bluuebunny/crossref_metadata_2025 huggingface dataset:
Applications of adaptive‐optics in ophthalmology
Authors: CHATEAU N
Published: October 2007

Purpose: This presentation reviews the current and potential applications of adaptive optics (AO) in the area of ophthalmology.

Methods: AO was invented by astrophysicists in order to eliminate image blur and twinkling in large terrestrial telescopes. This technique cancels the optical distortions that are introduced by the earth atmosphere, a turbid and inhomogeneous medium, in the light emitted by distant stars. Like the atmosphere, the human eye is optically imperfect: it suffers from wavefront aberrations whose pattern and amount differ between individuals. This is the reason why AO has met several applications in ophthalmology. One part of the AO technology consists in measuring the distortions of light using a wavefront sensor: this technique has been integrated into wavefront aberrometers that routinely improve the precision of LASIK procedures.

Results: The full implementation of AO has recently led to other breakthrough devices. AO visual simulators are enhanced aberrometers that allow patients to visualize, at the pre‐operative stage, the expected outcome of refractive surgery procedures, including presbyopic ablations. Several research laboratories have implemented AO to improve the resolution of various retinal imaging techniques (fundus camera, SLO, OCT) up to the scale of single retinal cells. Three‐dimensional images of cone photoreceptors have recently been obtained with a resolution of 3μm, both in the longitudinal and transverse dimensions of the retinal tissue. Aside from this world‐record, the presentation will also address the limitations of the technique and describe some of the work in progress towards the clinical applications of AO technology.

Conclusions: AO technology will likely provide new devices that meet unsatisfied needs in refractive surgery and retinal disagnostics.
Sports and wavefront aberrometry
Authors: GICQUEL JJ , DIGHIERO PL
Published: October 2007

Purpose: In this paper we study the future applications of wavefront aberrometry in high‐level sportsmen and in Tennis pros in particular

Methods: We compare the level of ocular aberrations between a group of International junior french tennis players from the « Pôle France » to Amateur Tennis Players of the same age, with a Shack‐Hartman aberrometer: IRX‐3 (Imagine Eyes ®). We try find if in the tennis pros group there is a correlation between the level of ocular aberrations and athletic performance.

Results: Compared to the literature data on normal subjects, the global level of ocular aberrations (total RMS) of professional tennis players is very low; but is not statisticaly different compared with our control group (amateur tennis players). Though non corrected monocular and binocular vision acuity is higher in the tennis pros group, theyr total RMS is not statistically different from the one of amateurs.

However, professional tennis players present with less high order aberration than amateurs.

We found a significant correlation between the level of ocular aberrations and tennis performance in the International tennis players group.

Conclusions: We found that the specific population of young international tennis players seems to have a natural « Supervision ». The good visual performances of these subjects are not correlated with a complete absence of ocular aberrations, but they present with very low level of high order aberrations.

Associations of selected ocular aberrations might even be beneficial. Aberrations distribution in this population may help define new standards for specific sport aptitudes.
Limitations of correcting aberrations with soft contact lenses
Authors: LOPEZ‐GIL N , CASTEJON‐MOCHON JF , BONAQUE S
Published: October 2007

Purpose: In this paper, we study the limitations of correcting aberrations with soft contact lenses, which are custom‐designed for each subject aberrations with special interest on the effect of measuring and correcting wavefront in different planes (pupil and cornea plane).

Methods: We analyze, by experiments, theoretical methods and computer simulations, issues such as aberration dynamics, lens movement and errors in pupil plane localization. The study is carried out for three types of eyes: normal, keratoconus, and eyes that have gone through penetrating queratoplasty.

Results: Main factor limiting this type of aberration correction is the static horizontal and vertical translation as well as the rotation of the contact lenses on the eye. Typical rotations (3º, 5º) and translations (0.5 mm) of the soft contact lenses could null the benefit of the high‐order corrections in normal eyes. The correction of the wavefront in a different plane were it has been measured is not negligible when the aberrations (low and high order) are high.

Conclusions: We found that customized correction for normal eyes leads to a loss of optical quality, compared to standard correction (sphere and cylinder), when displacements of the contact lenses appear. In spite of the mentioned effects, there are, however, pathologic cases in which it is possible to reduce the RMS and increase visual quality, especially in the keratoconus eyes. In those high aberrated eyes special care should be taken due to the changes of the wavefront when propagating from the cornea plane to the pupil plane.
Wavefront guided custom ablation: facts and fiction
Authors: NGUYEN KHOA JL
Published: October 2007

Wavefront guided customized ablation is an exciting new tool for the modern refractive practice. Wavefront aberrometry gives us an accurate “fingerprint” of the eye. However, we should ask ourselves the following questions: First, can we improve visual acuity outcomes? Secondly, how can we or can we avoid and fix high order aberrations ? In this presentation we describe in detail the new optical challenges of refractive surgery. Thru a review of the literature and based on personal experience we show you the basics of custom wavefront technology, the promises but also the potential pitfalls of aberration guided laser ablation.
The problem of non‐adherence with medical therapy
Authors: GEORGIADOU I
Published: October 2007

Purpose: To discuss the topic of non‐adherence with medical therapy.

Methods: Adherence may be defined as the extent to which a patient’s behaviour coincides with medical advice. The success of long‐term therapy in chronic diseases depends upon patient’s adherence.

Results: Unfortunately, published evidence suggests that poor adherence is the single most important problem in long‐term medical therapy. The level of non‐adherence is generally underestimated by clinicians. Improving adherence depends upon a successful doctor‐patient communication but numerous other factors also influence adherence e.g. ease of medical therapy administration etc. Good adherence is critical for preventing disease progression.

Conclusions: New approaches are needed to enhance adherence with chronic medical therapy in real‐life practice.
Adherence with antiglaucoma therapy
Authors: CARASSA RG
Published: October 2007

In recent years an increasing attention has been drawn towards the performance of drugs in the real world. Beyond the mere IOP lowering effect, the treatment success implies a number of issues regarding the acceptance and adherence to the therapy.

Health outcome studies and studies on compliance showed poor persistency and adherence levels for glaucoma medical therapy with higher scores for prostaglandine analogues. Adherence is in fact linked to many variables: regimen factors (as complexity of treatment, tolerability, side effects), patient factors (as memory, motivation, knowledge), provider factors (as dissatisfaction or poor communication with the physician) and situational factors ( as competing activities, change in routine). The choice of a therapeutic strategy capable of minimally influencing the patients’ quality of life is crucial for optimal adherence and improving doctor‐patient communication is essential in favouring patient’s decision‐making about health‐promoting behaviors.
Patient reported problems and adherence to glaucoma medications in the United States and India
Authors: SLEATH B
Published: October 2007

Purpose: The purpose of this research was to examine patient reported adherence and problems in using glaucoma medications.

Methods: In the United States, 324 patients on adjunctive therapy who were seen at four geographically distinct ophthalmology practices participated. In India, 243 patients seen at a glaucoma clinic in an eye hospital in Southern India participated. All patients were asked to complete a survey before their visits with their ophthalmologists.

Results: The U.S. sample ranged in age from 20 to 91 (mean age 68 years) and was 48% female. The India sample ranged in age from 19 to 90 (mean 63 years) and was 36% female. Sixty‐one percent of the U.S. sample and 42% of the India sample reported one or more problems in using their glaucoma medications. Fourteen percent of the U.S. sample reported being less than 100% adherent in taking their glaucoma medications in the past week. Patients who had difficulty remembering to take their glaucoma medications and those who reported other problems or concerns were significantly more likely to report being less adherent. Six percent of the India sample reported being less than 100% adherent in the past week. Patients who reported difficulty squeezing the bottle and those who reported difficulty opening the bottle were significantly more likely to reported being less adherent.

Conclusions: Patients in the U.S. and India reported many problems in using their glaucoma medications and in each country specific types of problems were related to patient non‐adherence.
Objective evaluation of adjunctive glaucoma therapy
Authors: ROBIN A
Published: October 2007

Purpose: To measure adherence with electronic monitoring in two populations of subjects: those using once‐daily prostaglandin analogs (q.d.), and those on adjunctive medicine to the prostaglandin analog.

Methods: Single‐site, open‐label, non‐randomized, parallel, 60 day study. 62 open angle glaucoma or ocular hypertension adult subjects currently using either a topical prostaglandin as sole ocular hypotensive medical therapy q.d. (“1‐drug” subjects, n=31) or a topical prostaglandin plus an adjunctive topical ocular hypotensive product either q.d., twice‐daily (b.i.d.), or three‐times‐daily (t.i.d.) in the same eye(s) (“2‐drug” subjects, n = 31). An electronic event medication monitoring device was used to record each opening of the bottle containing the ocular hypotensive medication. The main outcome measures were dosing errors (number of under or over‐adherence events) and coverage (proportion of pharmacological duration covered by dosing) relative to ophthalmologist‐prescribed regimen.

Results: Adherence to the prostaglandins q.d. was good in both groups by all measures (≤10% of subjects with >5 dosing errors and mean coverage of 97.2±6.1%). Adherence to the second medication in the 2‐drug group was poorer (37% of subjects with > 5 dosing errors and mean coverage of 85.6 ± 12.6%). For the subjects on β‐adrenoceptor antagonists, 24.8±18.4% of doses were taken at less than 10 hour intervals (over‐adherence).

Conclusions: The use of electronic monitoring provides more information than simple “pill count,” bottle weighing methods, or prescription refill rate, as it incorporates a time component. We found that more complex dosing regimens result in poorer adherence, although q.d. drugs in a complex dosing regimen were found to have good adherence.
Update on a new randomised adherence study
Authors: TSIRONI S
Published: October 2007

Purpose: To present the design and aims of a new randomised adherence study, investigating the value of an intervention on the level of adherence with glaucoma therapy.

Methods: Poor adherence with prescribed treatments significantly undermines treatment of glaucoma. In a new randomized study we will investigate the impact of intensive teaching and other measures on the level of adherence in consecutive newly diagnosed ocular hypertensive or glaucoma patients. A novel device, TDA, will be employed to facilitate adherence monitoring in the present study. This device may help physician in objectively assessing adherence with selective glaucoma therapy. This study will validate this monitoring device.

Results: Documentation of the impact of intensive teaching on the level of glaucoma patients’ adherence.

Conclusions: The results of this study may determine if adherence of glaucoma patients is modifiable by education and consequently, it will indicate if we should focus our efforts in this approach in the future management of glaucoma.
Epidemiology and clinical findings of exfoliation syndrome and glaucoma
Authors: TSIRONI S
Published: October 2007

Purpose: To review the most important information on epidemiology and clinical picture of exfoliation syndrome.

Methods: The reported prevalence of exfoliation syndrome varies widely over the world, reflecting a combination of differences due to race, age, environment, ethnicity and other yet‐to‐be defined reasons. Exfoliation syndrome is frequently associated with severe chronic secondary open‐angle glaucoma.

Results: The typical clinical identification of exfoliation can be relied upon the biomicroscopical detection of exfoliation material after pupillary dilatation. Whereas the classic picture of manifest exfoliation syndrome has often been described, the early stages of beginning exfoliation have not been yet defined. Next to the lens, exfoliation material is most prominent at the pupillary border. Pigment loss from the iris sphincter region and its deposition on anterior chamber structures is a hallmark of the exfoliation syndrome. Its ocular manifestations affect all of the structures of the anterior segment as well as conjunctiva and orbital structures. Exfoliation syndrome often is an asymmetric condition, though never truly unilateral. Consequently exfoliation glaucoma is usually asymmetric and it is typically associated with higher mean IOP levels, greater diurnal fluctuations in IOP and marked pressure spikes.

Conclusions: Exfoliation syndrome is a condition of worldwide distribution and significance. It has characteristic clinical features and is currently the most important single identifiable risk factor for open‐angle glaucoma.
New insights into pathophysiology of exfoliation
Authors: SCHLOETZER SCHREHARDT U
Published: October 2007

Purpose: Pseudoexfoliation (PEX) glaucoma is the most common identifiable cause of open‐angle glaucoma worldwide comprising the majority of glaucoma in some countries. The underlying disorder, PEX syndrome, is a generalized process of the extracellular matrix characterized by the production and progressive accumulation of a fibrillar extracellular material in intra‐ and extracellular tissues. New insights into its molecular pathophysiology have increased the understanding of this disorder and the current concepts of pathogenetic mechanisms of PEX syndrome/glaucoma will be presented in this review.

Methods: Basic science, clinical‐pathologic correlations, and review of the literature.

Results: Recent molecular biologic data support the pathogenetic concept of PEX syndrome as a type of stress‐induced elastosis, an elastic microfibrillopathy, with TGF‐ß1, increased oxidative stress, a dysbalance of proteolytic enzymes and their inhibitors, an impaired proteasome system, and low grade inflammatory processes being key factors in pathogenesis. Active involvement of trabecular meshwork cells in local production of PEX material in the juxtacanalicular area may be the primary cause of outflow resistance and chronic pressure elevation in PEX patients. Additional pathogenetic factors include marked pigment dispersion, increased aqueous humor protein concentrations, and pressure‐independent risk factors including an impaired ocular and retrobulbar perfusion.

Conclusions: PEX syndrome may not only cause severe open‐angle glaucoma but also a spectrum of other complications and imply an increased risk for cardiovascular disease. A thorough awareness of its pathologic features and its effects on ocular tissues is critical for an early recognition and accurate diagnosis.
Current concepts in the management of exfoliative glaucoma
Authors: KONSTAS AGP
Published: October 2007

Purpose: To review current concepts in the management of exfoliative glaucoma (XFG)

Methods: Presentation of recently published studies on the success of medical, laser and surgical therapy in XFG

Results: The management of XFG should be different to that employed in POAG. Due to the worse 24‐hour IOP characteristics in XFG, optimal control of 24‐hour IOP is needed to improve long‐term prognosis in XFG. There is cumulative evidence that new medications may show a different response in XFG compared with POAG. Directed therapy in XFG may employ fixed combinations or laser as initial therapy. Prompt surgical intervention is more often needed in XFG. The role of non‐penetrating surgery in XFG requires further elucidation.

Conclusions: Overall, the management of XFG remains a challenge.
Large intraocular pressure fluctuations: a risk factor for glaucoma progression
Authors: ASRANI S
Published: October 2007

Purpose: We are aware of the detrimental effects of peaks of intraocular pressure (IOP) above the normal range. However, we have observed that many of our patients continue to experience glaucomatous progression despite their mean IOP being below what the physician considers an adequate target IOP for that individual. We studied the risk associated with diurnal IOP variations in open angle glaucoma.

Methods: The patients who were enrolled in the study used the Zeimer self‐tonometer to measure IOP over a period of 5 days. The readings were taken upon waking, noon, mid‐afternoon, dinnertime and bedtime. Visual fields over the 10‐year duration of the study were reviewed for progression. We performed statistical analyses on these readings to study the relative risk of disease progression.

Results: Baseline office IOP had no predictive value (relative hazard: 0.98). The IOP range over multiple days was a significant risk factor for progression even after adjusting for office IOP, age, race and visual field damage at baseline (relative hazard ratio 5.76). 88% of patients in the upper 25 percentile of IOP fluctuation, and 57% of patients in the lower 25th percentile of IOP fluctuation, progressed within 8 years

Conclusions: In this presentation, corroborating studies, common IOP fluctuations and proposed mechanisms for IOP fluctuations will be presented. Ways to control IOP spikes will be discussed and pharmacotherapy options will be explored.

Diurnal fluctuations in IOP present a greater risk of visual‐field loss to the patient with glaucoma compared to mean IOP. By monitoring IOP more closely and by prescribing medication that offers the best control of IOP with the least amount of fluctuation, ophthalmologists can offer their patients the best therapy for glaucoma.
What have we learned about neuroprotection in the lab?
Authors: WHEELER LA , HARE WA , DONG CJ
Published: October 2007

Purpose: Work with both in vitro and in vivo models has provided insights into how and why retinal ganglion cells (RGCs) might die in glaucoma. In vitro and in vivo models have identified mechanisms of stress or injury‐induced death of RGCs. Techniques used were cell culture, retinal whole mount and slice prepartions to more complex in vivo models. These approaches have identified activation of the alpha‐2 pathway and blockade of the NMDA receptor has important targets in neuroprotection

Methods: In vitro studies used high speed confocal Ca2+ imaging at the IPL of living rat retinal slices. Changes of cytosolic free Ca2+ were monitored with the Ca2+ dye fluo‐4. Simultaneous recordings of ERG and single‐unit RGC activity were obtained from rabbit retina flat mounts. Experimental ocular hypertension was induced by laser in rats (WoldeMussie, IOVS, 2001) and primates (Hare, IOVS, 2002

Results: At the IPL, the Ca2+ signal was suppressed in a dose‐dependent manner by brimonidine and other alpha‐2 receptor agonists. The action of brimonidine was blocked by yohimbine, an alpha‐2 receptor antagonist. Application of NMDA to rabbit retinal flat mounts induced an increase in action potential spiking that was blocked by memantine. In vivo brimonidine and memantine reduced hypertensive injury to the optic nerve and retina

Conclusions: These findings suggest that a function of the retinal alpha 2 system is the regulation of synaptic transmission at IPL and that brimonidine may protect RGCs by preventing abnormal elevation of cytosolic free Ca2+ either in RGCs, in their presynaptic cells, or in both. Memantine is able to block NMDA‐induced increases in in RGC spiking activity at concentrations that had little or no effect on retinal light signaling.
Vasoactive intestinal peptide loaded in liposomes: a new immunomodulatory agent for the local treatment of experimental autoimmune uveoretinitis (EAU)
Authors: CAMELO S , LAJAVARDI L , BOCHOT A , FATTAL E , GOLDENBERG B , NAUD MC , BEHAR‐COHEN F , DE KOZAK Y
Published: October 2007

Purpose: Local delivery of therapeutic molecules is a promising method to treat ocular diseases, while at the same time, reducing severe systemic side effects. We tested the efficacy of one intravitreal injection (IVT) of rhodamine‐labeled liposomes loaded with Vasoactive Intestinal Peptide (VIP‐Rh‐Lip) to reduce experimental autoimmune uveoretinitis (EAU).

Methods: Injection of VIP‐Rh‐Lip was performed simultaneously with or 6 or 12 days after immunization with S‐Ag in CFA. Therapeutic efficacy on EAU was determined by clinical slit lamp examination. Retinal tissue destruction was assessed by histological examination, inflammatory cells infiltration by immuno‐histochemistry. Intraocular cytokine production was determined by multiplex ELISA. The proliferation and cytokine secretion by cells isolated from inguinal LN were measured.

Results: IVT injection of VIP‐Rh‐Lip simultaneously and 6 days after S‐Ag immunization decreased EAU clinical score and protected retinal tissue from destruction compared to control animals. In treated rats intraocular inflammatory cytokines and NO production by intraocular macrophages was decreased suggesting they were deactivated. In vivo and in vitro T cell reactivity to S‐Ag was reduced. IL‐10 production by cells isolated from inguinal LN, re‐stimulated in vitro in presence of S‐Ag was increased in VIP‐Rh‐Lip injected rats compared to control animals.

Conclusions: A single intraocular injection of VIP‐Rh‐Lip is an effective therapeutic strategy to protect ocular tissues during uveitis, by reducing intraocular inflammation and by diminishing T cell reactivity at the systemic level.
Control of experimental uveoretinitis by specific or nonspecific regulatory T‐cells
Authors: TERRADA C , DE KOZAK Y , LEHOANG P , SALOMON B , BODAGHI B
Published: October 2007

Purpose: We have previously described a murine model of experimental uveoretinitis. In this study, we have compared the therapeutic effects of polyclonal versus antigen specific CD4+CD25+ regulatory T cells after intravenous or intravitreal injection according to the activation statut

Methods: In mice expressing hemagglutinin (HA) in the retina after subretinal injection of rAAV, uveitis was induced by intravenous administration of 2 x 106 activated HA‐specific T cells. These cells were obtained from purified Thy‐1.1 TCR‐HA CD25‐ cells and stimulated by irradiated BALB/c splenocytes and HA peptide for 4 days. At the same time or 4 days later, in vitro‐activated or fresh HA‐specific or polyclonal BALB/c CD4+CD25+ T cells were injected intravenously or intravitreally(IVI). A challenge was performed by intravenous activated HA‐specific effector T cells, 21 days after the induction of uveitis. Intraocular inflammation was clinically and histologically studied in all animals.

Results: Fresh CD4+CD25+ T cells controlled uveitis only if they were specific for the target antigen (HA). Compared to intravenous injection, the effect observed after intravitreal injection was obtained with low number of cells. Furthermore, protection against a challenge was achieved only after local administration of HA‐specific regulatory T cells. Activated polyclonal BALB/c CD4+CD25+ T cells IVI controled the disease but have no effect after a challenge.

Conclusions: Regulation of experimental uveoretinitis may be obtained by using CD4+CD25+ T‐cells. Specificity and activation status of these cells are critical points. In order to develop new in situ therapeutic strategies, in vitro‐activated polyclonal T regs are relevant cells.
Animal models of primary intraocular lymphoma
Authors: TOUITOU V , BODAGHI B , DE KOZAK Y , LEHOANG P , FRIDMAN C , FISSON S
Published: October 2007

Purpose: Primary intraocular lymphoma (PIOL) is a high grade non‐Hodgkin lymphoma which pathogenesis is still unclear. Few animal models exist in order to study this condition. We discuss and evaluate the contribution of different animal models available for intraocular lymphoma.

Methods: Although intraocular lymphoma in human is usually a B‐cell lymphoma, most of existing models are based on T‐cell proliferation. Recently, a major step forward has been realized with the development of new models of intraocular B‐cell lymphoma. Moreover, to evaluate the role of the immune microenvironment in this condition, a murine model of intraocular B‐cell lymphoma was developed in immunocompetent hosts after intravitreal injection of a syngeneic lymphomatous B‐cell line.

Results: These animal models of primary intraocular T‐cell or B‐cell lymphoma contributed to a better characterization of the molecular and cellular microenvironment of PIOL. New therapeutic tools, such as the use of lymphotoxin, or the manipulation of the immune microenvironment in order to control the tumor are being evaluated in these models.

Conclusions: These more relevant experimental models will allow the development of new tools for the understanding of PIOL pathogenesis and its therapeutic control.
Bartonellosis
Authors: GARWEG JG
Published: October 2007

Purpose: Bartonellosis, a rarely diagnosed bacterial zoonosis caused by Bartonella species is capable of inducing a number of neurological diseases, such as nervous paresis and Parinaud syndrome, and it may affect the eye, and namely the retina.

Methods: Cats are the main reservoir for human‐pathogen species, i.e. Bartonella henselae , the etiologic agent in cat scratch disease, but dogs can also be infected with Bartonella parasites. Ocular bartonellosis is widely associated with Bartonella henselae, is most often associated with ocular complications, which may include Parinaud oculoglandular syndrome, neuroretinitis, and focal retinochoroiditis.

Results: The typical clinical presentation of neuroretinitis and Parinaud syndrome will be presentetd and personal treatment experience will serve the basis for discussion. Numerous other clinical patterns have been reported occasionally. The diagnosis of ocular bartonellosis relies on the identification of suggestive clinical signs in conjunction which is confirmed by serological and eventually aqueous humour testing. B. henselae‐associated ocular disease is usually self‐limited but go along with transient more or less significant visual complaints. If the infection is clinically severe or sight‐threatening, treatment may be considered, usually with doxycycline or erythromycin, eventually combined with rifampin.

Conclusions: B. henselae infection may be significantly more common than clinically diagnosed and should be considered in patients with Parinaud oculoglandular syndrome, neuroretinitis, or focal retinochoroiditis, particularly when there is a history of pet or flea exposure.
Ocular toxoplasmosis
Authors: KODJIKIAN L
Published: October 2007

Ocular toxoplasmosis due to Toxoplasma gondii is presumably the most frequent infectious cause of posterior uveitis throughout the world. Ocular toxoplasmosis is characterized by recurrent episodes

of necrotizing retinochoroiditis thought to be caused by both proliferation of live organisms that emerge from tissue cysts within the retina and an associated inflammatory reaction. Toxoplasmic

retinochoroiditis can be associated with severe morbidity if disease extends to structures critical for vision, including the macula and optic disk, if there is damage to the eye from inflammation, or if

there are complications such as retinal detachment or neovascularization. Clinical diagnosis is helped by ancillary laboratory testing, Witmer‐Desmonts coefficient and western blot. The current

approach to treatment of severe toxoplasmic retinochoroiditis involves finite courses of anti‐Toxoplasma gondii drugs, with or without corticosteroids, in emergency. New strategies for treatment of ocular toxoplasmosis are tested and will be developed during present SIS.
Quantitative cataract measurement
Authors: SÖDERBERG PG
Published: October 2007

Purpose: To provide an overview of the impact of cataract on optical image transfer and the possibilities to measure cataract quantitatively.

Methods: The current paper reviews strategies for how limitations of the imaging transfer of the eye originating from the lens can be quantitatively measured.

Results: The diameter of the pupil should be standardized in comparisons of optical image transfer. In vitro, aberrations and light scattering can be measured directly as point spread function characterized by Strehl ratio. Also, the effect of stray light, resonant absorption and aberrations can be measured directly. All, in vivo techniques require consideration of the impact of the cornea on the optical image transfer. Further, if psychophysical sensing is used, the image transfer of the total visual system depends on the optical transfer and the neurosenory transfer. Slit lamp microscopy with slit illumination, optionally improved with Scheimplug projection, or alternatively with retroillumination provides quantitative geographic information about the distribution of emission of light scattering, but inconsistently correlates to the image transfer. Visual acuity measures high contrast resolution. Cataract causes loss of contrast sensitivity, mainly due to scattering and stray light. The effect of stray light can be sensed psychophysically. The point spread function and aberrations in the optical system can be measured with double pass technique.

Conclusions: Cataract can be measured quantitatively as reduction of optical transfer of the eye which is limited by aberrations, light scattering, stray light and resonant absorption.
Cataract classification systems, a critical review
Authors: SASAKI K
Published: October 2007

Purpose: Since the 1990s, large‐scale cataract epidemiologic studies have been conducted world‐wide by researchers from developed nations. Valuable data have resulted from these studies. However, cataract classification, the fundamental methodology for all studies, has not been closely scrutinized. This presentation reviews cataract classification of the past and present, and suggests future improvement..

Results: Past: The investigators often choose one classification system from, e.g., Oxford, Wilmer, LOCS, and some others. These were proposed since the late 1980s each with a unique design. However, to compare results from different studies, the cataract classification system must be standardized. By late 1990s, the WHO has recognized this necessity, and a new system was developed in 2000 by the WHO working group.

Present: Dr H Sasaki and Dr S West were the first to use the new WHO‐sponsored system. Although a simplified classification system, it is highly quantitative when compared with previous systems. The new system is now beginning to be applied. Based on experience since 2000, the usefulness and characteristics of this new system will be presented.

Future: In general, cataract grading agrees reasonably well with visual acuity. However, there is a specific type of lens opacification, i.e., “Retrodots”, that causes deterioration of vision and yet most ophthalmologists are still unfamiliar with it. Therefore, even the WHO‐sponsored system will require revisions as other subtle cataract sub‐types will also be detected in the future. It must be emphasized that further improvements in cataract classification, based on the investigators’ cumulative experience, are certain to continue.
Lens opacification in Icelanders 50 years and older, risk factors. Reykjavik eye study
Authors: JONASSON F
Published: October 2007

Purpose: To examine prevalent and 5‐year incident risk factors for cortical and nuclear lens opacification in adult citizens of Reykjavik.

Methods: For baseline examination we used a random sample from the population census for citizens of Reykjavik ≥50 years, equal proportion for both gender and each year of birth. Participation rate was 76% (1045). 5 years later 88% of the survivors participated. For diagnosis of opacification we used Scheimpflug and retroilluminated images of the lenses. For statistical analysis we used logistic regression analysis.

Results: Cigarette‐smoking more than 20 pack‐years increased the risk for nuclear lens opacification (OR=2.52: 95% CI 1.52‐4.13: p<.001) as did pipe‐ or cigar smoking (OR=2.48:95% CI 1.20‐5.12: p<.05). Systemic corticosteroid use was a risk factor for cortical cataract (OR=3.70: 95% CI 1.43‐9.56: p<.05). Spending more than 4 hours/day outside on weekdays increased the risk of grade II & III cortical cataract, OR= 2.91 (1.13‐9.62: p<.05). Comparing positive rate ratio of early cortical opacities in Reykjavik and Melbourne, by upper and lower lens hemispheres, the rate is about 90 for both cities for the lower half of the lens while for the upper half of the lens this figure is 70.6 for Reykjavik and 46.8 for Melbourne. This is in an a agreement with the difference in zenith angle between the two cities. After adjusting for age, sex and smoking nuclear cataract is associated with twofold increased 5‐year mortality risk (p<.05).

Conclusions: Modifiable risk factors include smoking, solar UV radiation and the use of cortical steroids. Nuclear lens opacification carries increased 5‐year risk of mortality and may be a suitable index for projected life span.
Prevalence and risk factors of lens opacities in urban and rural chinese in Beijing
Authors: JONAS JB , XU L , CUI T , ZHANG S , SUN B , ZHENG Y , HU A , LI J , MA K
Published: October 2007

Purpose: To determine the prevalence of lens opacities in the elderly Chinese population in an urban and a rural region of Beijing.

Methods: The study included 4439 subjects out of 5324 subjects invited to participate (response rate 83.4%). It was divided into a rural part (1973 (44.4%) subjects) and an urban part (2466 (55.6%) subjects). The study was limited to participants age 40 and older and the mean age was 56.2 ± 10.6 years (range, 40 – 101 years). Nuclear, cortical and posterior subcapsular lens opacities were assessed based on standardized slit lamp photographs of the lens using a modification of the grading score of the Age‐Related Eye Disease Study (AREDS).

Results: Of the 4439 persons examined, 4378 (98.6%) subjects (8724 eyes) provided lens data. Prevalence of any cataract surgery was 1.3% (95% confidence interval [CI]: 1.0, 1.7), being statistically independent of gender (p=0.51; odds ratio [OR]: 0.86; 95%CI: 1.00, 1.34), rural area versus urban region (p=0.25), and level of education (p=0.84). Prevalence of any nuclear lens opacity was 82.0% (95%CI: 80.8, 83.2), of any cortical lens opacity was 10.3% (95%CI: 9.4, 11.3), and of any posterior subcapsular opacity 4.3% (95%CI: 3.7, 4.9). If grade “2” of nuclear lens opacity was considered to be normal, prevalence of nuclear cataract was 50.3% (95%CI: 48.8, 51.8), and the overall prevalence of any cataract was 53.1% (95%CI: 51.6, 54.6), increasing from 6.5% (95%CI, 5.2, 7.8) in those 40 to 49 years old, to 52.3% (95%CI: 47.4, 55.3) in those 50 to 59 years old, and to 97.8% (95%CI: 96.4, 99.2) in those 70 years and older (p<0.001). Frequencies of any cortical cataract and any subcapsular posterior cataract, respectively, were 10.3% (95%CI: 9.4, 11.3), and 4.3% (95%CI: 3.7, 4.9), respectively.

Conclusions: Cataract is common among adult Chinese residents in Beijing with age as the most important associated factor. In view of the relatively low rate of cataract surgery performed so far, one may expect a marked increase in the number of cataract surgeries to meet the visual needs of the growing elder population in China.
Biometry issues
Authors: SMITH G
Published: October 2007

To outline the biometric variables that we consider to be exclusion criteria when making the IOL power calculations for patients having simultaneous bilateral cataract surgery. I will also attempt to go beyond standard optimisation of biometry to yield results with a very tight standard deviation. I will then examine whether or not the biometric result in the first eye of unilateral surgery can be used to predict the outcome of the second eye.
Straylight after cataract operation
Authors: GRABNER G , MARVAN M
Published: October 2007

Purpose: To measure intraocular straylight in patients with pseudophakia and to compare the results with those of patients in a large population sample without eye diseases and with different signs of cataract.

Methods: In a large prospective European study with five participating eye clinics a total of 2211 active drivers, 45 years of age and older, were included. The examination included a complete ophthalmological evaluation with multiple visual function tests and the measurement of intraocular straylight with a newly developed system. Lens opacities were classified with the LOCS III lens classification system.

Results: Increasing density of lens opacification was significantly related to increased straylight values. This resulted in a modified behavior regarding the patients driving habits.

Unexpectedly, patients with bilateral pseudophakia showed similar straylight values as those that were classified as having bilateral moderate cataract. Mean age of the pseudophakic patient group was similar to subjects with more severe forms of cataract.

Conclusions: Following cataract surgery and implantation of a clear artificial lens, one would expect intraocular straylight to be significantly lower that in the control population with moderate cataract. This was not the case in this large series of patients, however.

Several causes may be considered relevant for this observation:

First pseudophakia‐related changes, such as untreated posterior capsular fibrosis and, possibly IOL decentration, have to be considered.

Secondly increasing straylight values with age that are not only lenticular of origin, but also a consequence of age‐related pigmentary changes such as migration and thinning of uveal pigment from the iris, increasing vitreal opacities and loss of melanin within the retinal pigment epithelium itself.
C‐quant for clinical screening
Authors: ASPINAL PA , DHILLON B , HILL AR , GRAVES R
Published: October 2007

Purpose: A study was carried out on 105 patients referred for cataract surgery at the Princess Alexandra Eye Pavilion Edinburgh. The aim of the study was to

a) examine criteria significant for referral in current practice.

b) explore the implications of a greater emphasis to QoL critera

Methods: Three categories of variable were assessed – visual function (visual acuity,contrast sensitivity); cataract morphology ( oxford grading system, stray light meter) and quality of life (QoL ‐ vf14, Sparrow scales). Referral procedures followed current clinical practice. A follow up on 30 patients was carried out 3 months after surgery.

Results: 78% of patients were referred for surgery and of these 77% were first eyes. The main discriminators for surgery in current practice for all patients and those with Snellen <=6/12 were LogMar acuity, Pelli Robson contrast sensitivity, stray light, brunescence, and white scatter, and QoL. Stray light measures correlated with LogMar (r=0.28, p<.01 and Pelli Robson r=.35, p<.01). Exploratory regression in both groups showed that LogMar distance acuity followed by the stray light measures were the best discriminators of current practice.

Quality of life scales as criteria for surgery were more difficult to predict (70% as opposed to 83% accuracy) and showed Pelli Robson contrast sensitivity as the main predictor in conjunction with LogMar and straylight measures. Follow up at 3 months on QoL scales showed a very high proportion of patients reporting satisfaction.

Conclusions: Stray light measures are found to predict current referral practice and quality of life scales. Current practice is from the patients perspective effective in delivering high post surgery satisfaction rates.
Genetics of corneal endothelial dystropies
Authors: VITHANI EN
Published: October 2007

Purpose: Purpose‐ To determine whether mutations in genes SLC4A11 and TCF8 causative of recessive CHED and PPCD, respectively, may also play a pathogenic role in the more common Fuchs corneal endothelial dystrophy. The endothelial (posterior) corneal dystrophies, which result from primary endothelial dysfunction, include Fuchs endothelial dystrophy (FECD), posterior polymorphism dystrophy (PPCD) and congenital hereditary endothelial dystrophy (CHED). As they share common features of disease it is possible that a proportion of them could be clinical manifestations of different mutations of the same gene.

Methods: Method‐Exons SLC4A11 and TCF8 gene were PCR amplified in 64 Chinese FECD cases and then subjected to bi‐directional sequencing. Eighty Chinese samples were used as normal age matched controls. To characterise SLC4A11 mutations wild type and mutant cDNA constructs were transfected in to HEK293 cells and protein extracts used for immunoblot analysis and cell surface processing assays. Confocal immunolocalization were also performed using established protocols.

Results: Results‐Three heterozygous mutations were identified in this screen of 64 FECD patients. These were two missense mutations (G709E and T754M) and one deletion mutation (99‐100delTC). Missense mutations involved amino acid residues showing high interspecies conservation indicating that mutations at these sites would be deleterious. Accordingly, immunoblot analysis, biochemical assay of cell surface localization and confocal immunolocalization showed that missense mutants were defective in localization to the cell surface. No convincing pathogenic mutations were identified in the TCF8 gene.

Conclusions: Conclusion‐ Our data suggests that 4.7% (95% CI=0.98% to 13.1%) of FECD in the Chinese can be attributable to SLC4A11 mutations.
Familial correlations and gene‐environment interactions for myopia
Authors: SAW SM
Published: October 2007

Purpose: To investigate the combined contributions of environmental and genetic risk factors for myopia in children.

Methods: Children aged 7 to 9 years from 3 schools were recruited and the children have been followed annually since 1999. Cycloplegic autorefraction and biometry measures were conducted annually in the schools, and buccal specimens were collected. TheWhole Genome Association (WGA) scans of buccal DNA using the Illumina Sentrix HumanHap 550 Genotyping BeadChip assay will be performed. We propose to compare the top ranked genes of 1250 children with greater change in refraction with children with the smallest changes in refraction.

Results: There were 1478 Chinese, 349 Malays and 152 children who were Indian and other races. Using a Cox Proportional Hazards model, children with 2 myopic parents had 3.89 times higher risks of myopia, compared with children with 0 myopic parents. Parental history of myopia interacted with reading in books per week to increase the risks of myopia, suggesting gene‐environment interaction. There were 159 sibling pairs in this cohort. After adjusting for age and sex, the between‐sibling correlation in refractive error was 0.447 (95% confidence interval 0.314, 0.564) and between‐sibling 1‐year change in refractive error was high at 0.420 (95% confidence interval 0.282, 0.543). The pilot WGA study of matched sets of 5 unamplified buccal DNA samples, 5 amplified buccal DNA samples, and 5 saliva DNA samples using the Oragene saliva kit revealed mean call rates of 0.9986, 0.9881, and 0.9929, respectively.

Conclusions: Thus, both the contributions of environment and genes will be documented in detail in this cohort.
Clinical look‐a‐like
Authors: KAWASAKI A
Published: October 2007

Purpose: There are a number of neuro‐ophthalmic disorders which exhibit similar clinical manifestations and thus pose a diagnostic challenge to the practicing ophthalmologist. Early recognition and differentiation of the common neuro‐ophthalmic diagnoses that resemble each other can avoid time‐consuming and expensive investigations.

Methods: A format of case examples is used to illustrate pairs of neuro‐ophthalmic conditions that have similar initial presentation. The discussion focuses on key features that are unique to each entity.

Conclusions: The clinician will be more familiar with common neuroophthalmic “look‐alikes” and will know specific tips for how to distinguish between the two diagnostic conditions.
Management misadventures
Authors: BOSCHI A
Published: October 2007

Purpose: Neuro‐ophthalmic diseases have the potential for delay in diagnosis, misdiagnosis, or mismanagement.

Methods: The presented clinical cases will cover optic neuropathy such as arteritic and non‐arteritic ischemic optic neuropathy, idiopathic intracranial hypertension, Graves’ disease, sarcoidosis, myasthenia and others.

Through the clinical cases of the common neuro‐ophthalmic disorders, we will discuss the common mis‐steps in the clinical and imaging diagnostic approach. We will also consider the consequences of delay diagnosis, and the importance of an early treatment will be highlight.

For each case, we will review the clinical diagnostic criteria and the management recommendations will be discussed.
Long‐term results of combined treatment with excision and cryosurgery for malignant epithelial tumors of the conjunctiva
Authors: ALTAN‐YAYCIOGLU R , PEKSAYAR G , ONAL S
Published: October 2007

Purpose: To evaluate the long‐term results of combined treatment with excision and cryosurgery for malignant epithelial tumours of the conjunctiva.

Methods: The medical records of patients diagnosed with conjunctival malignant epithelial tumours and treated with excision and cryosurgery were retrospectively reviewed. The demographic features of the patients, characteristics of the tumours, and the peculiarities of the recurrences were recorded. The recurrence‐free survival was determined, and the logrank test was used to compare the recurrences according to histological classification.

Results: A total of 55 subjects (57 eyes), 19 female and 36 male, were included. Their ages ranged between 15 and 82 years (mean 55 +/‐ 14 years). Histological diagnosis was conjunctival intraepithelial neoplasia (CIN) in 26 (46%) and invasive squamous cell carcinoma (SCC) of the conjunctiva in 31 eyes (54%). All eyes were treated with excision and cryosurgery with nitrous oxide probe. During the follow‐up period of 6 months to 15 years, seven (12.3%) recurrences were observed. The success rate for patients with CIN and invasive SCC was 88.5 and 87.1%, respectively. There was no difference for recurrence rates between CIN and invasive SCC groups according to logrank test (P=0.68).

Conclusions: Over the long‐term follow‐up, cryosurgery following excision is a successful method in the treatment of conjunctival intraepithelial tumours and invasive squamous cell carcinoma of conjunctiva with favourable outcome and minimal complications.