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Santilli CM, Johnson S, Thunstrom CR, Armbrust KR. Glycated Hemoglobin Improvement After Medical and Surgical Eye Care in American Veterans Involves Multidisciplinary Care. Clin Ophthalmol 2023; 17:1675-1682. [PMID: 37325065 PMCID: PMC10266375 DOI: 10.2147/opth.s412187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose The effects of diabetes mellitus (DM) on visual function have been extensively studied. Fewer studies evaluate the effect of visual function on DM, and previous small studies have shown mixed results concerning the relationship between glycated hemoglobin (HbA1c) and cataract surgery. We performed a retrospective, observational, single-site study at a Veterans hospital to evaluate this relationship and the relationship between HbA1c and non-surgical eye care. Patients and Methods We compared pre- and post-operative/examination HbA1c in 431 surgical and 431 matched, non-surgical subjects who underwent eye examination at the same institution. Subgroup analysis was performed by age, elevated (≥8) pre-operative/examination HbA1c, and change in diabetic management. We also assessed for a relationship between changes in best-corrected visual acuity (BCVA) and HbA1c. The Minneapolis Veterans Affairs Health Care System Research Administration determined this study to be Institutional Review Board exempt from the requirements of 38 CFR 16 under Category 4 (iii). Results Pairwise comparison of pre- versus post-operative HbA1c trended towards reduction at 3-6 months in all surgical subjects, with a statistically significant reduction in older subjects, and those with higher pre-operative HbA1c. Eye examination subjects experienced a significant HbA1c reduction 3-6 months after eye examination. Reduction in post-operative/examination HbA1c was associated with concurrent change in diabetic management. Conclusion We found an overall reduction in HbA1c in diabetic Veterans who interacted with an ophthalmologist, whether for cataract surgery or eye examination. HbA1c reduction was greatest when ophthalmic care was delivered as part of a multidisciplinary care team. Our findings add new evidence to further support the importance of ophthalmic care in patients with DM and suggest improved visual function may facilitate improved glycemic control.
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Affiliation(s)
- Christopher M Santilli
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Shaun Johnson
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Coltt R Thunstrom
- Department of Statistics, University of Minnesota, Minneapolis, MN, USA
| | - Karen R Armbrust
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
- Department of Ophthalmology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
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2
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Taraborelli D, Thomas JJ, Kim L, Fashina T, Hayek B, Mattia JG, Vandy M, Sugar E, Crozier I, Yeh S, Shantha JG. Visual acuity and vision-related quality of life outcomes following cataract surgery in Ebola virus disease survivors. GLOBAL JOURNAL OF CATARACT SURGERY AND RESEARCH IN OPHTHALMOLOGY 2023; 2:23-29. [PMID: 38463383 PMCID: PMC10921641 DOI: 10.25259/gjcsro_29_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Objectives The objectives of this study were to assess relationships between vision-related quality of life (QoL) and visual acuity (VA) in Ebola virus disease (EVD) survivors after cataract surgery in the Ebola Viral Persistence in Ocular Tissues and Fluids (EVICT) Study. Materials and Methods EVD survivors with undetectable Ebola virus (EBOV) ribonucleic acid in their aqueous humour were eligible to receive manual small-incision cataract surgery (MSICS). Among those that received surgery, assessments of VA and vision-related QoL were assessed pre-and post-cataract surgery. VA was converted from units on a tumbling 'E' chart to the logarithm of the minimal angle of resolution VA (logMAR VA). Vision-related QoL was assessed using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Linear regression was used to evaluate the associations between VA and vision-related QoL. P = 0.05 was considered statistically significant for all analyses. Results Thirty-four EVD survivors underwent cataract surgery in the EVICT study. Before MSICS, the mean logMAR VA was 2.24 (standard deviation [SD]: 0.98), and the mean NEI-VFQ-25 composite score was 54 (SD: 15); however, there was no significant association between the pre-surgery measurements (average difference in VA/10 unit increase in NEI-VFQ-25: -0.04, 95% confidence interval (CI): -0.33-0.26, P = 0.80). There was a significant improvement in logMAR VA after MSICS (mean: 1.6, P < 0.001), but there was no significant change in the NEI-VFQ-25 composite (-0.87, 95% (CI): -10.32-8.59, P = 0.85). None of the subscales showed significant improvements (P > 0.12 for all); however, the magnitude of the mean change for distance activities (6.65), near activities (6.76), general vision (-7.69), social functioning (-9.13) and colour vision (13.33) met the criteria for a clinically meaningful difference (4-6). In the subset with paired measurements (n = 16), there were no significant association changes in logMAR VA and NEI VFQ-25 composite scores (P > 0.12 for all). Conclusion Following cataract surgery, VA in EVD survivors improved, but these improvements were not reflected in NEI VFQ-25 composite scores or specific subscales; however, the small sample size limits generalizability absent more research. Differences in sociocultural context and activities that affect the QoL in resource-limited areas may contribute to the limitations seen with NEI VFQ-25. In addition, better eye dominance could contribute to any lack of association as NEI VFQ-25 evaluates vision as a whole. Further, assessment of factors contributing to improved QoL may help to define the impact of vision health in varied environments.
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Affiliation(s)
- Donna Taraborelli
- Harvard T.H. Chan School of Public Health, Harvard University, Cambridge
| | - Joanne J. Thomas
- Department of Ophthalmology, Medical College of Georgia, Augusta
| | - Lucas Kim
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha
| | - Tolulope Fashina
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha
| | - Brent Hayek
- Department of Ophthalmology, North Georgia Eye Clinic, Gainesville, United States
| | - John G. Mattia
- Department of Ophthalmology, Lowell and Ruth Gess Eye Hospital, Freetown
| | - Matthew Vandy
- Department of Ophthalmology, Director Hospital and Ambulatory Services, National Eye Programme Senior Ophthalmologist, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Elizabeth Sugar
- Department of Biostatistics, Johns Hopkins University, Baltimore
| | - Ian Crozier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha
| | - Jessica G. Shantha
- Francis I Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, United States
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3
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Kuze M, Negishi K, Koyasu T, Kondo M, Tsubota K, Ayaki M. Cataract type and pupillary response to blue and white light stimuli. Sci Rep 2021; 11:1828. [PMID: 33469062 PMCID: PMC7815835 DOI: 10.1038/s41598-020-79751-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/06/2020] [Indexed: 11/29/2022] Open
Abstract
We evaluated the pupil reaction to blue and white light stimulation in 70 eyes with cataract and in 38 eyes with a selective blue-light filtering intra-ocular lens. The diameter of the pupil before stimulation was set as baseline (BPD) and, after a stimulus duration of 1 s, the post-illumination pupillary response (PIPR) was measured using an electronic pupillometer. The BPD showed no significant difference among three grades of nuclear sclerosis (NS). In contrast, the PIPRs differed significantly among the NS grades eyes including with and without subcapsular cataract (SC) and IOL eyes for white light (p < 0.05, Kruskal-Wallis test), but not for blue light. Subcapsular opacity did not affect the BPD or PIPR in all cataract grades for either light stimulus. The tendency of larger PIPR in the pseudophakic eyes than the cataract eyes for both lights, however significant difference was found only for white light (p < 0.05 for white light, p > 0.05 for blue light). Our study demonstrates retention of the PIPR for blue light, but not for white light in cataract eyes. We also confirmed that the pupillary response in pseudohakic eyes with a selective blue light-filtering intra ocular lens was greater than that in cataractous eyes for white light.
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Affiliation(s)
- Manami Kuze
- Division of Ophthalmology, Matsusaka Central General Hospital, Matsusaka, Japan.
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | | | - Mineo Kondo
- Department of Ophthalmology, Mie University School of Medicine, Mie, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
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4
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Kasović M, Štefan A, Štefan L. The Associations Between Objectively Measured Gait Speed and Subjective Sleep Quality in First-Year University Students, According to Gender. Nat Sci Sleep 2021; 13:1663-1668. [PMID: 34594142 PMCID: PMC8478338 DOI: 10.2147/nss.s328218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To examine the associations between gait speed and sleep quality in first-year university students, according to gender. METHODS In this cross-sectional study, we recruited 193 first-year university students [mean age±standard deviation (SD): 19.6±1.1 years; mean height: 178.0±10.5 cm; mean weight: 74.0±11.0 kg; 26.9% women). Sleep quality was assessed using the Pittsburgh Sleep Quality questionnaire, with a lower score indicating "better" sleep quality. Gait speed was measured using the Zebris pressure platform. The associations were examined with generalized linear models and multiple regression analysis. RESULTS In the unadjusted model, faster participants had significantly "better" sleep quality (β=-3.15, 95% CI -3.82 to -2.47, p<0.001). When the model was adjusted for sex, age, body-mass index, self-rated health, smoking status, and psychological distress, faster participants remained having "better" sleep quality (β=-2.88, 95% CI -3.53 to -2.22, p<0.001). CONCLUSION This study shows that sleep quality can be predicted by gait speed in the first-year university students.
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Affiliation(s)
- Mario Kasović
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, Zagreb, 10 000, Croatia.,Faculty of Sports Studies, Department of Sport Motorics and Methodology in Kinanthropology, Masaryk University, Brno, 625 00, Czech Republic
| | - Andro Štefan
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, Zagreb, 10 000, Croatia
| | - Lovro Štefan
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, Zagreb, 10 000, Croatia.,Faculty of Sports Studies, Department of Sport Motorics and Methodology in Kinanthropology, Masaryk University, Brno, 625 00, Czech Republic.,Faculty of Science, Department of Recruitment and Examination (RECETOX), Masaryk University, Brno, 625 00, Czech Republic
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5
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Measurement of Force Required for Anterior Displacement of Intraocular Lenses and Its Defining Parameters. MATERIALS 2020; 13:ma13204593. [PMID: 33076490 PMCID: PMC7602541 DOI: 10.3390/ma13204593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 12/25/2022]
Abstract
Intraocular stability during or after cataract and glaucoma filtration surgeries and vitreous surgery with a gas/silicone oil tamponade might differ among intraocular lenses (IOLs). We used six different one-piece IOL models and measured the force that displaced the IOLs from the vitreous cavity to anterior chamber as a measure of stability against the pressure gradient between the anterior and posterior IOL surfaces. We measured IOL hardness, haptics junction area, and posterior IOL bulge to identify what determines the IOL displacement force. The KOWA YP2.2 IOL (1.231 mN) required significantly greater force than the HOYA XY1 (0.416 mN, p = 0.0004), HOYA 255 (0.409 mN, p = 0.0003), Alcon SN60WF (0.507 mN, p = 0.0010), and Nidek NS60YG (0.778 mN, p = 0.0186) IOLs; J&J ZCB00V IOL (1.029 mN) required greater force than the HOYA XY1 (p = 0.0032) and HOYA 255 (p = 0.0029) IOLs; the Nidek NS60YG IOL required greater force than the HOYA 255 (p = 0.0468) IOL. The haptics junction area was correlated positively with the IOL displacement force (r = 0.8536, p = 0.0306); the correlations of the other parameters were non-significant. After adjusting for any confounding effects, the haptics junction area was correlated significantly with the IOL displacement force (p = 0.0394); the IOL hardness (p = 0.0573) and posterior IOL bulge (p = 0.0938) were not. The forces that displace IOLs anteriorly differed among one-piece soft-acrylic IOLs, and the optics/haptics junction area was the major force determinant.
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6
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Langina-Jansone Z, Truksa R, Ozolinsh M. Visual acuity and color discrimination in patients with cataracts. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2020; 37:A212-A216. [PMID: 32400545 DOI: 10.1364/josaa.382397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/18/2020] [Indexed: 06/11/2023]
Abstract
Color vision tests can give information about pathological changes in eye structures. The purpose of our research was to study the color vision sensitivity and visual acuity changes before and after cataract surgery. We used a saturated Farnsworth D15 color vision arrangement test to check color sensitivity changes in confusion line directions. The test is easily perceptible (essential to eldery patients), and it is possible to check color sensitivity changes in tritan, protan, and deutan confusion line directions. The results were analyzed in several ways: by summing the color differences between adjacent caps according to Bowman and averaging the color difference vectors according to Vingrys and King-Smith. Color difference vectors determine the severity (or confusion), selectivity (or scatter), and type of color deficiency to the presented cap arrangements. In the least squares regression method, the error type is determined by the angular proximity of the best-fit line to known confusion axes representing protan, deutan, tritan, or unspecified color defects. All three tests showed that cataract-induced lens opacity significantly decreases a patient's chromatic resolution in the visible light region. Before the cataract surgery, the D15 test stimulus arrangement sequence showed similarities with tritan color deficiency.
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7
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De Nobrega AK, Luz KV, Lyons LC. Resetting the Aging Clock: Implications for Managing Age-Related Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1260:193-265. [PMID: 32304036 DOI: 10.1007/978-3-030-42667-5_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Worldwide, individuals are living longer due to medical and scientific advances, increased availability of medical care and changes in public health policies. Consequently, increasing attention has been focused on managing chronic conditions and age-related diseases to ensure healthy aging. The endogenous circadian system regulates molecular, physiological and behavioral rhythms orchestrating functional coordination and processes across tissues and organs. Circadian disruption or desynchronization of circadian oscillators increases disease risk and appears to accelerate aging. Reciprocally, aging weakens circadian function aggravating age-related diseases and pathologies. In this review, we summarize the molecular composition and structural organization of the circadian system in mammals and humans, and evaluate the technological and societal factors contributing to the increasing incidence of circadian disorders. Furthermore, we discuss the adverse effects of circadian dysfunction on aging and longevity and the bidirectional interactions through which aging affects circadian function using examples from mammalian research models and humans. Additionally, we review promising methods for managing healthy aging through behavioral and pharmacological reinforcement of the circadian system. Understanding age-related changes in the circadian clock and minimizing circadian dysfunction may be crucial components to promote healthy aging.
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Affiliation(s)
- Aliza K De Nobrega
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Kristine V Luz
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Lisa C Lyons
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL, USA.
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8
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Phototoxicity of environmental radiations in human lens: revisiting the pathogenesis of UV-induced cataract. Graefes Arch Clin Exp Ophthalmol 2019; 257:2065-2077. [PMID: 31227898 DOI: 10.1007/s00417-019-04390-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/30/2019] [Accepted: 06/05/2019] [Indexed: 12/13/2022] Open
Abstract
The magnitude of cataract pathology is indeed significant as it is the principal cause of blindness worldwide. Also, the prominence of this concept escalates with the current aging population. The burden of the disease is more tangible in developing countries than developed ones. Regarding this concern, there is a gap in classifying the pathogenesis of the ultraviolet (UV) radiation-induced cataracts and explaining the possible cellular and subcellular pathways. In this review, we aim to revisit the effect of UV radiation on cataracts categorizing the cellular pathways involved. This may help for better pharmaceutical treatment alternatives and their wide-reaching availability. Also, in the last section, we provide an overview of the protecting agents utilized as UV shields. Further studies are required to enlighten new treatment modalities for UV radiation-induced pathologies in human lens.
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9
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Zheng L, Wu XH, Lin HT. The effect of cataract surgery on sleep quality: a systematic review and Meta-analysis. Int J Ophthalmol 2017; 10:1734-1741. [PMID: 29181319 DOI: 10.18240/ijo.2017.11.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022] Open
Abstract
AIM To evaluate the effect of cataract surgery on sleep quality and to compare the difference between ultraviolet-blocking clear intraocular lens (UVB-IOL) and blue-filtering intraocular lens (BF-IOL) implantation. METHODS Electronic search was performed of PubMed, MEDLINE, Embase and the Cochrane Library up to January 2016. Studies were eligible when they evaluated the sleep quality before and after cataract surgery by Pittsburgh sleep quality index (PSQI). A random/fixed-effects Meta-analysis was used for the pooled estimate. Heterogeneity was assessed with the I2 test. RESULTS Six studies were selected from 5623 references. Cataract surgery significantly reduced the PSQI scores at postoperative 0-3mo [mean difference (MD) =-0.62, 95%CI: -1.14 to -0.11, P=0.02, I2=66%] and 3-12mo (MD=-0.32, 95%CI: -0.62 to -0.02, P=0.04, I2=0), respectively. Considering different intraocular lens (IOL) implantations, relative post-operative PSQI reduction was found for both UVB-IOL and BF-IOL, but a significant reduction was detected only for UVB-IOL. No significant difference was found with the effect of BF-IOL vs UVB-IOL on sleep quality. CONCLUSION This study found that cataract surgery significantly improved the PSQI score-derived subjective sleep quality irrespective of the IOL type implanted. These findings highlight a substantial benefit of cataract surgery on systemic health with photoreceptive restoration in addition to visual acuity improvements.
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Affiliation(s)
- Ling Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China.,Jieyang People's Hospital, Jieyang Affiliated Hospital, Sun Yat-sen University, Jieyang 522000, Guangdong Province, China
| | - Xiao-Hang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Hao-Tian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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10
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Brøndsted AE, Haargaard B, Sander B, Lund-Andersen H, Jennum P, Kessel L. The effect of blue-blocking and neutral intraocular lenses on circadian photoentrainment and sleep one year after cataract surgery. Acta Ophthalmol 2017; 95:344-351. [PMID: 27966269 DOI: 10.1111/aos.13323] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 09/30/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the long-term effect on circadian photoentrainment and sleep in patients implanted with neutral and blue-blocking intraocular lenses 1 year after cataract surgery. METHODS Randomized, controlled trial involving 67 patients with age-related cataract. Intervention was cataract surgery with implantation of either a neutral or a blue-blocking intraocular lens (IOL). Main outcome was activation of the intrinsically photosensitive retinal ganglion cells (ipRGC) measured by chromatic pupillometry. The circadian rhythm was analysed by 24-hr melatonin profiles and actigraphy; the latter was also used to determine objective sleep quality. The Pittsburgh Sleep Quality Index determined subjective sleep quality. RESULTS One year after surgery, peak melatonin concentration was 3.3 pg/ml (95% CI, 2-5.5) corresponding to 50% lower for the participants allocated to blue-blocking IOLs compared with participants allocated to neutral IOLs. Compared with preoperative levels, the ipRGC response had increased by 13.7% (95% confidence interval [CI], 3.2-22.6) 1 year after surgery. Objective sleep quality was also improved as the time of wakefulness after sleep onset had improved by 5 min (95% CI, 1-10) for the entire population while sleep efficiency had increased by two percentage points (95% CI, 0.42-3.65) although exclusively, for the participants allocated to blue-blocking IOLs. CONCLUSION Blue-blocking IOLs increased sleep efficiency but lowered nocturnal melatonin secretion compared with neutral IOLs. Cataract surgery improved the response of ipRGCs and sleep quality. However, the effect of cataract surgery on sleep quality may be unrelated to circadian photoentrainment.
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Affiliation(s)
- Adam Elias Brøndsted
- Department of Ophthalmology; Center of Head and Orthopedics; Rigshospitalet; Glostrup Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | | | - Birgit Sander
- Department of Ophthalmology; Center of Head and Orthopedics; Rigshospitalet; Glostrup Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology; Center of Head and Orthopedics; Rigshospitalet; Glostrup Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Poul Jennum
- Department of Ophthalmology; Center of Head and Orthopedics; Rigshospitalet; Glostrup Denmark
- Danish Center for Sleep Medicine, Clinical Neurophysiology; Center of Neurology; Rigshospitalet; Glostrup Denmark
| | - Line Kessel
- Department of Ophthalmology; Center of Head and Orthopedics; Rigshospitalet; Glostrup Denmark
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11
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Li X, Kelly D, Nolan JM, Dennison JL, Beatty S. The evidence informing the surgeon's selection of intraocular lens on the basis of light transmittance properties. Eye (Lond) 2016; 31:258-272. [PMID: 27935597 PMCID: PMC5306461 DOI: 10.1038/eye.2016.266] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/27/2016] [Indexed: 01/01/2023] Open
Abstract
In recent years, manufacturers and distributors have promoted commercially available intraocular lenses (IOLs) with transmittance properties that filter visible short-wavelength (blue) light on the basis of a putative photoprotective effect. Systematic literature review. Out of 21 studies reporting on outcomes following implantation of blue-light-filtering IOLs (involving 8914 patients and 12 919 study eyes undergoing cataract surgery), the primary outcome was vision, sleep pattern, and photoprotection in 9 (42.9%), 9 (42.9%), and 3 (14.2%) respectively, and, of these, only 7 (33.3%) can be classed as high as level 2b (individual cohort study/low-quality randomized controlled trials), all other studies being classed as level 3b or lower. Of the level 2b studies, only one (14.3%) found in favor of blue-light-filtering IOLs vs ultraviolet (UV)-only filtering IOLs on the basis of an association between better post-operative contrast sensitivity (CS) at select frequencies with the former; however, that study did not measure or report CS preoperatively in either group, and the finding may simply reflect better preoperative CS in the eyes scheduled to be implanted with the blue-light-filtering IOL; moreover, that study failed to measure macular pigment, a natural preceptoral filter of blue-light, augmentation of which is now known to improve CS. In terms of photoprotection, there is no level 2b (or higher) evidence in support of blue filtering IOLs vs UV-only filtering IOLs. On the basis of currently available evidence, one cannot advocate for the use of blue-light-filtering IOLs over UV-only filtering IOLs.
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Affiliation(s)
- X Li
- Pharmaceutical & Molecular Biotechnology Research Centre, Department of Chemical & Life Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - D Kelly
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - J M Nolan
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - J L Dennison
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - S Beatty
- Nutrition Research Centre Ireland, Macular Pigment Research Group, School of Health Science, Waterford Institute of Technology, Waterford, Ireland.,Institute of Vision Research, Whitfield Clinic, Waterford, Ireland
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Yan SS, Wang W. The effect of lens aging and cataract surgery on circadian rhythm. Int J Ophthalmol 2016; 9:1066-74. [PMID: 27500118 DOI: 10.18240/ijo.2016.07.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/14/2016] [Indexed: 12/31/2022] Open
Abstract
Many organisms have evolved an approximately 24-hour circadian rhythm that allows them to achieve internal physiological homeostasis with external environment. Suprachiasmatic nucleus (SCN) is the central pacemaker of circadian rhythm, and its activity is entrained to the external light-dark cycle. The SCN controls circadian rhythm through regulating the synthesis of melatonin by pineal gland via a multisynaptic pathway. Light, especially short-wavelength blue light, is the most potent environmental time cue in circadian photoentrainment. Recently, the discovery of a novel type of retinal photoreceptors, intrinsically photosensitive retinal ganglion cells, sheds light on the mechanism of circadian photoentrainment and raises concerns about the effect of ocular diseases on circadian system. With age, light transmittance is significantly decreased due to the aging of crystalline lens, thus possibly resulting in progressive loss of circadian photoreception. In the current review, we summarize the circadian physiology, highlight the important role of light in circadian rhythm regulation, discuss about the correlation between age-related cataract and sleep disorders, and compare the effect of blue light- filtering intraocular lenses (IOLs) and ultraviolet only filtering IOLs on circadian rhythm.
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Affiliation(s)
- Shen-Shen Yan
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Wei Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
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13
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Shenshen Y, Minshu W, Qing Y, Yang L, Suodi Z, Wei W. The effect of cataract surgery on salivary melatonin and sleep quality in aging people. Chronobiol Int 2016; 33:1064-72. [PMID: 27384816 DOI: 10.1080/07420528.2016.1197234] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Yan Shenshen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Wang Minshu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yuan Qing
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Liu Yang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Zhai Suodi
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Wang Wei
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
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Erichsen JH, Brøndsted AE, Kessel L. Effect of cataract surgery on regulation of circadian rhythms. J Cataract Refract Surg 2016; 41:1997-2009. [PMID: 26603409 DOI: 10.1016/j.jcrs.2015.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/07/2015] [Accepted: 03/16/2015] [Indexed: 12/23/2022]
Abstract
UNLABELLED This review looked at the effect of cataract surgery on the regulation of circadian rhythms and compared the effect of blue light-filtering and clear intraocular lenses (IOLs) on circadian rhythms. A systematic review and metaanalysis were performed, and the level of evidence was evaluated based on the principles described in the Grading of Recommendations Assessment, Development, and Evaluation system. A literature search of PubMed, Embase, and Cochrane Library databases was performed, as well as a search for unpublished trials at the U.S. National Institutes of Health Clinical Trials web site. Trials that reported the effect of cataract surgery on circadian rhythms were included. Outcomes were the Pittsburgh Sleep Quality Index (PSQI) global score, number of poor sleepers, Epworth Sleepiness Score, sleep efficiency, and mean concentration of melatonin. Cataract surgery improved regulation of circadian rhythms measured by the PSQI questionnaire, but the clinical relevance is uncertain. There was no difference between the effect of the 2 IOL types. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Jesper Høiberg Erichsen
- From the Faculty of Health and Medical Sciences (Erichsen), University of Copenhagen, Copenhagen, Department of Ophthalmology (Erichsen, Brøndsted), Glostrup Hospital, Glostrup, and Department of Ophthalmology (Kessel), Roskilde Hospital, Roskilde, Denmark.
| | - Adam E Brøndsted
- From the Faculty of Health and Medical Sciences (Erichsen), University of Copenhagen, Copenhagen, Department of Ophthalmology (Erichsen, Brøndsted), Glostrup Hospital, Glostrup, and Department of Ophthalmology (Kessel), Roskilde Hospital, Roskilde, Denmark
| | - Line Kessel
- From the Faculty of Health and Medical Sciences (Erichsen), University of Copenhagen, Copenhagen, Department of Ophthalmology (Erichsen, Brøndsted), Glostrup Hospital, Glostrup, and Department of Ophthalmology (Kessel), Roskilde Hospital, Roskilde, Denmark
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15
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Mendoza-Mendieta ME, Lorenzo-Mejía AA. Associated depression in pseudophakic patients with intraocular lens with and without chromophore. Clin Ophthalmol 2016; 10:577-81. [PMID: 27099465 PMCID: PMC4820230 DOI: 10.2147/opth.s95212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND With aging, the crystalline lens turns yellowish, which increases the absorption of wavelengths in the blue electromagnetic spectrum, reducing their photoreception in the retina. Since these wavelengths are the main stimulus in the regulation of the circadian rhythm, progressive reduction in their transmission is associated with chronic sleep disturbances and depression in elderly patients. Cataract extraction improves circadian photoreception at any age. However, lenses that block blue waves have 27% to 38% less melatonin suppression than lenses that block only ultraviolet (UV) rays. PURPOSE To assess the depression symptoms in subjects who have had bilateral phacoemul-sification and intraocular lens (IOL) implants, one group with yellow chromophore IOLs and the other group with transparent IOLs were compared. SETTING Association to Prevent Blindness in Mexico (APEC), Hospital "Dr Luis Sánchez Bulnes". DESIGN This was an observational, cross-sectional, and single-center study. MATERIALS AND METHODS Twenty-six subjects between 60 and 80 years of age, with a history of bilateral phacoemulsification and placement of the same type of IOL in both eyes from 4 to 12 months prior to the study, who attended the follow-up visits and agreed to participate in this study, and provided signed informed consent were included in the study. They were asked to answer the short version of the 15-item Geriatric Depression Scale. RESULTS The average age of the study participants was 72.5±5.94 years. The group without chromophore included 46.1% (n=12) of the patients and the group with chromophore included 53.9% (n=14) of the patients (P=0.088). CONCLUSION In the group of patients with IOLs that block the passage of blue light, the depression rate was 21.4%, a rate similar to that observed in the elderly population, whereas no patients in the group with transparent IOLs had depression.
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Affiliation(s)
| | - Ana Aurora Lorenzo-Mejía
- Association to Prevent Blindness in Mexico (APEC), Hospital "Dr Luis Sánchez Bulnes", Mexico City, Mexico
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16
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Ding J, Zhu B. Is Low Hemoglobin Concentration Highly Associated with the Onset of Cognitive Impairment in Elderly People? Rejuvenation Res 2016; 19:174-5. [PMID: 26950291 DOI: 10.1089/rej.2016.1817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jie Ding
- 1 Department of Anesthesiology, The Third Affiliated Hospital of Soochow University , Changzhou, China
| | - Bin Zhu
- 2 Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University , Changzhou, China
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17
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Lin JB, Tsubota K, Apte RS. A glimpse at the aging eye. NPJ Aging Mech Dis 2016; 2:16003. [PMID: 28721262 PMCID: PMC5515005 DOI: 10.1038/npjamd.2016.3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/03/2015] [Accepted: 12/09/2015] [Indexed: 12/11/2022] Open
Abstract
Extensive investigations have demonstrated that organismal aging is associated with tissue dysfunction in many organs. The eye is no exception to this rule. Under healthy conditions, the eye is designed like an advanced camera with the central role of translating light from the external world into a coherent neural signal that can be transmitted to the brain for processing into a precise visual image. This complex process requires precisely maintained machinery. At the front of the eye, the transparency of both the cornea and the lens are crucial to allow passage of photons to the light-sensitive portion of the eye. Similarly, the highly organized structure of the retina located at the back of the eye is indispensable to allow for effective signal transduction and efficient signal transmission. Aging affects ocular structures in various ways, and these sequelae have been well defined as distinct clinical entities. In many instances, aging leads to ocular tissue dysfunction and disease. Nonetheless, despite clear evidence that age-associated visual impairment has significant psychosocial consequences, current treatment paradigms for many of these conditions are inadequate. In addition, strategies to decelerate or reverse age-associated deterioration in ocular function are still in their infancy. This review focuses on the cellular and molecular pathophysiology of the aging eye. Ultimately, we hope that a refined understanding of the aging eye can guide targeted therapies against cellular aging and disease.
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Affiliation(s)
- Jonathan B Lin
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO, USA
- Neuroscience Graduate Program, Division of Biology and Biomedical Sciences, Washington University School of Medicine, St Louis, MO, USA
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Rajendra S Apte
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO, USA
- Neuroscience Graduate Program, Division of Biology and Biomedical Sciences, Washington University School of Medicine, St Louis, MO, USA
- Department of Developmental Biology, Washington University School of Medicine, St Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
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18
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Ayaki M, Nagura T, Toyama Y, Negishi K, Tsubota K. Motor function benefits of visual restoration measured in age-related cataract and simulated patients: Case-control and clinical experimental studies. Sci Rep 2015; 5:14595. [PMID: 26420727 PMCID: PMC4588563 DOI: 10.1038/srep14595] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/01/2015] [Indexed: 02/04/2023] Open
Abstract
The aim of the present study was to measure gait velocity in cataract and simulated patients. The study was performed on 239 cataract patients, 115 age-matched subjects, and 11 simulated patients. We measured gait velocity and analyzed gait using a three-dimensional motion analysis system. Mean gait velocity before and 2 and 7 months after cataract surgery was 0.91 ± 0.19, 1.04 ± 0.21, and 1.06 ± 0.21 m/s, respectively, for males and 0.84 ± 0.22, 0.91 ± 0.24, and 0.92 ± 0.25 m/s, respectively, for females. The increase after surgery was significant in both groups at 7 months (P < 0.05). Gait velocity was significantly slower in cataract patients compared with controls before surgery, but no longer different after surgery. In simulated patients, mean velocity was 87.0 ± 11.4% of normal vision with a 3° visual field and 92.4 ± 12.3% of normal when counting fingers. Initial velocity was 89.1 ± 14.6% of normal vision with a 3° visual field and 92.7 ± 11.6% of normal when counting fingers. There was a significant difference between normal and impaired visual function (P < 0.05). The results demonstrate the close relationship between visual function and gait in cataract patients and simulated patients.
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Affiliation(s)
- Masahiko Ayaki
- Departments of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Nagura
- Orthopedic surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiaki Toyama
- Orthopedic surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuno Negishi
- Departments of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Departments of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Brøndsted AE, Sander B, Haargaard B, Lund-Andersen H, Jennum P, Gammeltoft S, Kessel L. The Effect of Cataract Surgery on Circadian Photoentrainment: A Randomized Trial of Blue-Blocking versus Neutral Intraocular Lenses. Ophthalmology 2015; 122:2115-24. [PMID: 26233628 DOI: 10.1016/j.ophtha.2015.06.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Cataract decreases blue light transmission. Because of the selective blue light sensitivity of the retinal ganglion cells governing circadian photoentrainment, cataract may interfere with normal sleep-wake regulation and cause sleep disturbances. The purpose was to investigate the effect of cataract surgery on circadian photoentrainment and to determine any difference between blue-blocking and neutral intraocular lenses (IOLs). DESIGN The study was a single-center, investigator-driven, double-masked, block-randomized clinical trial. PARTICIPANTS One eye in 76 patients with bilateral age-related cataract eligible for cataract surgery was included. METHODS Intervention was cataract surgery by phacoemulsification. Patients were randomized to receive a blue-blocking or neutral IOL. MAIN OUTCOME MEASURES Primary outcome was activation of intrinsic photosensitive ganglion cells using post-illumination pupil response (PIPR) to blue light from 10 to 30 seconds after light exposure as a surrogate measure. Secondary outcomes were circadian rhythm analysis using actigraphy and 24-hour salivary melatonin measurements. Finally, objective and subjective sleep quality were determined by actigraphy and the Pittsburgh Sleep Quality Index. RESULTS The blue light PIPR increased 2 days (17%) and 3 weeks (24%) after surgery (P < 0.001). The majority of circadian and sleep-specific actigraphy parameters did not change after surgery. A forward shift of the circadian rhythm by 22 minutes (P = 0.004) for actigraphy and a tendency toward an earlier melatonin onset (P = 0.095) were found. Peak salivary melatonin concentration increased after surgery (P = 0.037). No difference was detected between blue-blocking and neutral IOLs, whereas low preoperative blue light transmission was inversely associated with an increase in PIPR (P = 0.021) and sleep efficiency (P = 0.048). CONCLUSIONS Cataract surgery increases photoreception by the photosensitive retinal ganglion cells. Because of inconsistency between the significant findings and the many parameters that were unchanged, we can conclude that cataract surgery does not adversely affect the circadian rhythm or sleep. Longer follow-up time and fellow eye surgery may reveal the significance of the subtle changes observed. We found no difference between blue-blocking and neutral IOLs, and, because of the minor effect of surgery in itself, an effect of IOL type seems highly unlikely.
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Affiliation(s)
- Adam Elias Brøndsted
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark.
| | - Birgit Sander
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Birgitte Haargaard
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Poul Jennum
- Faculty of Health Sciences, University of Copenhagen, Denmark; Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Steen Gammeltoft
- Clinical Biochemistry Section, Department of Diagnostics, Rigshospitalet, Glostrup, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark
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Ayaki M, Negishi K, Suzukamo Y, Tsubota K. Color of intra-ocular lens and cataract type are prognostic determinants of health indices after visual and photoreceptive restoration by surgery. Rejuvenation Res 2015; 18:145-52. [PMID: 25526429 PMCID: PMC4403229 DOI: 10.1089/rej.2014.1613] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study compared post-operative quality of life and sleep according to the type of cataract opacity and color of the implanted intra-ocular lens (IOL). Methods: This is a cohort study and participants were 206 patients (average age 74.1 years) undergoing cataract surgery with the implantation of a clear ultra-violet (UV)-blocking IOL (C) or a yellow blue-light-blocking IOL (Y). Participants were evaluated using the National Eye Institute Visual Function Questionnaire (VFQ-25) and Pittsburgh Sleep Quality Index (PSQI) before surgery and 2 and 7 months after surgery. Changes in sub-scale scores of VFQ-25 and PSQI were compared. Results: Sub-scale analyses for improvement after surgery revealed significant differences in ocular pain scores on the VFQ-25 (Y>C; the higher the score, the better the outcome). Furthermore, there were significant differences between the two IOLs in terms of the sleep latency score (C>Y) and sleep disturbances score (C>Y). A posterior sub-capsular cataract was significantly correlated with improvements in ocular pain and sleep latency scores. These effects were successfully represented by the change in scores rather than absolute post-operative scores because individual standard of response may often change after intervention, recognized as a response shift phenomenon in patient-reported outcome study. Regarding seasonal differences, patients who had surgery in summer exhibited relatively better sleep quality than those who had surgery in winter. Conclusions: Analysis of sub-scales of health indices demonstrated characteristic prognoses for each IOL and cataract type. Cataract surgery may potentially contribute to systemic health in older adults.
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Affiliation(s)
- Masahiko Ayaki
- 1 Department of Ophthalmology, Keio University School of Medicine , Tokyo, Japan
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21
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Short-term influence of cataract surgery on circadian biological rhythm and related health outcomes (CLOCK-IOL trial): study protocol for a randomized controlled trial. Trials 2014; 15:514. [PMID: 25547247 PMCID: PMC4320588 DOI: 10.1186/1745-6215-15-514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/10/2014] [Indexed: 12/11/2022] Open
Abstract
Background Light information is the most important cue of circadian rhythm which synchronizes biological rhythm with external environment. Circadian misalignment of biological rhythm and external environment is associated with increased risk of depression, insomnia, obesity, diabetes, cardiovascular disease, and cancer. Increased light transmission by cataract surgery may improve circadian misalignment and related health outcomes. Although some observational studies have shown improvement of depression and insomnia after cataract surgery, randomized controlled trials are lacking. We will conduct a parallel-group, assessor-blinded, simple randomized controlled study comparing a cataract surgery group at three months after surgery with a control group to determine whether cataract surgery improves depressive symptoms, sleep quality, body mass regulation, and glucose and lipid metabolism. Methods/Design We will recruit patients who are aged 60 years and over, scheduled to receive their first cataract surgery, and have grade 2 or higher nuclear opacification as defined by the lens opacities classification system III. Exclusion criteria will be patients with major depression, severe corneal opacity, severe glaucoma, vitreous haemorrhage, proliferative diabetic retinopathy, macular oedema, age-related macular degeneration, and patients needing immediate or combined cataract surgery. After baseline participants will be randomized to two groups. Outcomes will be measured at three months after surgery among the intervention group, and three months after baseline among the control group. We will assess depressive symptoms as a primary outcome, using the short version geriatric depression scale (GDS-15). Secondary outcomes will be subjective and actigraph-measured sleep quality, sleepiness, glycated haemoglobin, fasting plasma glucose and triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index, abdominal circumference, circadian rhythms of physical activity and wrist skin temperature, and urinary melatonin metabolite. Chronotype and visual function will be assessed using the ‘morningness-eveningness’ questionnaire, the Munich chronotype questionnaire, and the National Eye Institute Visual Function Questionnaire. Discussion Although there are potential limitations due to the difference in duration from baseline survey to outcome measurements between two groups, any seasonal effect on the outcome measurement will be balanced as a result of continuous inclusion of participants through the year, and outcomes will be adjusted for day length at outcome measurements at analysis. Trial registration UMIN000014559, UMIN Clinical Trials Registry, registered on 15 July 2014.
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