Glaucoma; confocal scanning laser ophthalmoscopy; screening; stereo photographs; intraobserver variability
A possible association between visual acuity (VA) and dementia was investigated in 2716 subjects who were aged between 53 and 102 at first visit and had varying degrees of dementia. Better VA was found to be significantly correlated with a lower dementia level (person coefficient range 0.146–0.261 over 10 years of follow-up, all correlations are significant, p<0.0001) as well as with a higher global cognitive score (person coefficient range −0.254 to −0.318 over 10 years of follow-up, all correlations are significant, p<0.0001), a grade encompassing 19 different cognitive tests. This correlation remained significant after adjustment for age, years of education, gender, use of ophthalmic drugs and years of follow-up.
To assess quality of life (QoL) indices and their associations with treatment modality, sociodemographics, and cancer-related needs in choroidal melanoma patients.
Patients (N=99) treated at the University of California, Los Angeles for choroidal melanoma within the prior 5 years (M = 2.05) completed questionnaires assessing demographics, cancer-related needs, vision-specific QoL, depressive symptoms, and concern about recurrence. Visual acuity, comorbidities, treatment modality (radiotherapy, enucleation), and years since diagnosis were gathered from medical records. Primary analyses were multiple regressions.
Although concern about cancer recurrence was elevated, QoL was better than in other oncology samples and comparable to healthy samples on some outcomes. Enucleation was associated with worse vision-specific QoL, and presence of comorbid diseases was associated with worse vision-specific QoL, depressive symptoms, and concern about cancer recurring (all ps<.05). Patients who experienced at least one stressful life event in the past year (versus no events) reported more depressive symptoms (p<.01). Report of more unmet cancer needs was associated with worse vision-specific QoL, depressive symptoms and more concern about recurrence (all ps<.05), uniquely explaining 5%–12% of the variance.
For choroidal melanoma patients an average of two years after treatment, number of physical comorbidities and unmet cancer needs were the strongest correlates of poorer QoL.
quality of life; choroid neoplasms; cancer
To examine the relationship between change in optic nerve head (ONH) morphology and retinal blood flow in patients with open-angle glaucoma (OAG) of African (AD) and European descent (ED) over three years.
112 patients with OAG (29 AD; 83 ED) underwent assessment of ONH morphology using Heidelberg retinal tomography (HRT-III) and retinal blood flow using confocal scanning laser Doppler. Repeated measures analysis of covariance was used to compare baseline and 3-year measurements and Pearson correlations were calculated to evaluate the relationships.
In OAG patients of AD, change in superior mean retinal blood flow was strongly, negatively correlated with change in cup/disc (C/D) area ratio (r=−0.78, p=0.020) and cup area (r=−0.75, p=0.0283) and strongly, positively correlated with change in rim area (r=0.74, p=0.0328) over three years. In OAG patients of AD, change in inferior mean retinal blood flow was strongly, negatively correlated with changes in C/D area ratio (r=−0.88, p=0.0156) and linear C/D ratio (r=−0.86, p=0.0265) over three years. In OAG patients of ED, these correlations were weak and did not reach statistical significance.
OAG patients of AD may have a stronger vascular component to their glaucoma pathophysiology than patients of ED.
glaucoma; retina; optic nerve
Large variations in results of diagnostic tests for mild to moderate dry eye are widely recognised. The purpose of this study was to assess if there was concordance between common dry eye diagnostic tests.
A total of 91 subjects were recruited to the study. The tear film and ocular surface were evaluated using the phenol red thread test, tear break up time (TBUT), biomicroscopic examination and impression cytological (IC) assessment of conjunctival goblet cells. Dry eye symptoms were assessed using McMonnies questionnaire and statistical correlations between all tests were assessed.
This study cohort did not include severe aqueous deficient dry eye patients as determined by the phenol red thread test (PRT). A statistically significant difference was noted between PRT results and all other tests (***P ≤ 0.001). Only meibomian gland pathology, McMonnies questionnaire, reduced goblet cell density and TBUT (≤7 seconds) demonstrated correlation determined by McNemar’s test.
A correlation was only found between tests assessing lipid/mucous deficiency (meibomian gland evaluation, goblet cells density, TBUT, and McMonnies questionnaire).
correlation dry eye diagnostic tests
Little is known about motor vehicle collision (MVC) risk in older drivers with age-related macular degeneration (AMD). The purpose of this study is to examine associations between MVC involvement and AMD presence and severity.
In a retrospective cohort study pooling the samples from four previous studies, we examined associations between MVC rate and older drivers with early, intermediate, or advanced AMD as compared to those in normal eye health. MVC data were based on accident reports obtained from the state agency that compiles this information.
MVC rate was highest among those in normal eye health and progressively declined among those with early and intermediate disease, and then increased for those with advanced AMD. However, only for drivers with intermediate AMD was the MVC rate significantly different (lower) as compared to those in normal eye health, regardless of whether the rate was defined in terms of person-years (RR 0.34, 95% CI 0.13–0.89) or person-miles (RR 0.35, 95% CI 0.13–0.91) of driving.
These results suggest that older drivers with intermediate AMD have a reduced risk of collision involvement. Further research should investigate whether self-regulatory driving practices by these drivers (avoiding challenging driving situations) underlies this reduced risk.
driving; age-related macular degeneration; vision impairment
In terms of blind-person years, the worldwide burden of childhood blindness is second only to cataracts. In many developing countries, 30–72% of childhood blindness is avoidable. The authors conducted this study to determine the causes of childhood blindness and visual impairment (VI) in Botswana, a middle-income country with limited access to ophthalmic care.
This study was conducted over 4 weeks in eight cities and villages in Botswana. Children were recruited through a radio advertisement and local outreach programmes. Those ≤15 years of age with visual acuity <6/18 in either eye were enrolled. The WHO/Prevention of Blindness Eye Examination Record for Children with Blindness and Low Vision was used to record data.
The authors enrolled 241 children, 79 with unilateral and 162 with bilateral VI. Of unilateral cases, 89% were avoidable: 23% preventable (83% trauma-related) and 66% treatable (40% refractive error and 31% amblyopia). Of bilateral cases, 63% were avoidable: 5% preventable and 58% treatable (33% refractive error and 31% congenital cataracts).
Refractive error, which is easily correctable with glasses, is the most common cause of bilateral VI, with cataracts a close second. A nationwide intervention is currently being planned to reduce the burden of avoidable childhood VI in Botswana.
Acquired cataract and cognitive impairment are both common age related problems, and ophthalmologists are increasingly likely to encounter patients who have both. Dementia types which display early visuo-perceptual impairment may present first to ophthalmology services. When these patients have coexisting cataract it may be difficult to distinguish visual complaints due to cataract from those due to dementia.
The interaction between visual impairment due to cataract, and neurodegenerative disorders affecting the central visual pathways, is not fully understood. Visual impairment due to cataract may stress impaired attentional mechanisms, and cataract extraction may improve cognitive performance in some patients with early cognitive impairment; however the benefits of cataract surgery in established dementia are less clear. Here we review the literature on this subject and consider the implications for practice.
Cataract; Dementia; Cognitive impairment; Visuo-perceptual impairment
Far-red/near-infrared phototherapy or photobiomodulation (PBM) has recently been reported to be an effective and non-invasive treatment method to inhibit lesions of diabetic retinopathy (DR) in animals. This study investigated the safety and efficacy of PBM in diabetic patients to treat non-center-involving diabetic macular oedema (NCDME).
This was a non-randomised, consecutive, case series, where 4 patients with type 2 diabetes with NCDME were treated for 160 s per day with PBM for 2–9 months. Demographic data including age, sex, HbA1c%, electronic ETDRS visual acuity, and retinal and macular thickness were measured using spectral domain ocular coherence tomography (SD-OCT) before and after treatment.
Four eyes of 4 patients were treated, with fellow eyes serving as untreated controls. Daily PBM treatment for only 80 s per treatment twice daily caused a significant reduction in focal retinal thickening in all 4 treated eyes. No adverse effects attributable to therapy were noted by the patients or study investigators during the study period.
PBM potentially offers a non-invasive and cost-effective therapeutic option for patients with NCDME. Further studies of this therapeutic option in DR are warranted
Peptidoglycan (PGN) recognition proteins (PGLYRPs) are innate immune
molecules that recognise bacterial cell wall PGN, and participate in several
inflammatory diseases such as arthritis. We sought to elucidate the
contribution of PGLYRPs in murine uveitis (intraocular inflammatory disease)
elicited by PGN, and the extent to which systemically administered PGN
alters uveitis compared with arthritis versus locally triggered ocular
Mice deficient for PGLYRP-2, PGLYRP-3 or PGLYRP-4 were administered
PGN by an intraperitoneal or intraocular injection. Arthritis was assessed
by near-infrared imaging and histopathology, while uveitis was measured by
intravital videomicroscopy and histopathology.
Systemic PGN exposure predisposed to arthritis through a PGLYRP-2
dependent mechanism. By contrast, systemic PGN exposure did not predispose
to uveitis, and PGLYRP-2 deficiency had no impact on the development the
uveitis. When PGN was administered locally, a robust uveitis ensued, which
occurred independently of PGLYRP-2. Regardless of whether PGN was
administered systemically or locally, neither PGLYRP-3 nor PGLYRP-4
deficiency significantly altered ocular inflammation compared with wild-type
Our findings highlight the complexity of PGLYRPs and how PGLYRP-2 may
use different molecular pathways in the joints versus eyes. Collectively,
our results support a non-essential or redundant role for PGLYRPs-2, -3, -4
To evaluate the utility of in vivo imaging of rabbit model of choroidal melanoma utilizing high-frequency contrast-enhanced ultrasound (HF-CE-US) with 2-or 3-dimensional modes, and to correlate the sonographic findings with histopathologic characteristics.
Five New Zealand white rabbits which were immunosuppressed with daily cyclosporin A were inoculated into their right eyes with aliquots of 1.5×106 / 50 µL of 92.1 human uveal melanoma cells cultured in RPMI. At week 4, the tumor-bearing eyes were imaged using high-frequency ultrasound with microbubble contrast agent to determine the 2-dimensional tumor size and relative blood volume and by 3-dimensional mode to determine tumor volume. Histologic tumor burden was quantified in enucleated eyes by ImageJ software, and microvascular density (MVD) was determined by counting vascular channels in PAS without hematoxylin sections.
Utilizing HF-CE-US, melanomas were visualized as relatively hyperechoic regions in the images. The correlation coefficients of sonographic size or volume compared with histologic area were 0.72 and 0.70, respectively. The sonographic tumor relative blood volume correlated with the histologic tumor vascularity (R2=0.92, P=0.04)
There is a positive correlation between in vivo sonographic tumor volume/size and histologic tumor size in our rabbit choroidal melanoma model. HF-CE-US corresponds to microvascular density and blood volume.
To investigate the choroidal vascular regulation in age related macular degeneration (AMD) we compared the regulatory responses induced by isometric exercise in control subjects and patients with AMD.
Seventeen eyes of 17 patients with dry AMD in the study eye and 19 eyes of 19 controls were included in this study. Both groups were well matched in regards to age, race and gender. Brachial artery blood pressure determinations and laser Doppler flowmetry (Oculix) measurements of relative foveolar choroidal blood velocity, volume, and flow were obtained in the study eye of each subject during 30 seconds of baseline, and then, during 3 minutes of isometric exercise consisting of squeezing a hand grip in each hand. Similar measurements were then also obtained during the two minutes following the cessation of exercise. Using non-paired, two-tailed t-test, changes in circulatory parameters during exercise and following the end of exercise were compared between AMD patients and control subjects. The slope for the relationship between circulatory changes and perfusion pressure changes was calculated and compared between AMD patients and controls using linear regression analysis. Analysis of data was performed in a masked fashion. Circulatory measurements are shown in arbitrary units (AU).
There were no statistically significant differences between the changes in ChBVel, ChBVol and ChBFlow observed in control subjects and AMD patients during the isometric exercise phase and after exercise.
Our results suggest that the response of the choroidal circulation to this type of isometric exercise resulting in a moderate increase in blood pressure does not seem to be affected by AMD.
Isometric exercises; choroidal blood flow; Age-Related Macular Degeneration (AMD)
To investigate the risk factors for myopia, including near work and outdoor activity, in Singapore Chinese preschool children.
A cross-sectional study, with disproportionate random sampling by 6-month age groups, of 3009 Singapore Chinese children aged 6–72 months was performed. Information on family history, near work and outdoor activity was obtained. Spherical equivalent refraction (SEA) was assessed.
Children with two myopic parents were more likely to be myopic (adjusted OR=1.91; 95% CI 1.38 to 2.63) and to have a more myopic SER (regression coefficient=−0.35; 95% CI −0.47 to −0.22) than children without myopic parents. For each 1 cm taller height, the SER was more myopic by 0.01 dioptres. Neither near work nor outdoor activity was associated with preschool myopia.
A family history of myopia was the strongest factor associated with preschool myopia. In contrast, neither near work nor outdoor activity was found to be associated with early myopia. These data suggest that genetic factors may play a more substantial role in the development of early-onset myopia than key environmental factors.
It has been postulated that eye movement disorders in chronic progressive external ophthalmoplegia (CPEO) have a neurological as well as a myopathic component to them.
To investigate whether there is a supranuclear component to eye movement disorders in CPEO using eye movement recordings.
Saccade and smooth pursuit (SP) characteristics together with vestibulo-ocular reflex (VOR) gain and VOR suppression (VORS) gain in 18 patients with CPEO and 34 normal patients were measured using Eyelink II video-oculography.
The asymptotic values of the peak velocity main sequence curves were reduced in the CPEO group compared to those of normal patients, with a mean of 161°/s (95% CI 126°/s to 197°/s) compared with 453°/s (95% CI 430 to 475°/s), respectively. Saccadic latency was longer in CPEO (263 ms; 95% CI 250 to 278), compared to controls (185 ms; 95% CI 181 to 189). Smooth pursuit and VOR gains were impaired in CPEO, although this could be explained by non-supranuclear causes. VORS gain was identical in the two groups.
This study does not support a supranuclear component to the ophthalmoplegia of CPEO, although the increased latencies observed may warrant further investigation.
A 53-year-old man presented with an acute bilateral posterior uveitis with extensive necrotizing retinochoroiditis but without chorioretinal scarring. A thorough workup did not reveal any underlying disease. The possibilities of atypical ocular toxoplasmosis as well as herpetic retinal necrosis were considered and specific therapy instituted, with little improvement. The patient died within two months as result of an undifferentiated squamous cell carcinoma.
Histopathological examination, immunohistochemistry and multi-locus polymerase chain reaction confirmed T. gondii infection of the retina
Macroscopic examination of enucleated globe showed extensive retinal necrosis and vitreous detachment. Histological examination of retinal tissue identified numerous round–to-elliptical toxoplasmic cysts within the retina, with retinal necrosis and minimal choroidal inflammation. Immunohistochemical analyses confirmed the cysts were due to Toxoplasma gondii. DNA extracted from formalin-fixed, paraffin-embedded tissue sections was subjected to multi-locus PCR analysis at the following typing loci: SAG1, SAG2, SAG3, SAG4, B1, NTS2, GRA6, and GRA7. DNA sequencing of positive PCR products at the NTS2, SAG1, and GRA7 loci confirmed the presence of a non-archetypal strain of T. gondii infecting the eye of the patient experiencing a severe, atypical ocular toxoplasmosis
A highly divergent, non-archetypal strain of Toxoplasma gondii was responsible for causing a severe, atypical bilateral retinochoroiditis in a patient from Brazil.
Microbiology; Pathology; Genetics; Infection; Diagnostic tests/Investigation