0.79), and in Spectralis™ OCT for intraretinal cysts (IRC) (ICC: 0.93). Spectralis™ OCT showed superior agreement for IRC and epiretinal membranes (ERM) (ICCStratus™ : for IRC 0.61; for ERM 0.56; ICCSpectralis™ : for IRC 0.93; for ERM 0.84). Lowest agreement was found for subretinal fibrosis (FIB) with an ICCStratus™ of 0.65, and an ICCSpectralis™ of 0.52. Spectralis™

Conclusion Increased image resolution of Spectralis™ OCT did not markedly improve the inter‐observer agreement except for grading intraretinal cysts and epiretinal membranes.
Vitreomacular adhesion in exudative age macular degeneration
Authors: BERROD JP , HAOUACHE G , HUBERT I
Published: November 2010

Purpose To evaluate posterior vitreomacular adhesion in exudative age‐related macular degeneration (AMD) using Stratus optical coherence tomography (OCT).

Methods Retrospective observational consecutive case series about 50 eyes of 50 patients (age 57‐91 years) treated for choroidal neovacularisation (CNV) and examined with ( OCT). Vitreomacular adhesion was defined when the posterior hyaloid line was attached to inner retina .

Results A vitreomacular adhesion was found in 27 eyes (54%). The location of vitreomacular adhesion was observed in all cases over the area of the CNV.

Conclusion Vitreomacular adhesion may promote exsudative age macular degeneration. A prospective study with spectral OCT could confirm these findings. Vitrectomy or pharmacologic vitreolysis could be considered for the treatment or the prevention of exudative AMD.
Lutein supplementation improves scotopic sensitivity recovery in AMD
Authors: MAKRIDAKI M , BERENDSCHOT TTJM , VAN DER VEEN RLP , CARDEN D , PARRY NRA , MURRAY IJ
Published: November 2010

Purpose To monitor photopic and scotopic sensitivity recovery during a one year period of supplementation with lutein (L).

Methods A two centred, placebo controlled study of L supplementation was conducted in Maastricht, The Netherlands and Manchester, UK. L capsules (10mg ester), or placebo (P) were taken by AMD patients daily. There were 29 patients in the L group and 31 patients in the P group. Sensitivity recovery functions and MPOD (Macular Pigment Optical Density) were measured at baseline and at 4, 8 and 12 months. MPOD was measured with a flicker‐based method. Sensitivity recovery following a bleach was obtained by recording visual thresholds (white 1 deg target, nasal eccentricity 11 deg).

Results In the L group, there was a mean increase of MPOD from 0.40 (0.17) at baseline to 0.54 (0.21), at visit 4, SDs in brackets (p< 0.0001). In the P group, MPOD was 0.47 (0.19) at baseline and 0.49 (0.19) at visit 4. The mean rod recovery rate for the L group was 3.1 dB/min (1.08) at baseline that increased to 3.65 (0.31) at visit 4. This was statistically significant (p =0.17). The mean rod recovery rate for the P group was reduced from 3.3 (1.3) to 3.1 (1.35), (NS). The rod recovery time for the L group reduced from 15.9 minutes (7.9) to 14.5 minutes (8.4), NS. In the P group, rod recovery time increased from 14.3 (7.7) to 16.8 minutes (p= 0.021). For cone recovery or rod‐cone break time no significant differences between baseline and visit 4 in either the L group or the P group were found.

Conclusion Rod‐based sensitivity recovery kinetics are improved after the augmentation of MPOD with lutein. In patients in whom there is no increase in MP a significant increase in rod‐based sensitivity recovery time can be expected.
Corneal biomechanics in age‐related macular degeneration
Authors: CELLINI M , PAZZAGLIA A , STROBBE E , GIZZI C , BALDUCCI N , CAMPOS EC
Published: November 2010

Purpose To compare the corneal hysteresis (CH) and the corneal resistance was increase force (CRF) of patients with age‐related macular degeneration (ARMD) and control subjects.

Methods The CH and the CRF were compared among 20 patients with ARMD (ARMD group: 10 with neovascular and 10 with non‐neovascular ARMD) aged from 54 yrs to 78 yrs (68.9±15.9 yrs) and 20 age‐matched control patients (control group). In ARMD and control group the eye's axial length was: 23.14 ±0.95 mm vs. 23.04 ±1.16 mm (p<0.715) and the corneal thickness was: 555.1±3.08 vs. 558±4.14 µ (p<0.274). The CH and CRF values were achieved by ocular response analyzer (ORA).

Results We found a statistical significant difference in the CRF between patients with ARMD and control subjects (ARMD group 11.13±1.30 vs. control group: 9.82±1.37; p<0.001) was found. A difference, but no stastical significant was found also for CH index between patients with AMD and control subjects (ARMD group: 10.15±1.25 vs. control group: 10.02±1.68 mm/hg; p<0.376). When we examined separately the two subgroups of patients with ARMD (neovascular and nonneovascular ARMD), the average CH were higher in patients with neovascular AMD compared with patients with non‐neovascular ARMD (neovascular ARMD group: 10.77±1.00 vs. non‐neovascular ARMD 10.17±1.08; p<0.074) and CRF was also increased in neovascular ARMD (neovascular ARMD group: 11.86±0.99 vs. non‐neovascular ARMD 10.88±1.37; p<0.032).

Conclusion Despite the limitations placed by the small sample of the examined cases, patients with ARMD had a statistical significant increase of CRF compared with healthy control group. Furthermore we found the same statistical significant increase of CRF in neovascular ARMD patients compared with non‐neovascular ARMD
Associations of early age‐related macular degeneration with ocular and general parameters. The Central India Eyes and Medical Study
Authors: LIBONDI T , JONAS JB , NANGIA V , KULKARNI M , GUPTA R , KHARE A
Published: November 2010

Purpose To assess associations between age‐related macular degeneration (AMD) and ocular and general parameters.

Methods The Central India Eye and Medical Study, a population‐based study performed in rural Central India, included 4711 subjects (aged 30+ years) out of 5885 eligible subjects (response rate: 80.1%). Fundus photographs were assessed using the Wisconsin Age‐Related Maculopathy Grading system.

Results Fundus photographs were available for 4542 (96.4%) subjects. Early AMD was present in 215/4542 subjects (4.7±0.3%), and late AMD was detected in 8/4542 (0.2±0.03%) subjects. After adjustment for age, prevalence of AMD was significantly associated with hyperopic refractive error (P=0.001), shorter axial length (P=0.01), and higher corneal refractive power (P=0.02).AMD was not significantly associated with blood pressure, serum concentration of cholesterol, glycosylated haemoglobin Hb1Ac, high‐density lipoproteins and postprandial glucose, gender, level of education, any parameter of smoking, alcohol consumption, psychiatric depression or of daily activities, anterior chamber depth, lens thickness, intraocular pressure, size of the optic disc, neuroretinal rim and parapapillary atrophy, nor amount of nuclear cataract and status after cataract surgery.. If the statistical analysis was adjusted for age and refractive error, age‐related macular degeneration was marginally significantly associated with a low intake of fruits (P=0.06).

Conclusion Hyperopia (and short axial length) besides age was the single most important associated factor for AMD in adult Indians.
The influence of cardiovascular diseases on the development of neovascular AMD
Authors: NAPORA KJ , OBUCHOWSKA I , MARIAK Z
Published: November 2010

Purpose Identification of cardiovascular risk factors for neovascular form of age‐related macular degeneration (AMD).

Methods 61 patients were studied prospectively, 44 women and 17 men, aged from 57 to 85 years old, treated at the Department of Ophthalmology of the Medical University of Bialystok in the years 2008‐2009 due to AMD. Each patient was given a full eye examination, their blood pressure was measured a few times and their glucose or lipid metabolism was labeled. AMD was diagnosed on the basis of fluorescein angiography and OCT. The patients were divided into two groups: the dry form of AMD ‐ 24 people and the wet form of AMD – 37 people. Groups were compared in terms of the following factors: age, sex, a history of coronary heart disease, hypertension, hypercholesterolemia, a history of smoking. The results were statistically analysed using the Fisher test.

Results It was found that people with wet AMD more often have unregulated blood pressure, impaired lipid and glucose metabolism, are more often active or passive smokers compared to patients with dry AMD; the differences are statistically significant (p<0.05). The ratio of women to men in the group with neovascular AMD was 4.4:3 and the dry form was 11:1 (p<0.05). In both groups there were no statistically significant differences regarding patient’s age and history of coronary heart disease.

Conclusion 1. Unregulated blood pressure, abnormal lipid and glucose metabolism and smoking may pose potential risk factors for neovascular AMD. 2. Men more often have the wet rather than the dry form of AMD. Scientific work financed from the funds for science in 2009‐2011.