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Craig JP, Barsam A, Chen C, Chukwuemeka O, Ghorbani-Mojarrad N, Kretz F, Michaud L, Moore J, Pelosini L, Turnbull AMJ, Vincent SJ, Wang MTM, Ziaei M, Wolffsohn JS. BCLA CLEAR Presbyopia: Management with corneal techniques. Cont Lens Anterior Eye 2024; 47:102190. [PMID: 38851946 DOI: 10.1016/j.clae.2024.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report reviews the evidence for the treatment profile, safety, and efficacy of the current range of corneal techniques for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. In presbyopia correction by conductive keratoplasty, radiofrequency energy is applied to the mid-peripheral corneal stroma, leading to mid-peripheral corneal shrinkage and central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.
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Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK.
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung City, Taiwan
| | - Obinwanne Chukwuemeka
- Cornea, Contact Lens and Myopia Management Unit, De-Lens Ophthalmics Family and Vision Care Centre, Abuja, Nigeria
| | - Neema Ghorbani-Mojarrad
- School of Optometry and Vision Science, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | | | | | | | - Andrew M J Turnbull
- Royal Bournemouth Hospital, University Hospitals Dorset, UK; Faculty of Life and Health Sciences, Ulster University, UK
| | - Stephen J Vincent
- Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - Michael T M Wang
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Mohammed Ziaei
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - James S Wolffsohn
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK
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Castro-Torres JJ, Casares-López M, Ortiz-Peregrina S, Martino F, Gómez-Robledo L, Jiménez JR. Effect of the chromaticity of stimuli on night vision disturbances. Sci Rep 2024; 14:10183. [PMID: 38702452 PMCID: PMC11068904 DOI: 10.1038/s41598-024-61069-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/30/2024] [Indexed: 05/06/2024] Open
Abstract
The perception of halos and other night vision disturbances is a common complaint in clinical practice. Such visual disturbances must be assessed in order to fully characterize each patient's visual performance, which is particularly relevant when carrying out a range of daily tasks. Visual problems are usually assessed using achromatic stimuli, yet the stimuli encountered in daily life have very different chromaticities. Hence, it is important to assess the effect of the chromaticity of visual stimuli on night vision disturbances. The aim of this work is to study the influence of the chromaticity of different visual stimuli on night vision disturbances by analyzing straylight and visual discrimination under low-light conditions. For that, we assessed the monocular and binocular visual discrimination of 27 subjects under low illumination using the Halo test. The subjects' visual discrimination was assessed after exposure to different visual stimuli: achromatic, red, green, and blue, both at the monitor's maximum luminance and maintaining the same luminance value for the different visual stimuli. Monocular straylight was also measured for an achromatic, red, green, and blue stimuli. The blue stimulus had the greatest effect on halos in both monocular and binocular conditions. Visual discrimination was similar for the red, green, and achromatic stimuli, but worsened at lower luminance. The greatest influence of straylight was observed for the blue stimulus. In addition, visual discrimination correlated with straylight measurements for achromatic stimuli, wherein greater straylight values correlated with an increased perception of halos and other visual disturbances.
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Affiliation(s)
- José J Castro-Torres
- Laboratory of Vision Sciences and Applications, Department of Optics, University of Granada, 18071, Granada, Spain.
| | - Miriam Casares-López
- Laboratory of Vision Sciences and Applications, Department of Optics, University of Granada, 18071, Granada, Spain
| | - Sonia Ortiz-Peregrina
- Laboratory of Vision Sciences and Applications, Department of Optics, University of Granada, 18071, Granada, Spain
| | - Francesco Martino
- Laboratory of Vision Sciences and Applications, Department of Optics, University of Granada, 18071, Granada, Spain
| | - Luis Gómez-Robledo
- Basic and Applied Colorimetry Lab, Department of Optics, University of Granada, 18071, Granada, Spain
| | - José R Jiménez
- Laboratory of Vision Sciences and Applications, Department of Optics, University of Granada, 18071, Granada, Spain
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Martino F, Pereira-da-Mota AF, Amorim-de-Sousa A, Castro-Torres JJ, González-Méijome JM. Pupil size effect on binocular summation for visual acuity and light disturbance. Int Ophthalmol 2022:10.1007/s10792-022-02614-w. [DOI: 10.1007/s10792-022-02614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
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Pepose J, Brigell M, Lazar E, Heisel C, Yousif J, Rahmani K, Kolli A, Hwang M, Mitrano C, Lazar A, Charizanis K, Sooch M, McDonald M. A randomized phase 2 clinical trial of phentolamine mesylate eye drops in patients with severe night vision disturbances. BMC Ophthalmol 2022; 22:402. [PMID: 36209072 PMCID: PMC9548101 DOI: 10.1186/s12886-022-02621-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Dim light vision disturbances (DLD) comprise a wide range of symptoms affecting the quality of vision at low illumination including glare, halos, and starbursts. This exploratory study investigated 1.0% phentolamine mesylate ophthalmic solution (PMOS) as a treatment to improve vision and image quality for patients with DLD. METHODS In this placebo-controlled, randomized, double-masked clinical trial, 24 adult patients with severe DLD were randomized in a 2:1 ratio to receive either one dose of PMOS or placebo. Subjects were eligible if they reported experiencing severe night vision difficulty that was not eliminated by distance spectacle correction and scored ≥0.3 log units below the normal range of contrast sensitivity assessed under mesopic conditions with glare at ≥2 spatial frequencies. Key efficacy outcomes were change from baseline in pupil diameter, contrast sensitivity, and visual acuity. Safety measures including intraocular pressure, conjunctival hyperemia, and systemic effects were also assessed. RESULTS Eight subjects were randomized to placebo (63% female; mean age 47 years) and 16 were randomized to PMOS (75% female; mean age 42 years). Mean (SD) pupil diameter of PMOS-treated subjects decreased significantly - 1.3 mm (0 to - 2.8 mm) with p < 0.0001. Mean contrast sensitivity with glare in PMOS-treated subjects improved significantly post-treatment at spatial frequencies 3, 6, 12, and 18 cycles per degree (p ≤ 0.03). PMOS also demonstrated improvements in the numbers of letters read for mesopic and photopic, high- and low-contrast visual acuity (LCVA). Importantly, a statistically greater proportion of PMOS-treated eyes registered mesopic LCVA 5 letter (69% vs. 31%, p = 0.029) and 10 letter (34% vs. 6%, p = 0.04) improvement, with a trend at 15 letters (19% vs. 0%, p = 0.16). PMOS was well tolerated with the only reported side effect being a mild increase in conjunctival hyperemia. CONCLUSION PMOS was well tolerated and effectively reduced pupil size with improvements in contrast sensitivity and visual acuity in adults with severe DLD. Future Phase 3 studies should be conducted to further evaluate its potential to treat DLD. TRIAL REGISTRATION The trial registration number is NCT04004507 (02/07/2019). Retrospectively registered.
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Affiliation(s)
- Jay Pepose
- Pepose Vision Institute, St. Louis, MO, USA.,Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Mitchell Brigell
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | | | - Curtis Heisel
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Jonah Yousif
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Kavon Rahmani
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA.
| | - Ajay Kolli
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Min Hwang
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Cara Mitrano
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Audrey Lazar
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | | | - Mina Sooch
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Marguerite McDonald
- Department of Ophthalmology, New York University Langone Medical Center, New York, NY, USA
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Barbero S, Bradley A, López-Gil N, Rubinstein J, Thibos L. Catastrophe optics theory unveils the localised wave aberration features that generate ghost images. Ophthalmic Physiol Opt 2022; 42:1074-1091. [PMID: 35620968 PMCID: PMC9543491 DOI: 10.1111/opo.13008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 12/19/2022]
Abstract
Monocular polyplopia (ghost or multiple images) is a serious visual impediment for some people who report seeing two (diplopia), three (triplopia) or even more images. Polyplopia is expected to appear if the point spread function (PSF) has multiple intensity cores (a dense concentration of a large portion of the radiant flux contained in the PSF) relatively separated from each other, each of which contributes to a distinct image. We present a theory that assigns these multiple PSF cores to specific features of aberrated wavefronts, thereby accounting optically for the perceptual phenomenon of monocular polyplopia. The theory provides two major conclusions. First, the most likely event giving rise to multiple PSF cores is the presence of hyperbolic, or less probably elliptical, umbilic caustics (using the terminology of catastrophe optics). Second, those umbilic caustics formed on the retinal surface are associated with certain points of the wave aberration function, called cusps of Gauss, where the gradient of a curvature function vanishes. However, not all cusps of Gauss generate those umbilic caustics. We also provide necessary conditions for those cusps of Gauss to be fertile. To show the potential of this theoretical framework for understanding the nature and origin of polyplopia, we provide specific examples of ocular wave aberration functions that induce diplopia and triplopia. The polyplopia effects in these examples are illustrated by depicting the multi-core PSFs and the convolved retinal images for clinical letter charts, both through computer simulations and through experimental recording using an adaptive optics set-up. The number and location of cores in the PSF is thus a potentially useful metric for the existence and severity of polyplopia in spatial vision. These examples also help explain why physiological pupil constriction might reduce the incidence of ghosting and multiple images of daily objects that affect vision with dilated pupils. This mechanistic explanation suggests a possible role for optical phase-masking as a clinical treatment for polyplopia and ghosting.
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Affiliation(s)
| | - Arthur Bradley
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Norberto López-Gil
- Instituto Universitario de Investigación en Envejecimiento, Universidad de Murcia, Murcia, Spain
| | | | - Larry Thibos
- School of Optometry, Indiana University, Bloomington, Indiana, USA
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Xu R, Gil D, Dibas M, Rickert M, Meyer D, Perron L, Kollbaum P, Bradley A. Time-course of the visual Impact on presbyopes of a low dose miotic. Ophthalmic Physiol Opt 2020; 41:73-83. [PMID: 33150654 DOI: 10.1111/opo.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/05/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the pupil and visual impact of a single early morning drop of a low concentration miotic. METHODS Pupil size, refraction, visual acuity (VA), near reading performance and intraocular pressure were monitored for 8 h at a wide range of light levels following bilateral instillation of single drops of 0.1% brimonidine tartate in 19 early presbyopes (40-50 years) and 11 mature presbyopes (>50 years). RESULTS Pupil miosis did not alter distance VA or refraction. Significant pupil miosis peaked at 1-2 h after dosing, which expanded the depth of focus of mature presbyopes with the mean improvement in near logMAR VA of -0.15, -0.07 and -0.03, at 20, 200 and 2000 lux, respectively. One hour after instillation, near reading speed improved by 21, 24 and 5 words per min for text size commonly seen in US newspaper and cellphone text messages, 18, 21 and 19 words per min for text size of grocery labels and 12, 13 and 30 words per min for text size of over-the-counter medications at light levels of 20, 200 and 2000 lux, respectively. No such improvements in near VA and near reading speed were observed in the young presbyopes having some residual accommodation. Most of the pupil miosis remained 8 h after instillation, whereas near VA improvements disappeared after 4 h. CONCLUSION Low dose miotics can enhance near vision in presbyopic subjects while retaining high quality distance vision over a wide range of light levels. Significant improvements in near vision were observed only during the 1-2 h period after dosing when miosis peaked.
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Affiliation(s)
- Renfeng Xu
- Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, USA
| | | | | | - Martin Rickert
- School of Optometry, Indiana University, Bloomington, USA
| | - Dawn Meyer
- School of Optometry, Indiana University, Bloomington, USA
| | - Laura Perron
- School of Optometry, Indiana University, Bloomington, USA
| | - Pete Kollbaum
- School of Optometry, Indiana University, Bloomington, USA
| | - Arthur Bradley
- School of Optometry, Indiana University, Bloomington, USA
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Macedo-de-Araújo RJ, Faria-Ribeiro M, McAlinden C, van der Worp E, González-Méijome JM. Optical Quality and Visual Performance for One Year in a Sample of Scleral Lens Wearers. Optom Vis Sci 2020; 97:775-789. [DOI: 10.1097/opx.0000000000001570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Thibos LN. Calculation of the geometrical point-spread function from wavefront aberrations. Ophthalmic Physiol Opt 2019; 39:232-244. [PMID: 31172533 DOI: 10.1111/opo.12619] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/10/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE This report uses the principles of geometrical optics to compute the optical point-spread function (PSF) from the wavefront error function. METHOD Step 1 uses Prentice's rule to determine the spatial form of the PSF established by tracing a field of rays from the eye's exit pupil to the retina. Ray vergence is related to the slope of the wavefront error function, which enables the mapping of light rays to produce a retinal 'spot diagram'. Step 2 completes the PSF by assigning an irradiance value to each ray in the spot diagram. RESULTS AND CONCLUSIONS Spot irradiance is inversely proportional to the Gaussian curvature (i.e. the product of principal curvatures) of each local region of wavefront error surface centered on the corresponding ray. The Gaussian curvature, in turn, may be computed as the determinant of the vergence error matrix associated with each point on the wavefront error surface. Elements of the vergence error matrix consist of sums and differences of the local power vector components M, J0 and J45 . This method is shown to be equivalent to published derivations of the geometric PSF using the Jacobian of the ray mapping function and equivalent also to the Hessian of the wavefront error function. Examples are presented for the familiar cases of spherical and astigmatic blur as well as for higher order aberrations and the formation of caustics in the retinal image.
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Affiliation(s)
- Larry N Thibos
- School of Optometry, Indiana University, Bloomington, USA
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Rubinstein J. On the geometry of visual starbursts. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2019; 36:B58-B64. [PMID: 31044956 DOI: 10.1364/josaa.36.000b58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
The patterns observed by people when they look at stars are collectively called starbursts. Similar patterns are observed when viewing any distant object with sufficiently large pupils. We show here that starbursts are mainly curved, formed by the intersections of caustic surfaces, and associated with a wavefront emitted by a far object, with the retina. In particular, we derive the equations governing these caustic curves, present a few properties of their solutions, and compare the solutions with recent clinical observations. We further classify the starbursts into primary (the caustic curves themselves) and secondary (the diffraction patterns near the caustics).
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Xu R, Thibos LN, Lopez-Gil N, Kollbaum P, Bradley A. Psychophysical study of the optical origin of starbursts. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2019; 36:B97-B102. [PMID: 31044967 DOI: 10.1364/josaa.36.000b97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/14/2019] [Indexed: 06/09/2023]
Abstract
Starbursts seen around small bright lights at night have been attributed to optical scatter, diffraction, or aberrations. We manipulated pupil aperture and aberrations to investigate the entopic appearance of perceived starbursts. The impact of circular, annular, and wedge-shaped pupil apertures, and spherical aberration sign and magnitude were used to identify pupil sub-apertures responsible for each radial perceived starburst line. Local intensity distributions within the starbursts mapped onto unique sub-regions of the pupil of both phakic and pseudophakic eyes, consistent with the hypothesis that ocular aberrations are the cause of starbursts. In paraxially focused eyes, the size of starbursts is predicted by the amount of spherical aberration, and starburst orientation is either the same or 180 deg rotated from the pupil region that creates each starburst line. No starbursts are seen when the pupil diameter is smaller than 3 mm. Replacing the eye's natural lens with a radially symmetric and optically homogeneous intraocular lens reduced the observed number of starbursts by 50%. Geometrical optics modeling including the measured aberrations of an individual eye can reveal point spread function structure that captures some of the key elements of the entopic perceptions.
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Marín-Franch I, Xu R, Bradley A, Thibos LN, López-Gil N. The effect of spherical aberration on visual performance and refractive state for stimuli and tasks typical of night viewing. JOURNAL OF OPTOMETRY 2018; 11:144-152. [PMID: 29292240 PMCID: PMC6039613 DOI: 10.1016/j.optom.2017.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The aim of this work was to examine the impact of Seidel spherical aberration (SA) on optimum refractive state for detecting and discriminating small bright lights on a dark background. METHODS An adaptive-optics system was used to correct ocular aberrations of cyclopleged eyes and then systematically introduce five levels of Seidel SA for a 7-mm diameter pupil: 0,±0.18, and±0.36diopters (D)mm-2. For each level of SA, subjects were required to detect one or resolve two points of light (0.54 arc min diameter) on a dark background. Refractive error was measured by adjusting stimulus vergence to minimize detection and resolution thresholds. Two other novel focusing tasks for single points of light required maximizing the perceived intensity of a bright point's core and minimizing its overall perceived size (i.e. minimize starburst artifacts). Except for the detection task, luminance of the point of light was 1000cdm-2 on a black background lower than 0.5cdm-2. RESULTS Positive SA introduced myopic shifts relative to the best subjective focus for dark letters on a bright background when there was no SA, whereas negative SA introduced hyperopic shifts in optimal focus. The changes in optimal focus were -1.7, -2.4, -2.0, and -9.2D of focus per Dmm-2 of SA for the detection task, resolution task, and maximization of core's intensity and minimization of size, respectively. CONCLUSION Ocular SA can be a significant contributor to changes in refractive state when viewing high-contrast point sources typically encountered in nighttime environments.
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Affiliation(s)
- Iván Marín-Franch
- Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Instituto Universitario de Investigación en Envejecimiento, Universidad de Murcia, 30100 Murcia, Spain.
| | - Renfeng Xu
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Arthur Bradley
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Larry N Thibos
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Norberto López-Gil
- Instituto Universitario de Investigación en Envejecimiento, Universidad de Murcia, 30100 Murcia, Spain
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