This Issue of Acta (2004)

The title of the Guest Editorial in this issue is ‘Are there advantages in implanting a yellow IOL to reduce the risk of AMD?’. The lack of really effective treatments for AMD make blue light and vitamin/antioxidant status two subjects of great current interest. As always industry addresses the health needs by putting new products on the market. New products mean marketing, and as practicing ophthalmologists we become exposed to a mixture of results from independent research, advertisements, marketing meetings and sponsored sessions at ophthalmic meetings. In this flurry of new information we may often find it difficult to differ between science, our own wishful thinking and marketing messages. In this context the Guest Editorial is particularly welcome. We learn that there is convincing evidence of damaging effects of light, particularly blue light, on retinal structures in experimental work and in population studies. As always, we must wait for results from properly designed, prospective, randomized long-term studies to learn whether theoretically motivated new lens designs may positively influence clinical outcomes. This is the real $64,000 or rather the $640,000 000 question. But the issue is both important and intriguing and one development we will all follow with great interest. The original articles in this issue cover a broad spectrum. Image-based screening for diabetic retinopathy is an important large-scale reality in the Nordic countries. The technical development is moving from film to digital fundus imaging. Saari and co-workers have compared two different digital cameras/methods. Their findings are important: the results from the different methods were certainly not equivalent. Visual function in Usher syndromes 1b and 2a have been studied by Pennings and co-workers in an impressive number of patients. Deterioration rates were only moderate in cross-sectional analyses, without any significant differences between the two syndromes, but much more rapid impairment was seen in some longitudinally followed patients. Activated protein C resistance is a genetic defect increasing the risk for thrombotic disease. This entity was discovered by Björn Dahlbäck in his lab only 100 meters away from Acta's present editorial office at Malmö University Hospital. It is therefore gratifying for me as a Malmö researcher to see that an increasing number of papers report that this defect is of great importance also for ocular circulatory disease. In this issue Nagy and co-workers report a much higher prevalence of APC resistance in patients with non-arteritic anterior ischemic neuropathy than in a healthy control population. Testing for APC resistance may be indicated in patients with NAION. Surgical techniques are continuously evolving. Several papers in the present issue report results of modern surgical techniques. Behndig and Eriksson used intracameral mydriatics in a consecutive series of almost 200 cataract surgeries. The authors found no increase of surgical time or complication rate, and conclude that this way of administering mydriatics works well in routine phacoemulsification surgery. Germundsson and Fagerholm report successful results with PTK in four patients with Salzmann's nodular degeneration. Vuori reports gonioscopic findings in 42 eyes that have undergone deep sclerectomy with collagen implants. There were several types of findings, synechias to and pigment accumulation at the trabeculo-Descemet's membrane, and puncture holes were seen in all eyes that had undergone Nd:YAG laser goniopuncture. Another gonioscopic study is published in the present issue. Nakamura et al. have assessed the chamber -angle pigmentation during long-term treatment with latanoprost. While latanoprost increased iris pigmentation in some patients, there was no evidence of increased pigmentation in the trabecular meshwork. The IOP lowering effect of another related compound, unoprostone is compared to brimonidine in a paper by Stewart and co-workers. Bergman et al. performed a highly unusual, prospective study of a representative population sample between 70 and 97 years of age in Gothenburg. The subjects were examined at age 70 in 1971, and then again at ages 82, 88, 95 and 97. The study sheds new light on visual function at higher ages. At 82 years 20% of subjects demonstrated decreased vision, defined as visual acuity ¾ 0.5. At 97 80% had reduced visual function. Reduced blood folate levels, smoking and high BMI correlated with reduced visual acuities at higher ages. The study clearly shows that “normal VA” is age dependent, but also raises questions about what the requirements should be for defining a normal subject at very high ages. A paper by Goldschmidt and co-workers addresses ocular anisometropia in a material of children and parents in Hong Kong. Myopic subjects had somewhat larger spherical refractive error in right eyes, but in most cases right/left differences were small. Klitgaard et al. investigated chemokine receptors and early activation markers in patients with acute anterior uveitis. The patients showed a specific activation of their systemic immune system. Hardarson et al. publish a very unusual paper in this issue of the journal. Part of the information is a video sequence which can be seen on Acta's website. This is the first time that such information is published by our journal. The authors have invented an in vivo technique for time-lapse recording of corneal epithelial healing. Images are acquired at 1-minute intervals for up to 4 days, thus making it possible to follow epithelial wound healing at the cellular level. Tokuda and co-workers evaluate the toxicity of vital stains. In their experiments ICG caused retinal damage in isolated rat retinas. Another Japanese group studied the effects of systemic betamethasone or cyclosporin A after experimental alkali injuries. Both drugs suppressed cytokines and reduced corneal opacity. Podskochy et al. studied UVR-induced corneal injury. UV radiation caused distinct expression of biglycan mRNA – absent in control corneas – indicating that biglycan is involved in the corneal repair process. In the Clinical Questions and Answers section we find the story of a 32-year highly myopic woman, who had a macular haemorrhage with low VA in the left eye after a phakic posterior chamber implant, and then comes back wanting treatment of the right eye. What to do? Read the discussion and the management suggested by the expert panel. A case series by Eriksson et al. describes OCT findings in juvenile x-linked retinoschisis. The retinal cleavage can be seen with OCT making this technique a new diagnostic tool for retinoschisis. We have some unusual case reports in the current issue. Hansen and co-workers describe the second case of primary corneal myxoma in the literature. Ehlers and Hjortdahl report two cases of acanthamoeba keratitis and suggest that the mature cataracts and iris atrophy that developed in both patients might have been caused by the intensive treatment rather than by the microorganism itself. Tarkkanen and co-workers describe a case of delayed fungal endophthalmitis by a species, that has not previously been reported to cause such infection. Airborne contamination was a likely causing factor, due to non-functioning or defective air-conditioning of the operating room. Delyfer et al. report successful laser coagulation of a choroidal membrane associated with optic disc drusen. And as always - do not forget the letters.