The optics of the eye-lens and lenticular senescence. A review

Pharmacological Treatments for Presbyopia

Accommodation is the change in dioptric power of the eye. It is a dynamic process that allows focusing on an object at all distances. In order to focus sharply, three physiological responses, known as the triad of accommodation, are produced by a change in pupil size, a change in shape and position of the lens, and ocular convergence. This is modulated by the autonomic nervous system, mainly the parasympathetic nervous system. Presbyopia is a refractive condition that occurs with aging, usually manifesting around 40-50 years of age, and is a result of the loss of accommodation in the eye, causing loss of visual performance when focusing on objects placed at different distances, starting with near vision. Glasses, contact lenses, surgical approaches and now pharmacological treatments are accepted methods of treating presbyopia. Pharmacological treatment is a promising new noninvasive option for treating presbyopia. Currently there are three pharmacological approaches to the treatment of presbyopia. The first one aims to produce miosis and, from a pinhole effect, increase depth of focus, and therefore improve uncorrected near visual acuity (UNVA). The second one addresses rehabilitating accommodation in a binocular way, allowing good vision at all distances. Finally, the third strategy uses lipoic acid to restore the lost elasticity of the lens. All of these pharmacological treatments are topical non-invasive eyedrops, with no serious adverse effects having been reported with any of the strategies, and require the right patient selection process to fulfill expectations and needs. The aim of this article is to provide an update on recent advances in this field.

Design of an Automatically Controlled Multi-Axis Stretching Device for Mechanical Evaluations of the Anterior Eye Segment

The young eye has an accommodative ability involving lens shape changes to focus over different distances. This function gradually decreases with age, resulting in presbyopia. Greater insights into the mechanical properties of anterior eye structures can improve understanding of the causes of presbyopia. The present study aims to develop a multi-axis stretching device for evaluating the mechanical properties of the intact eye lens. A stretching device integrating the mechanical stretcher, motor, torque sensor and data transmission mechanism was designed and developed by 3D printing. The mechanical stretcher can convert rotation into radial movement, both at constant speeds, according to the spiral of Archimedes. The loading unit equipped with eight jaws can hold the eye sample tightly. The developed device was validated with a spring of known constant and was further tested with anterior porcine eye segments. The validation experiment using the spring resulted in stiffness values close to the theoretical spring constant. Findings from measurements with porcine eye samples indicated that the measured forces are within the ranges reported in the literature. The developed multi-axis stretching device has good repeatability during experiments with similar settings and can be reliably used for mechanical evaluations of the intact eye lens.

Visual and cognitive functioning among older adults with low vision before vision rehabilitation: A pilot study

Introduction

The occurrence of age-related vision changes is inevitable. However, some of these changes can become pathological. Research indicates that vision and hearing loss is correlated with age-related cognitive decline, and with a higher risk of developing dementia due to Alzheimer's disease. Low vision rehabilitation could possibly be a protective factor against cognitive decline, as it provides the clients with compensatory strategies to overcome their visual deficits.

Objectives and hypothesis

The aim of this pilot study was to assess correlations between visual and cognitive functions in older adults referred for low vision rehabilitation. We hypothesized that more severe impairment of visual acuity and contrast sensitivity would be correlated with more advanced levels of cognitive impairment. The second objective was to examine which of these correlations would remain significant once established variables that influence cognition are statistically removed (e.g., age, education).

Methods

Thirty-eight older adults (age range: 66-97 years old) with a visual impairment (acuity <20/70) were recruited before the onset of their low vision rehabilitation. They underwent vision (reading acuity, reading speed, contrast sensitivity), hearing (audiogram, speech-in-noise perception) and cognitive (global cognition, memory, executive functions) testing, and demographic information was obtained.

Results and discussion

Correlations among global cognition and visual aid use, memory and reading speed, memory and contrast sensitivity, memory, and visual aid use, and between executive functions and contrast sensitivity were significant. Correlations between contrast sensitivity and memory, as well as between global cognition and visual aid use remained significant after controlling for age and education. The present study is relevant to clinicians who are assessing the cognitive status of older adults, such as neuropsychologists, because it highlights the importance of considering low vision when administering neuropsychological tests, especially to persons who have not yet received rehabilitation for their visual impairment.

Optimal flickering light stimulation for entraining gamma rhythms in older adults

With aging, optimal parameters of flickering light stimulation (FLS) for gamma entrainment may change in the eyes and brain. We investigated the optimal FLS parameters for gamma entrainment in 35 cognitively normal old adults by comparing event-related synchronization (ERS) and spectral Granger causality (sGC) of entrained gamma rhythms between different luminance intensities, colors, and flickering frequencies of FLSs. ERS entrained by 700 cd/m² FLS and 32 Hz or 34 Hz FLSs was stronger than that entrained by 400 cd/m² at Pz (p < 0.01) and 38 Hz or 40 Hz FLSs, respectively, at both Pz (p < 0.05) and Fz (p < 0.01). Parieto-occipital-to-frontotemporal connectivities of gamma rhythm entrained by 700 cd/m² FLS and 32 Hz or 34 Hz FLSs were also stronger than those entrained by 400 cd/m² at Pz (p < 0.01) and 38 Hz or 40 Hz FLSs, respectively (p < 0.001). ERS and parieto-occipital-to-frontotemporal connectivities of entrained gamma rhythms did not show significant difference between white and red lights. Adverse effects were comparable between different parameters. In older adults, 700 cd/m² FLS at 32 Hz or 34 Hz can entrain a strong gamma rhythm in the whole brain with tolerable adverse effects.

Method for Adapting the Grayscale Standard Display Function to the Aging Eye

Perceptual linearity of grayscale images based on a contrast sensitivity model is a widely recognized and used standard for medical imaging visualization. This approach ensures consistency across devices and provides perception of luminance variations in direct relationship to changes in image values. We analyze the effect of aging of the human eye on the precept of linearity and demonstrate that not only the number of just-noticeable differences diminishes for older subjects but also linearity across the range of luminance values is significantly affected. While loss of JNDs is inevitable for a fixed luminance range, our findings suggest possible corrective approaches for maintaining linearity.

Intraocular light scatter, reflections, fluorescence and absorption: what we see in the slit lamp

PURPOSE

Much knowledge has been collected over the past 20 years about light scattering in the eye- in particular in the eye lens- and its visual effect, called straylight. It is the purpose of this review to discuss how these insights can be applied to understanding the slit lamp image.

RESULTS

The slit lamp image mainly results from back scattering, whereas the effects on vision result mainly from forward scatter. Forward scatter originates from particles of about wavelength size distributed throughout the lens. Most of the slit lamp image originates from small particle scatter (Rayleigh scatter). For a population of middle aged lenses it will be shown that both these scatter components remove around 10% of the light from the direct beam. For slit lamp observation close to the reflection angles, zones of discontinuity (Wasserspalten) at anterior and posterior parts of the lens show up as rough surface reflections. All these light scatter effects increase with age, but the correlations with age, and also between the different components, are weak. For retro-illumination imaging it will be argued that the density or opacity seen in areas of cortical or posterior subcapsular cataract show up because of light scattering, not because of light loss. NOTES: (1) Light scatter must not be confused with aberrations. Light penetrating the eye is divided into two parts: a relatively small part is scattered, and removed from the direct beam. Most of the light is not scattered, but continues as the direct beam. This non-scattered part is the basis for functional imaging, but its quality is under the control of aberrations. Aberrations deflect light mainly over small angles (<1°), whereas light scatter is important because of the straylight effects over large angles (>1°), causing problems like glare and hazy vision. (2) The slit lamp image in older lenses and nuclear cataract is strongly influenced by absorption. However, this effect is greatly exaggerated by the light path lengths concerned. This obviates proper judgement of the functional importance of absorption, and hinders the appreciation of the Rayleigh nature of what is seen in the slit lamp image.

Simulating age-related changes in color vision to assess the ability of older adults to take medication

OBJECTIVE

To determine if simulated, age-related changes in color vision can adversely affect one's ability to properly take medication as simulated by bead selection.

DESIGN

Randomized controlled study.

SETTING

University site.

PARTICIPANTS

University students 18 to 26 years of age without eye disorders that would affect color vision.

INTERVENTIONS

Yellow-lens glasses to represent age-related color vision changes.

MAIN OUTCOME MEASURES

The number of correct beads selected and rating of task difficulty. The secondary outcomes were participants' responses based on which colors and color pairs were most difficult to discern and strategies they might have used to select beads.

RESULTS

The control group had no difficulties in selecting the appropriate beads, while the experimental group had significantly more mistakes, particularly with colors in the blue-violet spectrum. Average scores for the total number correct for the control and experimental groups were 36 (100%) and 27 (74.4%), P < 0.001, respectively, out of a possible 36 correct.

CONCLUSION

Declines in color vision with age can adversely affect an individual's abilities to appropriately select medications. For patients taking several medications, declines in color vision should be considered when counseling older persons on strategies for compliance. Although more studies are still needed to further generalize these findings to the geriatric population, this study has shown color vision can adversely affect medication compliance.

[Rare complication in microspherophakia surgery: early capsular contraction]

INTRODUCTION

Microspherophakia is characterized by a decreasing equatorial diameter of the crystalline lens and a relative spherical shape objectivized by an increase in the diameter of the anteroposterior axis. This rare abnormality, leading to severe glaucoma and lenticular myopia, can be sporadic or inherited.

OBSERVATION

We report the case of an 18-year-old woman with a history of bilateral angle-closure glaucoma consulting for recurring painful episodes with no relief from medical treatment. The clinical examination showed idiopathic microspherophakia, confirmed by crystalline lens diameter measures with B-scan biometry, associated with secondary glaucoma due to pupillary blockage even though bilateral iridotomy was achieved. A lens extraction was performed with a bag implantation, with no complications. Seven days after surgery, visual acuity dropped to 10/10 with no refractive error, but a major capsular contraction and a superior haptic luxation were noted. After a new surgery to reposition the haptic, at the end of 3 months the visual acuity was 10/10 without refractive error or hypertony.

CONCLUSION

This report is an example of a rare crystalline lens disease that required lens extraction. Postoperative complications raise the problem of implantation in this pathology because of the small capsular bag diameters and the high rate of bag contraction. Using a capsular tension ring may prevent this complication but a ring was not placed in this case because of a particular anatomic condition (small bag).

[Application of wavefront analysis in clinical and scientific settings. From irregular astigmatism to aberrations of a higher order--Part II: examples]

In recent years, wavefront analysis has ceased to be purely a laboratory application and emerged as a method used in ophthalmological diagnosis. This development has been promoted mainly by the widespread use of wavefront-guided LASIK (laser in situ keratomileusis). However, aberrometry is still not a common diagnostic technique, and for many ophthalmologists interpretation of the results is difficult. The second part of this serial paper reviews findings that are relevant for the ophthalmological community and highlights current scientific applications in this area.

Changes in the internal structure of the human crystalline lens with age and accommodation

Scheimpflug images were made of the unaccommodated and accommodated right eye of 102 subjects ranging in age between 16 and 65 years. In contrast with earlier Scheimpflug studies, the images were corrected for distortion due to the geometry of the Scheimpflug camera and the refraction of the cornea and the lens itself. The different nuclear and cortical layers of the human crystalline lens were determined using densitometry and it was investigated how the thickness of these layers change with age and accommodation. The results show that, with age, the increase in thickness of the cortex is approximately 7 times greater than that of the nucleus. The increase in thickness of the anterior cortex was found to be 1.5 times greater than that of the posterior cortex. It was also found that specific parts of the cortex, known as C1 and C3, showed no significant change in thickness with age, and that the thickening of the cortex is entirely due to the increase in thickness of the C2 zone. With age, the distance between the sulcus (centre of the nucleus) and the cornea does not change. With accommodation, the nucleus becomes thicker, but the thickness of the cortex remains constant.

Protein expression patterns for ubiquitous and tissue specific calpains in the developing mouse lens

Calcium activated proteases (calpains) have been implicated in the processing of lens crystallins during lens maturation and cataract formation. Ubiquitous type calpain 2 and calpain 10 and lens specific Lp82 and Lp85 protein distribution were determined using immunohistochemistry and immunoblotting in embryonic and post-natal mouse eyes. Calpain 2 was first expressed late in embryonic development and localized to the lens epithelium and transition zone. Lp82 was expressed at E9.5 in the lens placode, head ectoderm, and throughout the fiber cells during embryonic lens maturation. Lp82 co-localized at sites of crystallin modification in the juvenile lens. In the adult lens, Lp82 protein was maintained in cortical fibers but could not be detected in the lens nucleus. Lp85, the slightly larger splice variant of Lp82, was first observed at E9.5 and throughout early embryonic lens development. Abundant localization of this enzyme was observed in the cell nuclei of lens epithelium, elongating fibers, and undifferentiated mesoderm. Robust peri-nuclear localization of calpain 10 was observed in the head ectoderm, lens placode, and optic vesicle during early eye induction. Further, calpain 10 protein was maintained in the lens epithelium of pre- and post-natal lens. These data support the hypothesis that Lp82 in rodent lens has an important role in crystallin proteolysis during normal lens maturation. In contrast, calpain 2, Lp85, and calpain 10 may have roles in cell signaling pathways.

Microspherophakia

Microspherophakia is present when the crystalline lens is small and relatively spherical with increased antero-posterior thickness. Clinical findings for a patient with idiopathic bilateral microspherophakia are described. The patient was moderately myopic with slightly reduced visual acuity. The anterior chambers (R: 1.57 and L: 1.37 mm) were shallow compared with normals (3.46 to 3.80 mm) and the crystalline lenses were thicker (R: 4.77 and L: 4.89 mm) than normal (3.3 to 3.96 mm) with steeper than normal anterior (radii of curvature R: 6.2 and L: 6.3 mm) and posterior (R: 6.3 and L: 5.6 mm) surfaces. Microspherophakia may be associated with various syndromes and there is a strong possibility of glaucoma, particularly if the small lens is displaced.

Hydrogels as potential probes for investigating the mechanism of lenticular presbyopia

PURPOSE

To synthesize and characterize hydrogels with viscoelastic properties comparable to those of the natural lens.

METHODS

Hydrogels were synthesized in water by free-radical polymerization of the monomer poly(ethyleneglycol)-monomethacrylate. Three different molecular weights of poly(ethyleneglycol)-dimethacrylates were used as crosslinkers. For each crosslinker used, five different monomer-to-crosslinker weight ratios were utilized while the total mass of the reactants was kept constant. In another series, the concentration of the reactants was varied while the weight ratio of monomer to crosslinker was kept constant at 95 : 5. The percent optical transmission, equilibrium water content, moduli (elastic, shear, storage, and loss), and retardation time constant of the hydrogels were determined. In addition, endocapsular polymerization was performed in the capsular bag of porcine eyes.

RESULTS

The hydrogels examined exhibited the following ranges for viscoelastic properties: elastic modulus, 1.33-2.37 x 10(4) Pa; shear modulus, 3.35-6.72 x 10(3) Pa; storage modulus, 1.65-6.24 x 10(4) Pa. For any given hydrogel, raising its crosslinker's weight ratio increased its moduli and decreased its equilibrium water content and optical transmission. For any given monomer-to-crosslinker weight ratio, increasing the molecular weight of the crosslinker reversed these trends. Reactant concentrations increased the elastic modulus and decreased the equilibrium water content. The hydrogels formed ex vivo (in the evacuated capsular bag of porcine eyes) allowed for the clear and undistorted viewing of objects.

CONCLUSIONS

Hydrogels that exhibit physical and mechanical properties comparable to those of the natural lens were successfully identified, synthesized, and characterized, and the feasibility of endocapsular polymerization was demonstrated.

Presbyopia and the optical changes in the human crystalline lens with age

Lenses from 27 human eyes ranging in age from 10 to 87 years were used to determine how accommodation and age affect the optical properties of the lens. A scanning laser technique was used to measure focal length and spherical aberration of the lenses, while the lenses were subjected to stretching forces applied through the ciliary body/zonular complex. The focal length of all unstretched lenses increased linearly with increasing age. Younger lenses were able to undergo significant changes in focal length with stretching, whereas lenses older than 60 years of age showed no changes in focal length with stretching. These data provide additional evidence for predominantly lens-based theories of presbyopia. Further, these results show that there are substantial optical changes in the human lens with increasing age and during accommodation, since both the magnitude and the sign of the spherical aberration change with age and stretching. These results show that the optical properties of the older presbyopic lens are quite different from the younger, accommodated lens.