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Davies LN, Biswas S, Bullimore M, Cruickshank F, Estevez JJ, Khanal S, Kollbaum P, Marcotte-Collard R, Montani G, Plainis S, Richdale K, Simard P, Wolffsohn JS. BCLA CLEAR presbyopia: Mechanism and optics. Cont Lens Anterior Eye 2024; 47:102185. [PMID: 38796331 DOI: 10.1016/j.clae.2024.102185] [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: 05/28/2024]
Abstract
With over a billion adults worldwide currently affected, presbyopia remains a ubiquitous, global problem. Despite over a century of study, the precise mechanism of ocular accommodation and presbyopia progression remains a topic of debate. Accordingly, this narrative review outlines the lenticular and extralenticular components of accommodation together with the impact of age on the accommodative apparatus, neural control of accommodation, models of accommodation, the impact of presbyopia on retinal image quality, and both historic and contemporary theories of presbyopia.
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Affiliation(s)
- Leon N Davies
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK.
| | - Sayantan Biswas
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | | | - Fiona Cruickshank
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Jose J Estevez
- Caring Futures Institute, College of Nursing and Health Sciences, Optometry and Vision Science, Flinders University, Adelaide, Australia; Flinders Centre for Ophthalmology, Eye and Vision Research, Department of Ophthalmology, Flinders University, Adelaide, Australia
| | - Safal Khanal
- Department of Optometry and Vision Science, The University of Alabama at Birmingham, USA
| | | | | | | | - Sotiris Plainis
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK; Laboratory of Optics and Vision, School of Medicine, University of Crete, Greece
| | | | - Patrick Simard
- School of Optometry, Universite de Montreal, Montreal, Quebec, Canada
| | - James S Wolffsohn
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
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Croft MA, Mcdonald JP, Kiland J, Mattison JA, Roth GS, Ingram D, Kaufman PL. Sex as a risk factor regarding presbyopia in the rhesus monkey. PLoS One 2024; 19:e0300476. [PMID: 38635668 PMCID: PMC11025728 DOI: 10.1371/journal.pone.0300476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/11/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE To determine the effect of sex as a risk factor regarding presbyopia. METHODS Maximum accommodation was pharmacologically induced (40% cabachol corneal iontophoresis) in 97 rhesus monkeys (49 males and 48 females) ranging in age from 8 to 36 years old. Accommodation was measured by Hartinger coincidence refractometry. RESULTS Accommodative amplitude measured refractometrically decreased with age, and the rate of change was not different between males and females (p = 0.827). CONCLUSIONS Presbyopia is essentially sex neutral, and no one is spared. There may be modest variations between different populations for various reasons, but essentially it is monotonously predictable. At present there is no biological therapeutic.
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Affiliation(s)
- Mary Ann Croft
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Jared P. Mcdonald
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Julie Kiland
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Julie A. Mattison
- Translational Gerontology Branch, National Institute on Aging, NIH, Dickerson, MD, United States of America
| | - George S. Roth
- GeroScience Inc. and Prolongevity Technologies LLC, Pylesville, MD, United States of America
| | - Don Ingram
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States of America
| | - Paul L. Kaufman
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States of America
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, United States of America
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Rich W, Pan M, Liu J, Swindle-Reilly KE, Reilly MA. A method for generating zonular tension in the murine eye by embedding and compressing the globe in a hydrogel. Exp Eye Res 2024; 240:109809. [PMID: 38311284 DOI: 10.1016/j.exer.2024.109809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/08/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
The ocular lens is the primary organ within the eye responsible for accommodation. During accommodation, the lens is subject to biomechanical forces. We previously demonstrated that stretching the porcine lens can increase lens epithelial cell proliferation. Although murine lenses are commonly employed in lens research, murine lens stretching has remained unexplored. Murine lens stretching thus represents a novel source of potential discovery in lens research. In the present study, we describe a method for stretching the murine lens by compressing the murine globe embedded in a hydrogel. We hypothesized that, as the eye is compressed along the optic axis, the lens would stretch through zonular tension due to the equatorial region of the eye bulging outward. Our results showed that this led to a compression-dependent increase in murine lens epithelial cell proliferation, suggesting that compression of the embedded murine globe is a viable technique for studying the mechanobiology of the lens epithelium.
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Affiliation(s)
- Wade Rich
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Manqi Pan
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Jun Liu
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Ophthalmology and Visual Sciences, The Ohio State University, Columbus, OH, USA
| | - Katelyn E Swindle-Reilly
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Ophthalmology and Visual Sciences, The Ohio State University, Columbus, OH, USA; William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH, USA
| | - Matthew A Reilly
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Ophthalmology and Visual Sciences, The Ohio State University, Columbus, OH, USA.
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Liang Z, Yang K, Lv K, Ma Y, Chen X, Ren Z, Liang Y, Hou X, Wu H. Direct observation and measurement of circumlental space and its relation to anterior chamber angle characteristics in iridotomized phakic eyes with primary angle closure disease. Sci Rep 2024; 14:3881. [PMID: 38365883 PMCID: PMC10873345 DOI: 10.1038/s41598-024-54562-3] [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: 02/12/2023] [Accepted: 02/14/2024] [Indexed: 02/18/2024] Open
Abstract
Primary angle closure disease (PACD) is a major cause of blindness worldwide. It has a high prevalence in East Asia, especially in China, which leads to a higher incidence of blindness than open-angle glaucoma. The aim of this study was to directly observe the circumlental space (CLS) in laser peripheral iridotomized eyes with PACD and to determine whether this structure plays a role in the pathogenesis of PACD. Fifty eyes of 50 patients with PACD, who had received laser peripheral iridotomy performed with neodymium:yttrium-aluminum-garnet were recruited from glaucoma clinics from March 2021 to May 2022, including 17 primary angle closure suspect (PACS), 16 primary angle closure (PAC) and 17 primary angle closure glaucoma (PACG). They were classified into two groups based on whether the ciliary process and the crystalline lens equator were in contact using slit-lamp photograph: the attached group and the unattached group. The demographic, clinical characteristics and anterior segment parameters measured from ultrasound biomicroscopy were compared between the attached group and the unattached group. Thirty-three eyes were assigned to the attached group and 17 eyes belonged to the unattached group. In the unattached group, the mean CLS was 0.10 ± 0.07 mm. No significant differences were identified between the different diagnosis groups in age, sex, best-corrected visual acuity, intraocular pressure, white-to-white, axial length, central corneal thickness, anterior chamber depth, flat keratometry, steep keratometry or iridotomy diameter (p > 0.05). The unattached group had shorter trabecular-ciliary process distance (p = 0.021) and larger ciliary process area (p = 0.001) compared with the attached group. Small CLS and its potential effect (partial ciliary block) might be considered as one of the mechanisms of PACD.
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Affiliation(s)
- Zhiqiao Liang
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Kangyi Yang
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Kun Lv
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yao Ma
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xuanzhu Chen
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Zeqin Ren
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yong Liang
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xianru Hou
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Huijuan Wu
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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Knaus KR, Hipsley A, Blemker SS. A new look at an old problem: 3D modeling of accommodation reveals how age-related biomechanical changes contribute to dysfunction in presbyopia. Biomech Model Mechanobiol 2024; 23:193-205. [PMID: 37733144 DOI: 10.1007/s10237-023-01767-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/17/2023] [Indexed: 09/22/2023]
Abstract
Presbyopia is an age-related ocular disorder where accommodative ability declines so that an individual's focusing range is insufficient to provide visual clarity for near and distance vision tasks without corrective measures. With age, the eye exhibits changes in biomechanical properties of many components involved in accommodation, including the lens, sclera, and ciliary muscle. Changes occur at different rates, affecting accommodative biomechanics differently, but individual contributions to presbyopia are unknown. We used a finite element model (FEM) of the accommodative mechanism to simulate age-related changes in lens stiffness, scleral stiffness, and ciliary contraction to predict differences in accommodative function. The FEM predicts how ciliary muscle action leads to lens displacement by initializing a tensioned unaccommodated lens (Phase 0) then simulating ciliary muscle contraction in accommodation (Phase 1). Model inputs were calibrated to replicate experimentally measured lens and ciliary muscle in 30-year-old eyes. Predictions of accommodative lens deformation were verified with additional imaging studies. Model variations were created with altered lens component stiffnesses, scleral stiffness, or ciliary muscle section activations, representing fifteen-year incremental age-related changes. Model variations predict significant changes in accommodative function with age-related biomechanical property changes. Lens changes only significantly altered lens thickening with advanced age (46% decrease at 75 years old) while sclera changes produced progressive dysfunction with increasing age (23%, 36%, 49% decrease at 45, 60, and 75 years old). Ciliary muscle changes effected lens position modulation. Model predictions identified potential mechanisms of presbyopia that likely work in combination to reduce accommodative function and could indicate effectiveness of treatment strategies and their dependency on patient age or relative ocular mechanical properties.
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Affiliation(s)
- Katherine R Knaus
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | | | - Silvia S Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
- Department of Ophthalmology, University of Virginia, 415 Lane Road, MR5 Room 2133, Box 800759, Charlottesville, VA, USA.
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Jonas JB, Jonas RA, Jonas SB, Panda-Jonas S. Bruch's membrane and Brücke's muscle in the pars plana region. Acta Ophthalmol 2024; 102:e53-e59. [PMID: 38185862 DOI: 10.1111/aos.15678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/13/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE To examine Bruch's membrane (BM) in association with the longitudinal part of the ciliary muscle (LPCM) in the pars plana region. METHODS Using light microscopy, we histomorphometrically assessed BM and the LPCM in the pars plana region. RESULTS The histomorphometric study included 51 eyes (51 patients; mean age: 60.8 ± 15.0 years; axial length: 26.0 ± 3.3 mm; range: 21.0-36.0 mm). The LPCM (total length: 4.60 ± 1.10 mm) ended 1.15 ± 0.56 mm anterior to the ora serrata. Within the pars plana region, the LPCM (length: 2.58 ± 0.98 mm) had direct contact with BM for 1.95 ± 0.99 mm (71.1 ± 18.4% of the BM undersurface), while a capillary layer was interposed between the BM and the LPCM for 0.70 ± 0.40 mm (29.0 ± 18.4%). In the pars plana region free of LPCM close to the ora serrata, the percentage of BM covered by the capillary layer was higher than in the pars plana region containing the LPCM (63.0 ± 42.1% vs. 29.0 ± 18.4%; p < 0.001). At the LPCM end, BM was in direct contact with a collagenous tissue from the LPCM and was focally thickened as compared to BM with an underlying capillary layer (9.5 ± 5.3 μm vs. 4.3 ± 1.2 μm; p < 0.001). CONCLUSIONS The direct contact of BM with the LPCM in the pars plana in association with focal BM thickening at the LPCM end suggests an insertion of LPCM on the BM. Taking into account the biomechanical strength of BM, it may imply a functional unit of the LPCM with BM in the process of accommodation with a secondary movement of the posterior BM and tertiary thickening of the subfoveal choroidal space.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Rahul A Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Shefali B Jonas
- Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
| | - Songhomitra Panda-Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
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Pu Y, Liu Z, Ye L, Xia Y, Chen X, Wang K, Pierscionek BK. The major influence of anterior and equatorial zonular fibres on the far-to-near accommodation revealed by a 3D pre-stressed model of the anterior eye. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 242:107815. [PMID: 37729794 DOI: 10.1016/j.cmpb.2023.107815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/09/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE To explore the synergistic function of the ligaments in eye, the zonular fibres, that mediate change in eye lens shape to allow for focussing over different distances. METHODS A set of 3D Finite Element models of the anterior eye together with a custom developed pre-stress modelling approach was proposed to simulate vision for distant objects (the unaccommodated state) to vision for near objects (accommodation). One of the five zonular groups was cut off in sequence creating five models with different zonular arrangements, the contribution of each zonular group was analysed by comparing results of each specific zonular-cut model with those from the all-zonules model in terms of lens shape and zonular tensions. RESULTS In the all-zonular model, the anterior and equatorial zonules carry the highest tensions. In the anterior zonular-cut model, the equatorial zonular tension increases while the posterior zonular tension decreases, resulting in an increase in the change in Central Optical Power (COP). In the equatorial zonular-cut model, both the anterior and posterior zonular tensions increase, causing a decreasing change in COP. The change in COP decreases only slightly in the other models. For vitreous zonular-cut models, little change was seen in either the zonular tension or the change in COP. CONCLUSIONS The anterior and the equatorial zonular fibres have the major influence on the change in lens optical power, with the anterior zonules having a negative effect and the equatorial zonules contributing a positive effect. The contribution to variations in optical power by the equatorial zonules is much larger than by the posterior zonules.
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Affiliation(s)
- Yutian Pu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry for Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine and School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ziyuan Liu
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Lin Ye
- Faculty of Health, Education, Medicine and Social Care, Medical Technology Research Centre, Anglia Ruskin University, Bishops Hall Lane, Chelmsford, United Kingdom
| | - Yunxin Xia
- Key Laboratory for Biomechanics and Mechanobiology of Ministry for Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine and School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaoyong Chen
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Kehao Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry for Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine and School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
| | - Barbara K Pierscionek
- Faculty of Health, Education, Medicine and Social Care, Medical Technology Research Centre, Anglia Ruskin University, Bishops Hall Lane, Chelmsford, United Kingdom
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Yang H, Qian D, Chan G, Wang J, Sun X, Chen Y. Influence of miosis and laser peripheral iridotomy on intraocular lens power calculation in patients with primary angle closure disease. Eye (Lond) 2023; 37:2744-2752. [PMID: 36707639 PMCID: PMC10482892 DOI: 10.1038/s41433-023-02408-z] [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: 08/07/2022] [Revised: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To evaluate the effect of miosis and laser peripheral iridotomy (LPI) on intraocular lens (IOL) power prediction and ocular biometry in eyes with primary angle closure disease (PACD). METHODS In this prospective observational study, primary angle closure suspects (PACS), and subjects classified with primary angle closure (PAC)/primary angle-closure glaucoma (PACG) undergoing LPI were enrolled. Ocular biometric parameters were measured with IOLMaster700 at baseline (T0), one week after pilocarpine instillation (T1), and another week post LPI (T2). Biometric changes and the IOL power predicted for emmetropia using Barrett Universal II, Haigis, Holladay2, Hoffer Q and SRK/T formulae were analysed and compared among different time points. RESULTS 100 eyes of 50 PACS and 50 PAC/PACG patients were enrolled. Following pilocarpine-induced miosis, lens thickness (LT) increased and anterior chamber depth (ACD) decreased (all groups p < 0.01), while white-to-white diameter decreased and central corneal thickness increased significantly only in the PACS cohort (both p < 0.01). Compared to baseline, LPI induced an increase of ACD and a slight decrease of LT in PACS (both p < 0.01), whereas only axial length changed significantly (p = 0.012) in the PAC/PACG cohort. Regardless of the formula used, no significant difference to the predicted IOL power for emmetropia existed among the three time points in each group (all p > 0.1). CONCLUSION We report the changes of anterior segment parameters induced by miosis and LPI in PACD. These interventions do not significantly affect the IOL power calculation predicted for emmetropia in Chinese eyes when common third-, fourth-and new generation IOL formulae are used.
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Affiliation(s)
- Hongfang Yang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Dongjin Qian
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Geoffrey Chan
- Lions Eye Institute, University of Western Australia, Perth, WA, Australia
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia
| | - Jiajian Wang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China.
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China.
| | - Yuhong Chen
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China.
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Gao R, Liu J, Zhou X, Huang L, Huang W, Xue Y, Wang F, Gong S, Wu R, Wang Y. Influence of Pilocarpine Eyedrops on the Ocular Biometric Parameters and Intraocular Lens Power Calculation. J Ophthalmol 2023; 2023:7680659. [PMID: 37455794 PMCID: PMC10348856 DOI: 10.1155/2023/7680659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To evaluate the influence of pilocarpine eyedrops on the ocular biometric parameters and whether these parameter changes affect the intraocular lens (IOL) power calculation in patients with primary angle-closure glaucoma (PACG). Methods Twenty-two PACG patients and fifteen normal subjects were enrolled. Ocular biometric parameters including the axial length (AL), anterior chamber depth (ACD), lens thickness (LT), mean keratometry (Km), and white-to-white distance (WTW) were measured by using a Lenstar LS 900 device before and at least 30 minutes after instillation of 2% pilocarpine eyedrops. Lens position (LP) was calculated, and the IOL power prediction based on the ocular biometric parameters was performed using the Barrett Universal II, Haigis, Hoffer Q, Holladay I, or SRK/T formulas before and after pilocarpine application. Results In both PACG and normal groups, pilocarpine eyedrops induced a slight but statistically significant increase in the mean AL (0.01 mm for both groups) and mean LT (0.02 mm and 0.03 mm, respectively) but a significant decrease in the mean ACD (0.03 mm and 0.05 mm, respectively) and mean LP (0.02 mm and 0.04 mm, respectively). No significant changes in the mean Km and WTW were noticed in both groups. In addition, the IOL power calculation revealed insignificant changes before and after the pilocarpine instillation in both groups, regardless of the formula used. Conclusions Pilocarpine eyedrops can induce slight changes in the ocular biometric parameters including the AL, ACD, LT, and LP. However, these parameter changes will not result in a significant difference in IOL power estimation.
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Affiliation(s)
- Ruxin Gao
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Jinkun Liu
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Xiaojie Zhou
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Luping Huang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Weiyi Huang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Yingying Xue
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Fei Wang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Songjian Gong
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Renyi Wu
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Yuhong Wang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
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10
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Cabeza-Gil I, Fabrice M, Begoña C, Marco R. Quantification of scleral changes during dynamic accommodation. Exp Eye Res 2023; 230:109441. [PMID: 36958428 DOI: 10.1016/j.exer.2023.109441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/11/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
The mechanics of accommodation is a complex process that involves multiple intraocular ocular structures. Recent studies suggest that there is deformation of the sclera during accommodation that may also play a role in accommodation, influencing ciliary muscle contraction and contributing to the accommodative response. However, the type and magnitude of the deformations measured varies significantly across studies. We present high-resolution synchronous OCT measurements of the anterior sclera contour and thickness and lens thickness acquired in real-time during accommodative responses to 4D step stimuli. The lens thickness was used as an assessment of objective accommodation. No changes in nasal and temporal anterior scleral contour and scleral thickness were found during accommodation within the precision of our measurements. Our results demonstrate that there are no significant scleral deformations during accommodation.
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Affiliation(s)
- Iulen Cabeza-Gil
- Aragón Institute of Engineering Research (i3A), University of Zaragoza, Spain.
| | - Manns Fabrice
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Calvo Begoña
- Aragón Institute of Engineering Research (i3A), University of Zaragoza, Spain; Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre (CIBER-BBN), Zaragoza, Spain
| | - Ruggeri Marco
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA.
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11
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Lv K, Liang Z, Yang K, Chen X, Ma Y, Wu H. Novel Discoveries of the Relationship Between the Vitreous Zonule and the Anterior Segment Characteristics in Eyes With Primary Angle-Closure Disease. Invest Ophthalmol Vis Sci 2022; 63:16. [PMID: 36520454 PMCID: PMC9769030 DOI: 10.1167/iovs.63.13.16] [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] [Indexed: 12/23/2022] Open
Abstract
Purpose To investigate the presence of the vitreous zonule (VZ) in different subtypes of primary angle-closure disease (PACD) and to explore the relationship between VZ and anterior chamber angle characteristics. Methods Patients with clinical diagnoses of acute primary angle-closure (PAC)/PAC glaucoma (APAC[G]) or chronic PAC/PAC glaucoma (CPAC[G]) and healthy subjects were enrolled. A total of 300 eyes of 180 subjects were included. Anterior segment parameters and the presence of the VZ were assessed by ultrasound biomicroscopy. The presence of VZ was compared among different subtypes of PACD. Anterior segment parameters were compared between eyes in vitreous zonule group (VZG) and no vitreous zonule group (NVZG). Logistic regression analysis was conducted to identify factors associated with the presence of VZ. Results APAC(G) eyes had lower VZ presence compared to the fellow eyes of APAC(G) (P < 0.001). VZ was more likely to be seen in the eyes of healthy subjects and PAC suspect than in the eyes of PAC and PAC glaucoma (PACG) (P < 0.05). NVZG had shorter angle opening distance 500/750 (P < 0.001), smaller trabecular iris angle 500/750 (P < 0.001), smaller trabecular-iris space area 500/750 (P < 0.001), smaller trabecular-ciliary angle (P = 0.009), smaller iris area (P = 0.010), and greater lens vault (P = 0.004) compared to VZG. Greater lens vault (LV) was independently associated with absence of VZ (odds ratio = 0.253; 95% confidence interval, 0.109-0.586; P = 0.001). Conclusions VZ was less likely to be observed in PAC/PACG eyes. PACD eyes with less VZ had narrower angle, more anteriorly rotated ciliary body, and greater LV.
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Affiliation(s)
- Kun Lv
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Zhiqiao Liang
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Kangyi Yang
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Xuanzhu Chen
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yao Ma
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Huijuan Wu
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
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12
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Crooke A, Martínez-Alberquilla I, Madrid-Costa D, Ruiz-Alcocer J. Presbyopia: An outstanding and global opportunity for early detection of pre-frailty and frailty states. Front Med (Lausanne) 2022; 9:968262. [PMID: 36267611 PMCID: PMC9576860 DOI: 10.3389/fmed.2022.968262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Almudena Crooke
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain,Clinical and Experimental Eye Research Group, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain,*Correspondence: Almudena Crooke
| | - Irene Martínez-Alberquilla
- Clinical and Experimental Eye Research Group, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain,Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - David Madrid-Costa
- Clinical and Experimental Eye Research Group, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain,Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Ruiz-Alcocer
- Clinical and Experimental Eye Research Group, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain,Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
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13
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Croft MA, Peterson J, Smith C, Kiland J, Nork TM, Mcdonald JP, Katz A, Hetzel S, Lütjen-Drecoll E, Kaufman PL. Accommodative movements of the choroid in the optic nerve head region of human eyes, and their relationship to the lens. Exp Eye Res 2022; 222:109124. [PMID: 35688214 PMCID: PMC9783760 DOI: 10.1016/j.exer.2022.109124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 04/30/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022]
Abstract
The ciliary muscle (CM) powers the accommodative response, and during accommodation the CM pulls the choroid forward in the region of the ora serrata. Our goal was to elucidate the accommodative movements of the choroid in the optic nerve region in humans and to determine whether these movements are related to changes in the lens dimensions that occur with aging, in the unaccommodated and accommodated state. Both eyes of 12 human subjects (aged 18-51 yrs) were studied. Homatropine (1 drop/5%) was used to relax the ciliary muscle (unaccommodated or "resting" eye) and pilocarpine was used to induce the maximum accommodative response (2 drops/4%) (accommodated eye). Images of the fundus and choroid were collected in the region of the optic nerve (ON) via Spectralis OCT (infrared and EDI mode), and choroidal thickness was determined. Ultrasound biomicroscopy (UBM; 50 MHz, 35 MHz) images were collected in the region of the lens/capsule and ciliary body. OCT and UBM images were collected in the resting and accommodated state. The unaccommodated choroidal thickness declined significantly with age (p = 0.0073, r = 0.73) over the entire age range of the subjects studied (18-51 years old). The choroidal thickness was significantly negatively correlated with lens thickness in the accommodated (p = 0.01) and the unaccommodated states (p = 0.005); the thicker the lens the thinner the choroid. Choroid movements around the optic nerve during accommodation were statistically significant; during accommodation the choroid both thinned and moved centrifugally (outward/away from the optic nerve head). The accommodative choroid movements did not decline significantly with age and were not correlated with accommodative amplitude. Measurement of the choroidal thickness is possible with the Spectralis OCT instrument using EDI mode and can be used to determine the accommodative changes in choroidal thickness. The choroidal thickness decreased with age and during accommodation. It may be that age-related choroidal thinning is due to changes in the geometry of the accommodative apparatus to which it is attached (i.e., ciliary muscle/lens complex) such that when the lens is thicker, the choroid is thinner. Accommodative decrease in choroidal thickness and stretch of the retina/choroid may indicate stress/strain forces in the region of the optic nerve during accommodation and may have implications for glaucoma.
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Affiliation(s)
- Mary Ann Croft
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53792, USA.
| | - John Peterson
- Diagnostic Imaging Services Lead, UCSF Health, Wayne and Gladys Valley Center for Vision, 490 Illinois St., San Francisco, CA, 94158, USA
| | - Christopher Smith
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53792, USA
| | - Julie Kiland
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53792, USA
| | - T Michael Nork
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53792, USA
| | - Jared P Mcdonald
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53792, USA
| | - Alexander Katz
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53792, USA
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, USA
| | | | - Paul L Kaufman
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53792, USA; Wisconsin National Primate Research Center, USA
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14
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Croft MA, Nork TM, Heatley G, Mcdonald JP, Katz A, Kaufman PL. Intraocular accommodative movements in monkeys; relationship to presbyopia. Exp Eye Res 2022; 222:109029. [PMID: 35283107 PMCID: PMC9749451 DOI: 10.1016/j.exer.2022.109029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/21/2022] [Accepted: 03/06/2022] [Indexed: 12/16/2022]
Abstract
Our goal was to quantify the age-related changes in the dynamic accommodative movements of the vitreous and aqueous humor in iridic, aniridic, phakic and aphakic primate eyes. Six bilaterally iridic and four bilaterally iridectomized rhesus monkeys, ranging in age from 6 to 25 years, received a stimulating electrode in the midbrain Edinger-Westphal nucleus to induce accommodation, measured by a Hartinger coincidence refractometer. One of the four iridectomized monkeys underwent unilateral extracapsular and another monkey underwent intracapsular lens extraction. Eyes were imaged utilizing specialized techniques and contrast agents to resolve intraocular structures. During accommodation the anterior hyaloid membrane and the posterior lens capsule bowed backward. Central vitreous fluid and structures/strands moved posteriorly toward the optic nerve region as peripheral vitreous, attached to the vitreous zonule, was pulled forward by ciliary muscle contraction. Triamcinolone particles injected intravitreally were also observed in the anterior chamber and moved from the anterior chamber toward the cleft of the anterior hyaloid membrane and then further posteriorly into the vitreous-filled cleft between the vitreous zonule and the ciliary body pars plana. These accommodative movements occurred in all eyes, and declined with age. There are statistically significant accommodative movements of various intravitreal structures. The posterior/anterior fluid flow between the anterior chamber and the vitreous compartments during accommodation/disaccommodation represents fluid displacement to allow/facilitate lens thickening. The posterior accommodative movement of central vitreous fluid may result from centripetal compression of the anterior tips of the cistern-like structure attached to the vitreous zonule, and posterior displacement of the central trunk of the cistern during ciliary muscle contraction and centripetal muscle movement. The findings may have implications for presbyopia.
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Affiliation(s)
- Mary Ann Croft
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA.
| | - T Michael Nork
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA
| | - Gregg Heatley
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA
| | - Jared P Mcdonald
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA
| | - Alexander Katz
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA
| | - Paul L Kaufman
- Department of Ophthalmology and Visual Sciences, Madison, WI, 53792, USA; Wisconsin National Primate Research Center, Madison, WI, 53792, USA; McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, 53792, USA
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15
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Cabeza-Gil I, Ruggeri M, Chang YC, Calvo B, Manns F. Automated segmentation of the ciliary muscle in OCT images using fully convolutional networks. BIOMEDICAL OPTICS EXPRESS 2022; 13:2810-2823. [PMID: 35774316 PMCID: PMC9203087 DOI: 10.1364/boe.455661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
Quantifying shape changes in the ciliary muscle during accommodation is essential in understanding the potential role of the ciliary muscle in presbyopia. The ciliary muscle can be imaged in-vivo using OCT but quantifying the ciliary muscle shape from these images has been challenging both due to the low contrast of the images at the apex of the ciliary muscle and the tedious work of segmenting the ciliary muscle shape. We present an automatic-segmentation tool for OCT images of the ciliary muscle using fully convolutional networks. A study using a dataset of 1,039 images shows that the trained fully convolutional network can successfully segment ciliary muscle images and quantify ciliary muscle thickness changes during accommodation. The study also shows that EfficientNet outperforms other current backbones of the literature.
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Affiliation(s)
- Iulen Cabeza-Gil
- Aragón Institute of Engineering Research (i3A), University of Zaragoza, Zaragoza, Spain
| | - Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Yu-Cherng Chang
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Begoña Calvo
- Aragón Institute of Engineering Research (i3A), University of Zaragoza, Zaragoza, Spain
- Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre (CIBER-BBN), Zaragoza, Spain
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
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16
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Monterano Mesquita G, Patel D, Chang YC, Cabot F, Ruggeri M, Yoo SH, Ho A, Parel JMA, Manns F. In vivo measurement of the attenuation coefficient of the sclera and ciliary muscle. BIOMEDICAL OPTICS EXPRESS 2021; 12:5089-5106. [PMID: 34513244 PMCID: PMC8407821 DOI: 10.1364/boe.427286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
We acquired 1325 nm OCT images of the sclera and ciliary muscle of human subjects. The attenuation coefficients of the sclera and ciliary muscle were determined from a curve fit of the average intensity profile of about 100 A-lines in a region of interest after correction for the effect of beam geometry, using a single scattering model. The average scleral attenuation coefficient was 4.13 ± 1.42 mm-1 with an age-related decrease that was near the threshold for statistical significance (p = 0.053). The average ciliary muscle attenuation coefficient was 1.72 ± 0.88 mm-1, but this value may be an underestimation due to contributions from multiple scattering. Overall, the results suggest that inter-individual variations in scleral attenuation contribute to variability in the quality of transscleral OCT images of the ciliary muscle and the outcome of transscleral laser therapies.
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Affiliation(s)
- Gabrielle Monterano Mesquita
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Disha Patel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Yu-Cherng Chang
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Florence Cabot
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Sonia H. Yoo
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Arthur Ho
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
- Brien Holden Vision Institute, Sydney, NSW 2052, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW 2033, Australia
| | - Jean-Marie A. Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
- Brien Holden Vision Institute, Sydney, NSW 2052, Australia
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
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17
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Khadka NK, Timsina R, Rowe E, O'Dell M, Mainali L. Mechanical properties of the high cholesterol-containing membrane: An AFM study. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2021; 1863:183625. [PMID: 33891910 DOI: 10.1016/j.bbamem.2021.183625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 12/11/2022]
Abstract
Cholesterol (Chol) content in most cellular membranes does not exceed 50 mol%, only in the eye lens's fiber cell plasma membrane, its content surpasses 50 mol%. At this high concentration, Chol induces the formation of pure cholesterol bilayer domains (CBDs), which coexist with the surrounding phospholipid-cholesterol domain (PCD). Here, we applied atomic force microscopy to study the mechanical properties of Chol/phosphatidylcholine membranes where the Chol content was increased from 0 to 75 mol%, relevant to eye lens membranes. The surface roughness of the membrane decreases with an increase of Chol content until it reaches 60 mol%, and roughness increases with a further increment in Chol content. We propose that the increased roughness at higher Chol content results from the formation of CBDs. Force spectroscopy on the membrane with Chol content of 50 mol% or lesser exhibited single breakthrough events, whereas two distinct puncture events were observed for membranes with the Chol content greater than 50 mol%. We propose that the first puncture force corresponds to the membranes containing coexisting PCD and CBDs. In contrast, the second puncture force corresponds to the "CBD water pocket" formed due to coexisting CBDs and PCD. Membrane area compressibility modulus (KA) increases with an increase in Chol content until it reaches 60 mol%, and with further increment in Chol content, CBDs are formed, and KA starts to decrease. Our results report the increase in membrane roughness and decrease KA at very high Chol content (>60 mol%) relevant to the eye lens membrane.
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Affiliation(s)
- Nawal K Khadka
- Department of Physics, Boise State University, Boise, ID, USA
| | - Raju Timsina
- Department of Physics, Boise State University, Boise, ID, USA
| | - Erica Rowe
- Department of Biology, Boise State University, Boise, ID, USA
| | - Matthew O'Dell
- Biomolecular Sciences Graduate Program, Boise State University, Boise, ID, USA
| | - Laxman Mainali
- Department of Physics, Boise State University, Boise, ID, USA; Biomolecular Sciences Graduate Program, Boise State University, Boise, ID, USA.
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18
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Affiliation(s)
- Ronald A Schachar
- Department of Physics, University of Texas at Arlington, La Jolla, California, United States. E-mail:
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19
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Croft MA, Kaufman PL. Author Response: Systematic Imaging Experiments of Accommodation Do Not Require Image Registration. Invest Ophthalmol Vis Sci 2021; 62:18. [PMID: 33591361 PMCID: PMC7900845 DOI: 10.1167/iovs.62.2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mary Ann Croft
- Department of Ophthalmology and Visual Sciences, McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin, United States. E-mail:
| | - Paul L Kaufman
- Department of Ophthalmology and Visual Sciences, McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin, United States. E-mail:
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20
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Knaus KR, Hipsley A, Blemker SS. The action of ciliary muscle contraction on accommodation of the lens explored with a 3D model. Biomech Model Mechanobiol 2021; 20:879-894. [PMID: 33491156 DOI: 10.1007/s10237-021-01417-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 01/04/2021] [Indexed: 11/24/2022]
Abstract
The eye's accommodative mechanism changes optical power for near vision. In accommodation, ciliary muscle excursion relieves lens tension, allowing it to return to its more convex shape. Lens deformation alters its refractive properties, but the mechanics of ciliary muscle actions are difficult to intuit due to the complex architecture of the tissues involved. The muscle itself comprises three sections of dissimilarly oriented cells. These cells contract, transmitting forces through the zonule fibers and extralenticular structures. This study aims to create a finite element model (FEM) to predict how the action of the ciliary muscle sections leads to lens displacement. The FEM incorporates initialization of the disaccommodated lens state and ciliary muscle contraction, with three muscle sections capable of independent activation, to drive accommodative movement. Model inputs were calibrated to replicate experimentally measured disaccommodated lens and accommodated ciliary muscle shape changes. Additional imaging studies were used to validate model predictions of accommodative lens deformation. Models were analyzed to quantify mechanical actions of ciliary muscle sections in lens deformation and position modulation. Analyses revealed that ciliary muscle sections act synergistically: the circular section contributes most to increasing lens thickness, while longitudinal and radial sections can oppose this action. Conversely, longitudinal and radial sections act to translate the lens anteriorly with opposition from the circular section. This FEM demonstrates the complex interplay of the three sections of ciliary muscle in deforming and translating the lens during accommodation, providing a useful framework for future investigations of accommodative dysfunction that occurs with age in presbyopia.
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Affiliation(s)
- Katherine R Knaus
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | | | - Silvia S Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA. .,Department of Mechanical Engineering, University of Virginia, Charlottesville, VA, USA. .,Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA. .,Department of Ophthalmology, University of Virginia, 415 Lane Road, Box 800759, Charlottesville, VA, 22903, USA.
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21
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Differential Reorganization of Structural Elements of the Iridociliary and Perenticular Zones in the Hydrodynamic Blocks Formation. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2020-5.6.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Xu Y, Li M, Yao P, Wei R, Zhou X. A preliminary study on the visual outcomes after LaserACE for presbyopia. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1224. [PMID: 33178756 PMCID: PMC7607104 DOI: 10.21037/atm-20-2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background To investigate the visual outcomes over 1 year after laser anterior ciliary excision (LaserACE) procedure for presbyopic subjects. Methods A prospective, non-randomized, non-comparative study. Eight emmetropic eyes of four patients with presbyopia were included in this study. All eyes were treated with the LaserACE procedure using the VisioLite erbium-YAG laser (Ace Vision Group, USA). Subjects were assessed preoperatively and at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively. Outcome measures included questionnaires, visual acuity, manifest refraction, pupil size, keratometry, reading prescription, and intraocular pressure. Results Binocular distance corrected intermediate visual acuity (DCIVA) had improved from 0.33±0.12 logMAR to 0.12±0.12 logMAR after 6 months (P<0.05) and 0.13±0.12 logMAR after 12 months postoperatively (P<0.01). Binocular distance corrected near visual acuity (DCNVA) improved from 0.41±0.10 logMAR to 0.24±0.12 logMAR after 6 months (P<0.05) and 0.26±0.09 log MAR after 12 months postoperatively (P<0.05). An average decrease of 0.91±0.28 D in the reading prescription at a 40 cm reading distance was observed and remained stable over 12 months (P<0.05). There were no significant differences in manifest refraction, uncorrected distance visual acuity (UDVA), corneal curvature, high order aberrations, pupil size compared with preoperative and 6 months as well as 12 months postoperative visits (P>0.05). Conclusions The LaserACE procedure is shown to be safe and efficient for presbyopia correction without influencing distance vision or visual quality. However, its mechanism and long-term effects need further validation.
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Affiliation(s)
- Ye Xu
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Meiyan Li
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Peijun Yao
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ruoyan Wei
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Liu YC, Hall B, Lwin NC, Teo EPW, Yam GHF, Hipsley A, Mehta JS. Tissue Responses and Wound Healing following Laser Scleral Microporation for Presbyopia Therapy. Transl Vis Sci Technol 2020; 9:6. [PMID: 32818094 PMCID: PMC7396200 DOI: 10.1167/tvst.9.4.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/27/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the postoperative inflammatory and wound-healing responses after laser scleral microporation for presbyopia. Methods Thirty porcine eyes were used for the optimization of laser intensities first. Six monkeys (12 eyes) received scleral microporation with an erbium yttrium aluminum garnet (Er:YAG) laser, and half of the eyes received concurrent subconjunctival collagen gel to modulate wound-healing response. The intraocular pressure (IOP) and the laser ablation depth were evaluated. The animals were euthanized at 1, 6, and 9 months postoperatively. The limbal areas and scleras were harvested for histologic analysis and immunofluorescence of markers for inflammation (CD11b and CD45), wound healing (CD90, tenascin-C, fibronectin, and HSP47), wound contraction (α-smooth muscle actin [α-SMA]), vascular response (CD31), nerve injury (GAP43), and limbal stem cells (P63 and telomerase). Results In the nonhuman primate study, there was a significant reduction in IOP after the procedure. Overall, the ablation depth was 76.6% to 81.2% at 1 month and slightly decreased to 71.5% to 72.7% at 9 months. Coagulative necrosis around the micropores, as well as expression of CD11b, CD45, tenascin, fibronectin, HSP47, and GAP43, was distinct at 1 month but subsided with time. Collagen gel treatment significantly suppressed the upregulation of CD11b, CD45, fibronectin, and tenascin-C. The expression of CD90, α-SMA, and CD31 was minimal in all eyes. Conclusions The study demonstrated the course of inflammatory and wound-healing responses following laser scleral microporation. The tissue responses were small and self-limited, resolved with time, and were suppressed by concurrent collagen treatment. It provides a useful understanding of this new procedure. Translational Relevance The results would be helpful in the laser parameter modification to improve the long-term treatment stability.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Brad Hall
- Ace Vision Group, Inc., Newark, CA, USA
| | - Nyein Chan Lwin
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Ericia Pei Wen Teo
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Gary Hin Fai Yam
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | | | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
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Evaluation of the Relationship Between Age and Trabecular Meshwork Height to Predict the Risk of Glaucoma. Sci Rep 2020; 10:7115. [PMID: 32346035 PMCID: PMC7188680 DOI: 10.1038/s41598-020-64048-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/09/2020] [Indexed: 11/09/2022] Open
Abstract
This study evaluated age-related trabecular meshwork (TM) height variations in the eyes of adults in different age groups. We hypothesised that a reduction in TM occurs with increasing age. This retrospective, cross-sectional, observational study was conducted at Yonsei University Gangnam Severance Hospital between January 2015 and June 2019. We randomly included 250 eyes of 125 patients who underwent anterior segment optical coherence tomography (AS-OCT). The distance from the scleral spur to Schwalbe's line in patients with normal open anterior chamber angle was measured using AS-OCT. Results were stratified based on patients' age group-≤40, 41-50, 51-60, 61-70, 71-80, and 81-92 years. Thereafter, the results were compared among the age groups. The mean TM height of the patients was 770.929 ± 76.776 μm. TM height was 853.188 ± 94.117 μm in patients aged ≤40 years; it was 815.309 ± 75.723, 798.115 ± 66.040, 770.942 ± 52.774, 726.716 ± 63.979, and 715.968 ± 63.403 μm in patients aged 41-50, 51-60, 61-70, 71-80, and 81-92 years, respectively. The TM height tended to decrease with increasing age (P < 0.001). TM height was significantly shorter in older patients than in younger ones. Therefore, TM height may change with age and may contribute to increased glaucoma risk and prevalence.
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25
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Liu Z, Ruan X, Wang W, Liu J, Meng Y, Gu X, Fu J, Luo L, Liu Y. Comparison of radius of anterior lens surface curvature measurements in vivo using the anterior segment optical coherence tomography and Scheimpflug imaging. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:177. [PMID: 32309324 PMCID: PMC7154444 DOI: 10.21037/atm.2020.01.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background To assess the radius of anterior lens surface curvature (RAL) measurements with anterior segment optical coherence tomography (AS-OCT) in comparison with Scheimpflug imaging. Methods This prospective, cross-sectional study was carried out at Zhongshan Ophthalmic Center, Guangzhou, China. We enrolled 59 eyes, including 30 eyes from 30 cataractous volunteers (59 to 87 years) and 29 eyes from 29 young participants (19 to 49 years). After mydriasis, the RAL was measured automatically by the built-in software in the AS-OCT (CASIA 2). The Scheimpflug images were measured with the build-in caliper tool of the Scheimpflug camera (Pentacam), and RAL were further calculated with the principle of best-fitted circle. Intraobserver and interobserver reproducibility of RAL measurement using Scheimpflug camera were evaluated with limit of agreement (LoA) and intraclass correlation coefficient (ICC). Consistency between RAL measurement of Scheimpflug camera and AS-OCT were assessed with LoA, correlation analysis and linear regression. Results For all subjects, intraobserver (LoA: −0.25 to 0.23 mm, ICC: 0.996) and interobserver reproducibility (LoA: −0.85 to 0.92 mm, ICC: 0.947) of RAL were good using Scheimpflug imaging. Both AS-OCT and Scheimpflug imaging found that the age-related cataract participants had smaller RAL (P=0.010, P=0.001 respectively). LoA of RAL measurement between AS-OCT and Scheimpflug imaging was −3.83 to −0.79 mm, and the Pearson correlation efficient was 0.909 (P<0.001). The RAL values measured by AS-OCT were significantly greater than that by Scheimpflug camera with a mean difference of 2.31 mm for all participants (P<0.001). The RAL measurement could be converted using the equation: YCASIA 2 =1.155 × XPentacam + 1.060. Conclusions Both Scheimpflug camera system with internal caliper tool and the AS-OCT are fast and non-contact tools that could measure RAL successfully. The two measurement results are highly correlated and interchangeable through linear regression equation.
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Affiliation(s)
- Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiaoting Ruan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Juzi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yijing Meng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiaoxun Gu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jun Fu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
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Kaufman PL, Lütjen Drecoll E, Croft MA. Presbyopia and Glaucoma: Two Diseases, One Pathophysiology? The 2017 Friedenwald Lecture. Invest Ophthalmol Vis Sci 2019; 60:1801-1812. [PMID: 31038661 PMCID: PMC6540935 DOI: 10.1167/iovs.19-26899] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Paul L. Kaufman
- Department of Ophthalmology and Visual Sciences, Wisconsin National Primate Research Center, McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | | | - Mary Ann Croft
- Department of Ophthalmology and Visual Sciences, Wisconsin National Primate Research Center, McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin, United States
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27
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Domínguez-Vicent A, Monsálvez-Romín D, Esteve-Taboada JJ, Montés-Micó R, Ferrer-Blasco T. Effect of age in the ciliary muscle during accommodation: Sectorial analysis. JOURNAL OF OPTOMETRY 2019; 12:14-21. [PMID: 29627301 PMCID: PMC6318550 DOI: 10.1016/j.optom.2018.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 06/02/2023]
Abstract
PURPOSE To compare changes in the ciliary muscle area at different sectors between pre-presbyopic and presbyopic eyes during accommodation by means of an anterior segment optical coherence tomographer (OCT). METHODS The anterior ciliary muscle area was measured in 20 healthy and phakic pre-presbyopic eyes, whose mean age was 23.3±4.4 years, and in 20 healthy and phakic presbyopic eyes, whose mean age was 46.5±5.2 years. The relative change in the cross-sectional area of the ciliary muscle was measured at the nasal, inferior, and temporal sectors between 0 and -3 D of vergence, in -1 D step. A linear model was used to assess the correlation of each eye parameter with the accommodative demand. RESULTS Each population group showed a significant increase in the anterior ciliary muscle area for each sector. The maximum increase in the ciliary muscle area within the pre-presbyopic group was about 30%, and for the presbyopic one was about 25%. At the same time, it was obtained that the larger the vergence, the larger the variability. Furthermore, the linear model showed a positive tendency between the change in the ciliary muscle area of each sector and the vergence for both population groups, which coefficient of determination was in all cases greater than 0.93. CONCLUSION The anterior ciliary muscle area tends to increase with accommodation. The presbyopic nasal, inferior, and temporal ciliary muscle seem to have the same contractile capability as the young presbyopic ciliary muscle. These results might help to increase the evidences in the knowledge regarding the modern understanding of accommodation biometry and biomechanics.
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Affiliation(s)
| | | | - José J Esteve-Taboada
- Department of Optics and Optometry and Vision Sciences, University of Valencia, Spain
| | - Robert Montés-Micó
- Department of Optics and Optometry and Vision Sciences, University of Valencia, Spain
| | - Teresa Ferrer-Blasco
- Department of Optics and Optometry and Vision Sciences, University of Valencia, Spain
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Wolffsohn JS, Davies LN. Presbyopia: Effectiveness of correction strategies. Prog Retin Eye Res 2018; 68:124-143. [PMID: 30244049 DOI: 10.1016/j.preteyeres.2018.09.004] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 01/04/2023]
Abstract
Presbyopia is a global problem affecting over a billion people worldwide. The prevalence of unmanaged presbyopia is as high as 50% of those over 50 years of age in developing world populations, due to a lack of awareness and accessibility to affordable treatment, and is even as high as 34% in developed countries. Definitions of presbyopia are inconsistent and varied, so we propose a redefinition that states "presbyopia occurs when the physiologically normal age-related reduction in the eye's focusing range reaches a point, when optimally corrected for distance vision, that the clarity of vision at near is insufficient to satisfy an individual's requirements". Strategies for correcting presbyopia include separate optical devices located in front of the visual system (reading glasses) or a change in the direction of gaze to view through optical zones of different optical powers (bifocal, trifocal or progressive addition spectacle lenses), monovision (with contact lenses, intraocular lenses, laser refractive surgery and corneal collagen shrinkage), simultaneous images (with contact lenses, intraocular lenses and corneal inlays), pinhole depth of focus expansion (with intraocular lenses, corneal inlays and pharmaceuticals), crystalline lens softening (with lasers or pharmaceuticals) or restored dynamics (with 'accommodating' intraocular lenses, scleral expansion techniques and ciliary muscle electrostimulation); these strategies may be applied differently to the two eyes to optimise the range of clear focus for an individual's task requirements and minimise adverse visual effects. However, none fully overcome presbyopia in all patients. While the restoration of natural accommodation or an equivalent remains elusive, guidance is given on presbyopic correction evaluation techniques.
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Affiliation(s)
- James S Wolffsohn
- Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Leon N Davies
- Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
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Chen Z, Sun J, Li M, Liu S, Chen L, Jing S, Cai Z, Xiang Y, Song Y, Zhang H, Wang J. Effect of age on the morphologies of the human Schlemm's canal and trabecular meshwork measured with swept‑source optical coherence tomography. Eye (Lond) 2018; 32:1621-1628. [PMID: 29921951 PMCID: PMC6189106 DOI: 10.1038/s41433-018-0148-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/04/2018] [Accepted: 05/09/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose We aimed to measure the sizes of Schlemm’s canal (SC) and the trabecular meshwork (TM) in healthy individuals and to evaluate variations with age from childhood to old age by using swept-source optical coherence tomography (OCT). Methods Anterior chamber angle imaging of the superior, inferior, nasal, and temporal regions of the right and left eyes was performed with swept-source OCT. The diameter and area of SC and TM width and thickness were measured manually from OCT images. Results A total of 114 healthy individuals were enrolled and included 48 male subjects and 66 female subjects; their ages ranged from 7 to 83 years. Both the SC diameter and area in the four quadrants decreased significantly with aging (P < 0.001) and were wider in the nasal and temporal quadrants compared with the superior and inferior quadrants. Changes in SC size showed significant positive correlations with axial length (AL) and anterior chamber depth (P < 0.001). There was a significant positive association between age and TM thickness in the nasal and temporal quadrants (P < 0.05). The inferior quadrant TM width was the widest among the quadrants. The superior quadrant TM thickness was the thinnest among the quadrants. Changes in TM thickness in the nasal and temporal quadrants showed a significant negative correlation with AL (P < 0.05). There was no statistically significant correlation in SC and TM parameters with central corneal thickness, intraocular pressure, sex, or right or left eye (P > 0.05). Conclusions With aging, the SC diameter and area became smaller, TM thickness increased, and TM width seemed to remain constant. Measurements of the sizes of SC and the TM with swept-source OCT could assist in clinical assessments and treatment planning for glaucoma.
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Affiliation(s)
- Zhiqi Chen
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jian Sun
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mu Li
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shiliang Liu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Liugui Chen
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Sili Jing
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhen Cai
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan Xiang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yinwei Song
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong Zhang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Junming Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Long-term visual outcomes of laser anterior ciliary excision. Am J Ophthalmol Case Rep 2018; 10:38-47. [PMID: 29780911 PMCID: PMC5956797 DOI: 10.1016/j.ajoc.2018.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 11/13/2017] [Accepted: 01/18/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose To determine the long-term visual outcomes of six eyes of 3 patients up to 13 years following the Laser Anterior Ciliary Excision (LaserACE) procedure. Methods Three male patients of ages 59, 59, and 60 presented for evaluation at Storm Eye Institute, Medical University of South Carolina at 8, 10, and 13 years after the LaserACE procedure for presbyopia, respectively. All 3 patients had a history of laser vision correction (LVC) prior to LaserACE treatment. Visual performance was evaluated using ray-tracing aberrometry, specifically higher-order aberrations, visual Strehl of the optical transfer function (VSOTF), depth of focus (DoF), and effective range of focus (EROF). VSOTF was computed as a function of defocus using a through-focus curve. Subjective DoF was overlaid on the VSOTF through-focus curve to establish the best image quality metric threshold value for correlation between subjective and objective DoF. EROF was determined by measuring the difference in diopters between the near and distance DoF curves, at 50% of VSOTF. Results Distance-corrected visual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity for all patients remained at 20/20 or better up to 13 years postoperatively. EROF averaged 1.56 ± 0.36 (D) for all eyes. Conclusions and Importance LaserACE provided improvement in near vision functionality in these LVC patients with long-term stability. The LaserACE procedure is not on the visual axis, therefore these patients could still receive correction to their hyperopic regression.
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Gualdi L, Gualdi F, Rusciano D, Ambrósio R, Salomão MQ, Lopes B, Cappello V, Fintina T, Gualdi M. Ciliary Muscle Electrostimulation to Restore Accommodation in Patients With Early Presbyopia: Preliminary Results. J Refract Surg 2018; 33:578-583. [PMID: 28880331 DOI: 10.3928/1081597x-20170621-05] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/26/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To report short-term results of pulsed ciliary muscle electrostimulation to improve near vision, likely through restoring accommodation in patients with emmetropic presbyopia. METHODS In a prospective non-randomized trial, 27 patients from 40 to 51 years old were treated and 13 age- and refraction-matched individuals served as untreated controls. All patients had emmetropia and needed near sphere add between +0.75 and +1.50 diopters. The protocol included four sessions (one every 2 weeks within a 2-month period) of bilateral pulsed (2 sec on; 6 sec off) micro-electrostimulation with 26 mA for 8 minutes, using a commercially available medical device. The uncorrected distance visual acuity (UDVA) (logMAR) for each eye, uncorrected near (40 cm) visual acuity in each eye (UNVA) and with both eyes (UNVA OU) (logMAR), and reading speed (number of words read per minute at 40 cm) were measured preoperatively and 2 weeks after each session. Overall satisfaction (0 to 4 scale) was assessed 2 weeks after the last session. RESULTS UDVA did not change and no adverse events were noted in either group. Bilateral and monocular UNVA and reading speed were stable in the control group, whereas they continuously improved in the treated group (Friedman, P < .00001). Post-hoc significant differences were found for monocular and binocular UNVA after the second treatment and after the first treatment considering words read per minute (P < .001). One patient (3.7%) was not satisfied and 18 patients (66.7%) were very satisfied (score of 4). Average satisfaction score was 3 (satisfied). CONCLUSIONS Ciliary muscle contraction to restore accommodation was safe and improved the short-term accommodative ability of patients with early emmetropic presbyopia. [J Refract Surg. 2017;33(9):578-583.].
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Hipsley A, Hall B, Rocha KM. Scleral surgery for the treatment of presbyopia: where are we today? EYE AND VISION (LONDON, ENGLAND) 2018; 5:4. [PMID: 29497624 PMCID: PMC5827891 DOI: 10.1186/s40662-018-0098-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 01/28/2018] [Indexed: 11/28/2022]
Abstract
Presbyopia corrections traditionally have been approached with attempts to exchange power, either at the cornea or the lens planes, inducing multifocality, or altering asphericity to impact the optical system. Treatments that affect the visual axis, such as spectacle and contact lens correction, refractive surgeries, corneal onlays and inlays, and intraocular lenses are typically unable to restore true accommodation to the presbyopic eye. Their aim is instead to enhance 'pseudoaccommodation' by facilitating an extended depth-of-focus for which vision is sufficient. There is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution, rather than a 'vision correction' solution that compromises other components of the optical system. Scleral surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat presbyopia. While the theoretical justification of scleral surgical procedures remains controversial, there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat presbyopia. Enormous progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s, and this remains an active area of research. In this article, we discuss the historic scleral surgical procedures, the two scleral procedures currently available, as well as an outlook of the future for the scleral surgical space for treating presbyopia.
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Affiliation(s)
| | | | - Karolinne M. Rocha
- Storm Eye Institute, Medical University of South Carolina, Charleston, SC USA
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Rozanova OI, Shchuko AG, Mischenko TS. Fundamentals of Presbyopia: visual processing and binocularity in its transformation. EYE AND VISION 2018; 5:1. [PMID: 29417087 PMCID: PMC5784700 DOI: 10.1186/s40662-018-0095-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/04/2018] [Indexed: 12/05/2022]
Abstract
Background The accommodation has considerable interactions with the pupil response, vergence response and binocularity. The transformation of visual reception processing and the changes of the binocular cooperation during the presbyopia development are still poorly studied. So, the regularities of visual system violation in the presbyopia formation need to be characterized. This study aims to reveal the transformation of visual reception processing and to determine the role of disturbances in binocular interactions in presbyopia formation. Methods This study included 60 people with emmetropic refraction, uncorrected distance visual acuity 1.0 or higher (decimal scale), normal color perception, without concomitant ophthalmopathology. The first group consisted of 30 people (from 18 to 27 years old) without presbyopia, the second cohort comprised 30 patients (from 45 to 55 years old) with presbyopia. The eyeball anatomy and optics were evaluated using ultrasound biomicroscopy, aberrometry, and pupillometry. The functional state of the visual system was investigated under monocular and binocular conditions. The registration of the disparate fusional reflex limits was performed by the original technic using a diploptic device which facilitated investigation of the binocular interaction under natural conditions without the accommodation response, but with the different vergence load. The disparate fusional reflex was analyzed using the proximal and distal fusion borders, and the convergence and divergence fusion borders. The calculation of the area of binocularity field was performed in cm2. Results The presbyopia formation is characterized by a change in an intraocular anatomy, optics, visual processing, and binocularity. The processes of binocular interaction inhibition make a significant contribution to the misalignment of the visual perception. The modification of the proximal, distal and convergence fusion borders was determined. It was revealed that 87% of the presbyopic patients had binocularity shortage, whereas the reduction of binocularity field area in extreme grade was seen in 6% of cases. Conclusions The presbyopia formation is accompanied by a significant reorganization of the visual system activity and by the creation of the new visual processing interactions. These data may be useful in presbyopia surgery.
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Affiliation(s)
- Olga I Rozanova
- Irkutsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
| | - Andrey G Shchuko
- Irkutsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation.,2Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Tatyana S Mischenko
- Irkutsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
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Shao Y, Jiang Q, Hu D, Zhang L, Shen M, Huang S, Leng L, Yuan Y, Chen Q, Zhu D, Wang J, Lu F. Axial elongation measured by long scan depth optical coherence tomography during pilocarpine-induced accommodation in intraocular lens-implanted eyes. Sci Rep 2018; 8:1981. [PMID: 29386651 PMCID: PMC5792446 DOI: 10.1038/s41598-018-19910-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/09/2018] [Indexed: 12/30/2022] Open
Abstract
We used an ultra-long scan depth optical coherence tomography (UL-OCT) system to investigate changes in axial biometry of pseudophakic eyes during pilocarpine- induced accommodation. The right eyes from 25 healthy subjects (age range 49 to 84 years) with an intraocular lens (IOL) were imaged twice in the non-accommodative and the accommodative states. A custom-built UL-OCT instrument imaged the whole eye. Then accommodation was induced by two drops of 0.5% pilocarpine hydrochloride separated by a 5-minute interval. Following the same protocol, images were acquired again 30 minutes after the first drop. The central corneal thickness (CCT), anterior chamber depth (ACD), IOL thickness (IOLT), and vitreous length (VL) were obtained using custom automated software. The axial length (AL) was calculated by summing the CCT, ACD, IOLT, and VL. With accommodation, ACD increased by +0.08 ± 0.09 mm, while the VL decreased by −0.04 ± 0.09 mm (paired t-test each, P<0.05). CCT and IOLT remained constant during accommodation (P > 0.05). The non-accommodative AL was 23.47 ± 0.93 mm, and it increased by +0.04 ± 0.04 mm after accommodation (P<0.01). The AL increased and the IOL moved backward during pilocarpine-induced accommodation in pseudophakic eyes.
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Affiliation(s)
- Yilei Shao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiuruo Jiang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Di Hu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lingmin Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shenghai Huang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lin Leng
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yimin Yuan
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dexi Zhu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jianhua Wang
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Semiautomatic procedure to assess changes in the eye accommodative system. Int Ophthalmol 2017; 38:2451-2462. [PMID: 29075940 DOI: 10.1007/s10792-017-0752-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this pilot study was to evaluate a new semiautomatic procedure to assess in vivo changes in the crystalline lens and ciliary muscle during accommodation. METHODS A total of 14 subjects were divided into two groups, young (aged between 20 and 25 years) and adult (aged between 35 and 40 years), and measured with an anterior segment optical coherence tomography. A semiautomatic procedure was implemented to measure the central lens thickness (CLT), anterior lens radius (ALR) and the ciliary muscle area (CMA) for the unaccommodated eye and for a vergence of - 3.00 D. RESULTS The CLT increase for each population group was smaller than 5%, and the dispersion of each group was similar between them. Contrariwise, the reduction in the ALR was about 30% for both groups, although the young one showed the largest variability. The CMA increase was smaller than 30% for both groups, and the dispersion was similar between them. For each metric, differences between both groups were not statistically significant. CONCLUSIONS The semiautomatic procedure seems to be useful for the in vivo analysis of the accommodative system. Additionally, the results obtained showed that changes in the CLT were much smaller compared to those obtained for the ALR or CMA.
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Hipsley A, Ma DHK, Sun CC, Jackson MA, Goldberg D, Hall B. Visual outcomes 24 months after LaserACE. EYE AND VISION 2017; 4:15. [PMID: 28812042 PMCID: PMC5473977 DOI: 10.1186/s40662-017-0081-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/01/2017] [Indexed: 12/04/2022]
Abstract
Background To evaluate the effects on near and intermediate visual performance after bilateral Laser Anterior Ciliary Excision (LaserACE) procedure. Methods LaserACE surgery was performed using the VisioLite 2.94 μm erbium: yttrium–aluminum–garnet (Er:YAG) ophthalmic laser system in 4 oblique quadrants on the sclera over the ciliary muscle in 3 critical zones of physiological importance (over the ciliary muscles and posterior zonules) with the aim to improve natural dynamic accommodative forces. LaserACE was performed on 26 patients (52 eyes). Outcomes were analyzed using visual acuity testing, Randot stereopsis, and the CatQuest 9SF patient survey. Results Binocular uncorrected near visual acuity (UNVA) improved from +0.20 ± 0.16 logMAR preoperatively, to +0.12 ± 0.14 logMAR at 24 months postoperatively (p = 0.0014). There was no statistically significant loss in distance corrected near visual acuity (DCNVA). Binocular DCNVA improved from +0.21 ± 0.17 logMAR preoperatively, to +0.11 ± 0.12 logMAR at 24 months postoperatively (p = 0.00026). Stereoacuity improved from 74.8 ± 30.3 s of arc preoperatively, to 58.8 ± 22.9 s of arc at 24 months postoperatively (p = 0.012). There were no complications such as persistent hypotony, cystoid macular edema, or loss of best-corrected visual acuity (BCVA). Patients surveyed indicated reduced difficulty in areas of near vision, and were overall satisfied with the procedure. Conclusions Preliminary results of the LaserACE procedure show promising results for restoring visual performance for near and intermediate visual tasks without compromising distance vision and without touching the visual axis. The visual function and visual acuity improvements had clinical significance. Patient satisfaction was high postoperatively and sustained over 24 months. Trial registration NCT01491360 (https://clinicaltrials.gov/ct2/show/NCT01491360). Registered 22 November 2011.
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Affiliation(s)
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Kweishan, Taoyuan Taiwan.,Department of Chinese Medicine, Chang Gung University, Kweishan, Taoyuan Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Kweishan, Taoyuan Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Kweishan, Taoyuan Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Mitchell A Jackson
- Ace Vision Group Inc, 39655 Eureka Drive, Newark, CA 94560 USA.,Jackson Eye, Lake Villa, IL USA
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Croft MA, Lütjen-Drecoll E, Kaufman PL. Age-related posterior ciliary muscle restriction - A link between trabecular meshwork and optic nerve head pathophysiology. Exp Eye Res 2017; 158:187-189. [PMID: 27453343 PMCID: PMC5253323 DOI: 10.1016/j.exer.2016.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 01/24/2023]
Abstract
The ciliary muscle plays a major role in controlling both accommodation and outflow facility in primates. The ciliary muscle and the choroid functionally form an elastic network that extends from the trabecular meshwork all the way to the back of the eye and ultimately attaches to the elastic fiber ring that surrounds the optic nerve and to the lamina cribrosa through which the nerve passes. The ciliary muscle governs the accommodative movement of the elastic network. With age ciliary muscle mobility is restricted by progressively inelastic posterior attachments and the posterior restriction makes the contraction progressively isometric; placing increased tension on the optic nerve region. In addition, outflow facility also declines with age and limbal corneoscleral contour bows inward. Age-related loss in muscle movement and altered limbal corneoscleral contour could both compromise the basal function of the trabecular meshwork. Further, recent studies in non-human primates show that the central vitreous moves posteriorly all the way back to the optic nerve region, suggesting a fluid current and a pressure gradient toward the optic nerve. Thus, there may be pressure and tension spikes on the optic nerve region during accommodation and these pressure and tension spikes may increase with age. This constellation of events could be relevant to glaucomatous optic neuropathy. In summary, our hypothesis is that glaucoma and presbyopia may be literally linked to each other, via the choroid, and that damage to the optic nerve may be inflicted by accommodative intraocular pressure and choroidal tension "spikes", which may increase with age.
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Affiliation(s)
- Mary Ann Croft
- Department of Ophthalmology & Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison, USA.
| | | | - Paul L Kaufman
- Department of Ophthalmology & Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison, USA
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38
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Adamson P, Wilde T, Dobrzynski E, Sychterz C, Polsky R, Kurali E, Haworth R, Tang CM, Korczynska J, Cook F, Papanicolaou I, Tsikna L, Roberts C, Hughes-Thomas Z, Walford J, Gibson D, Warrack J, Smal J, Verrijk R, Miller PE, Nork TM, Prusakiewicz J, Streit T, Sorden S, Struble C, Christian B, Catchpole IR. Single ocular injection of a sustained-release anti-VEGF delivers 6months pharmacokinetics and efficacy in a primate laser CNV model. J Control Release 2016; 244:1-13. [PMID: 27810558 PMCID: PMC5494198 DOI: 10.1016/j.jconrel.2016.10.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/09/2016] [Accepted: 10/14/2016] [Indexed: 11/21/2022]
Abstract
A potent anti-vascular endothelial growth factor (VEGF) biologic and a compatible delivery system were co-evaluated for protection against wet age-related macular degeneration (AMD) over a 6month period following a single intravitreal (IVT) injection. The anti-VEGF molecule is dimeric, containing two different anti-VEGF domain antibodies (dAb) attached to a human IgG1 Fc region: a dual dAb. The delivery system is based on microparticles of PolyActive™ hydrogel co-polymer. The molecule was evaluated both in vitro for potency against VEGF and in ocular VEGF-driven efficacy models in vivo. The dual dAb is highly potent, showing a lower IC50 than aflibercept in VEGF receptor binding assays (RBAs) and retaining activity upon release from microparticles over 12months in vitro. Microparticles released functional dual dAb in rabbit and primate eyes over 6months at sufficient levels to protect Cynomolgus against laser-induced grade IV choroidal neovascularisation (CNV). This demonstrates proof of concept for delivery of an anti-VEGF molecule within a sustained-release system, showing protection in a pre-clinical primate model of wet AMD over 6months. Polymer breakdown and movement of microparticles in the eye may limit development of particle-based approaches for sustained release after IVT injection.
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Affiliation(s)
- Peter Adamson
- GSK Ophthalmology, Stevenage, UK; GSK, King of Prussia, PA, USA; ProQR Therapeutics NV, Zernikedreef 9, 2333CR Leiden, The Netherlands
| | - Thomas Wilde
- Drug Metabolism & Pharmacokinetics, UK; GSK, King of Prussia, PA, USA; Janssen Research & Development, PA 19002, USA
| | - Eric Dobrzynski
- Drug Metabolism & Pharmacokinetics, UK; GSK, King of Prussia, PA, USA
| | - Caroline Sychterz
- Drug Metabolism & Pharmacokinetics, UK; GSK, King of Prussia, PA, USA
| | - Rodd Polsky
- Safety Assessment, King of Prussia, PA, USA; GSK, King of Prussia, PA, USA
| | - Edit Kurali
- Target Science Statistics, Leiden, The Netherlands; Janssen Research & Development, PA 19002, USA
| | | | - Chi-Man Tang
- BioPharm Innovation, Madison, WI, USA; GSK Medicines Research Centre, Stevenage, UK; MedImmune, Granta Park, Cambridge, UK
| | - Justyna Korczynska
- BioPharm Discovery, Madison, WI, USA; GSK Medicines Research Centre, Stevenage, UK
| | - Fiona Cook
- BioPharm Discovery, Madison, WI, USA; GSK Medicines Research Centre, Stevenage, UK
| | - Irene Papanicolaou
- BioPharm Innovation, Madison, WI, USA; GSK Medicines Research Centre, Stevenage, UK
| | - Lemy Tsikna
- BioPharm Discovery, Madison, WI, USA; GSK Medicines Research Centre, Stevenage, UK; Avacta Life Sciences, Whittlesford, Cambridge, UK
| | - Chris Roberts
- BioPharm Discovery, Madison, WI, USA; GSK Medicines Research Centre, Stevenage, UK
| | - Zoe Hughes-Thomas
- BioPharm Discovery, Madison, WI, USA; GSK Medicines Research Centre, Stevenage, UK
| | - James Walford
- BioPharm Process Research, Zernikedreef 9, 2333CR Leiden, The Netherlands; GSK Medicines Research Centre, Stevenage, UK
| | - Daniel Gibson
- BioPharm Process Research, Zernikedreef 9, 2333CR Leiden, The Netherlands; GSK Medicines Research Centre, Stevenage, UK
| | - John Warrack
- AnalyticalSciences, Granta Park, Cambridge, UK; GSK Medicines Research Centre, Stevenage, UK
| | - Jos Smal
- OctoPlus NV, Leiden, The Netherlands
| | | | | | - T Michael Nork
- OSOD, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | | | | | | | - Ian R Catchpole
- GSK Ophthalmology, Stevenage, UK; BioPharm Innovation, Madison, WI, USA; GSK Medicines Research Centre, Stevenage, UK.
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Abstract
The rhesus macaque (Macaca mulatta) is one of the most extensively used nonhuman primate models for human diseases. This article presents a literature review focusing on major organ systems and age-associated conditions in humans and primates, combined with information from the Wisconsin National Primate Research Center Electronic Health Record database to highlight and contrast age-associated lesions in geriatric rhesus macaques with younger cohorts. Rhesus macaques are excellent models for age-associated conditions, including diabetes, osteoarthritis, endometriosis, visual accommodation, hypertension, osteoporosis, and amyloidosis. Adenocarcinoma of the large intestine (ileocecocolic junction, cecum, and colon) is the most common spontaneous neoplasm in the rhesus macaque. A combination of cross-sectional and longitudinal studies is required to truly define mechanisms of maturation, aging, and the pathology of age-associated conditions in macaques and thus humans. The rhesus macaque is and will continue to be an appropriate and valuable model for investigation of the mechanisms and treatment of age-associated diseases.
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Affiliation(s)
- H A Simmons
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
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40
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Croft MA, Heatley G, McDonald JP, Katz A, Kaufman PL. Accommodative movements of the lens/capsule and the strand that extends between the posterior vitreous zonule insertion zone & the lens equator, in relation to the vitreous face and aging. Ophthalmic Physiol Opt 2016; 36:21-32. [PMID: 26769326 PMCID: PMC4755275 DOI: 10.1111/opo.12256] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/09/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To elucidate the dynamic accommodative movements of the lens capsule, posterior lens and the strand that attaches to the posterior vitreous zonule insertion zone and posterior lens equator (PVZ INS-LE), and their age-related changes. METHODS Twelve human subjects (ages 19-65 years) and 12 rhesus monkeys (ages 6-27 years) were studied. Accommodation was induced pharmacologically (humans) or by central electrical stimulation (monkeys). Ultrasound biomicroscopy was used to image intraocular structures in both species. Surgical procedures and contrast agents were utilized in the monkey eyes to elucidate function and allow visualization of the intraocular accommodative structures. RESULTS Human: The posterior pole of the lens moves posteriorly during accommodation in proportion to accommodative amplitude and ciliary muscle movement. Monkey: Similar accommodative movements of the posterior lens pole were seen in the monkey eyes. Following extracapsular lens extraction (ECLE), the central capsule bows backward during accommodation in proportion to accommodative amplitude and ciliary muscle movement, while the peripheral capsule moves forward. During accommodation the ciliary muscle moved forward by ~1.0 mm, pulling forward the vitreous zonule and the PVZ INS-LE structure. During the accommodative response the PVZ INS-LE structure moved forward when the lens was intact and when the lens substance and capsule were removed. In both the monkey and the human eyes these movements declined with age. CONCLUSIONS The accommodative shape change of the central capsule may be due to the elastic properties of the capsule itself. For these capsule/lens accommodative posterior movements to occur, the vitreous face must either allow for it or facilitate it. The PVZ INS-LE structure may act as a 'strut' to the posterior lens equator (pushing the lens equator forward) and thereby facilitate accommodative forward lens equator movement and lens thickening. The age-related posterior restriction of the ciliary muscle, vitreous zonule and the PVZ-INS LE structure dampens the accommodative lens shape change. Future descriptions of the accommodative mechanism, and approaches to presbyopia therapy, may need to incorporate these findings.
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Affiliation(s)
- Mary Ann Croft
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA
| | - Gregg Heatley
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA
| | - Jared P McDonald
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA
| | - Alexander Katz
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA
| | - Paul L Kaufman
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, USA
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, USA
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41
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Flügel-Koch CM, Croft MA, Kaufman PL, Lütjen-Drecoll E. Anteriorly located zonular fibres as a tool for fine regulation in accommodation. Ophthalmic Physiol Opt 2015; 36:13-20. [PMID: 26490669 DOI: 10.1111/opo.12257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/07/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe an anteriorly located system of zonular fibres that could be involved in fine-tuning of accommodation. METHODS Forty-six human and 28 rhesus monkey eyes were dissected and special preparations were processed for scanning electron microscopy and reflected-light microscopy. Additional series of frontal and sagittal histological and ultrathin sections were analysed in respect to the origin and insertion of anteriorly located zonules. The presence of sensory terminals at the site of the originating zonules within the connective tissue of the ciliary body was studied by immunohistochemistry. For in-vivo visualization ultrasound biomicroscopy (UBM) was performed on 12 human subjects. RESULTS Fine zonular fibres originated from the valleys and lateral walls of the most anterior pars plicata that covers the anterior and inner circular ciliary muscle portion. These most anterior zonules (MAZ) showed attachments either to the anterior or posterior tines or they inserted directly onto the surface of the lens. At the site of origin, the course of the MAZ merged into the connective tissue fibres connecting the adjacent pigmented epithelium to the ciliary muscle. Numerous afferent terminals directly at the site of this MAZ-origin were connected to the intrinsic nervous network of the ciliary muscle. CONCLUSIONS A newly described set of zonular fibres features the capabilities to register the tensions of the zonular fork and lens capsule. The close location and neural connection towards the circular ciliary muscle portion could provide the basis for stabilization and readjustment of focusing that serves fast and fine-tuned accommodation and disaccommodation.
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Affiliation(s)
| | - Mary Ann Croft
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paul L Kaufman
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Wisconsin National Primate Research Center, University of Wisconsin, Madison, USA
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Laughton DS, Sheppard AL, Davies LN. A longitudinal study of accommodative changes in biometry during incipient presbyopia. Ophthalmic Physiol Opt 2015; 36:33-42. [DOI: 10.1111/opo.12242] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/07/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Deborah S. Laughton
- Ophthalmic Research Group Life & Health Sciences Aston University Birmingham UK
| | - Amy L. Sheppard
- Ophthalmic Research Group Life & Health Sciences Aston University Birmingham UK
| | - Leon N. Davies
- Ophthalmic Research Group Life & Health Sciences Aston University Birmingham UK
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Shao Y, Tao A, Jiang H, Mao X, Zhong J, Shen M, Lu F, Xu Z, Karp CL, Wang J. Age-related changes in the anterior segment biometry during accommodation. Invest Ophthalmol Vis Sci 2015; 56:3522-30. [PMID: 26030106 DOI: 10.1167/iovs.15-16825] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We investigated the dynamic response of human accommodative elements as a function of age during accommodation using synchronized spectral domain optical coherence tomography devices (SD-OCT). METHODS We enrolled 33 left eyes from 33 healthy subjects (age range, 20-39 years, 17 males and 16 females). Two SD-OCT devices were synchronized to simultaneously image the anterior segment through pupil and the ciliary muscle during 6.00 diopter (D) accommodation for approximately 3.7 seconds in two repeated measurements. The anterior segment parameters included the lens thickness (LT), radius of curvature of the lens anterior surface (LAC), maximum thickness of ciliary muscle (CMTMAX), and anterior length of the ciliary muscle (CMAL). A first-order exponential equation was used to fit the dynamic changes during accommodation. The age-related changes in the dynamic response and their relationship were calculated and compared. RESULTS The amplitude (r = -0.40 and 0.53 for LT and LAC, respectively) and peak velocity (r = -0.65 and 0.71 for LT and LAC, respectively) of the changes in LT and LAC significantly decreased with age (P < 0.05), whereas the parameters of the ciliary muscle remained unchanged (P > 0.05), except for the peak velocity of the CMAL (r = 0.44, P = 0.01). The difference in the time constant between the lens reshaping (LT and LAC) and CMTMAX increased with age (r = 0.46 and 0.57 for LT and LAC, respectively, P < 0.01). The changes in LT and LAC per millimeter of CMTMAX change decreased with age (r = -0.52 and -0.34, respectively, P < 0.05). The ciliary muscle forward movement correlated with the lens deformation (r = -0.35 and 0.40 for amplitude, while r = 0.36 and 0.58 for time constant, respectively, P < 0.05). CONCLUSIONS Age-related changes in the lens reshaping and ciliary muscle forward movement were found. Lens reshaping was much slower than the contraction of the ciliary muscle, especially in aging eyes, and this process required the ciliary muscle to contract more to reach a given response.
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Affiliation(s)
- Yilei Shao
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States 2School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, China
| | - Aizhu Tao
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States 2School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, China
| | - Hong Jiang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Xinjie Mao
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States 2School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, China
| | - Jianguang Zhong
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States 3Hangzhou First People's Hospital, Hangzhou, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, China
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, China
| | - Zhe Xu
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States 2School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, China
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States 4Electrical and Computer Engineering, University of Miami, Miami, Florida, United States
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Nankivil D, Maceo Heilman B, Durkee H, Manns F, Ehrmann K, Kelly S, Arrieta-Quintero E, Parel JM. The zonules selectively alter the shape of the lens during accommodation based on the location of their anchorage points. Invest Ophthalmol Vis Sci 2015; 56:1751-60. [PMID: 25698707 DOI: 10.1167/iovs.14-16082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the role of anterior and posterior zonular tension on the optomechanical lens response during accommodation simulation. METHODS Ten eyes from nine hamadryas baboons (4.9 ± 0.7 years) and 20 eyes from 18 cynomolgus monkeys (5.4 ± 0.3 years) were dissected, leaving the lens, zonules, ciliary body, hyaloid membrane, anterior vitreous, and a segmented scleral rim intact. The lens preparation was mounted in a lens stretcher, and the outer scleral shell was displaced radially in a stepwise fashion. The load, lens, and ciliary body diameters, lens power, lens thickness, and the anterior and posterior radius of curvature were measured during stretching. The zonular fibers attached to either the posterior or anterior lens surface were then carefully transected and the experiment was repeated. Zonular transection was confirmed in four eyes via laser scanning confocal microscopy after immunostaining. The effect of zonular transection on the tissue response to stretching was quantified. RESULTS Without anterior zonules, 48% and 97% of the changes in anterior and posterior radii are retained. Without posterior zonules, 81% and 67% of the changes in anterior and posterior radii are retained. The changes in lens shape were reduced after transecting either the anterior or posterior zonules; however, both surfaces still changed shape. CONCLUSIONS While either the anterior or posterior zonules alone are capable of changing the shape of both lens surfaces, the anterior zonules have a greater effect on the anterior lens surface, and the posterior zonules have a greater effect on the posterior lens surface.
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Affiliation(s)
- Derek Nankivil
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Bianca Maceo Heilman
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, United States Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami, Coral Gables, Florida, United States
| | - Heather Durkee
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, United States Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami, Coral Gables, Florida, United States
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, United States Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami, Coral Gables, Florida, United States
| | - Klaus Ehrmann
- Vision Cooperative Research Centre, Brien Holden Vision Institute, University of New South Wales, Sydney, Australia
| | - Shawn Kelly
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Esdras Arrieta-Quintero
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, United States
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Hiraoka M, Inoue K, Senoo H, Takada M. Morphological study of the accommodative apparatus in the monkey eye. Anat Rec (Hoboken) 2014; 298:630-6. [PMID: 25403484 PMCID: PMC4350428 DOI: 10.1002/ar.23100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 09/21/2014] [Indexed: 12/20/2022]
Abstract
For more than a century there has been debate concerning the mechanism of accommodation—whether the lens capsule or lens material itself determines the functional relationship between ciliary muscle contractility and lens deformation during refractive adaptation. This morphological study in monkey eyes investigates the composition and distribution of several connective tissue components in the accommodative apparatus relaying muscle force to lens organization. Elastin distributes on the marginal surface of the ciliary process. A zonule is composed of fibrillin produced by epithelial cells of the process. In the progress of extension over the posterior chamber, fibrils unite into strands and possess longitudinal plasticity. By induction of the elastin network, strands extend in a concentric direction covering the equatorial region of the capsule. Upon tethering to the lens, the strand ramifies into fibrils, penetrating deeply close to the epithelial layer of the lens and binding with the collagen of the intercellular spaces. Tight linkage of the zonule with the capsule transmits precise contractility. Inside the lens, the cortical layer's elastic connective tissue network forms widely spaced lamellae of crystalline fibers. In contrast, the central nuclear lamellae are tightly opposed. The accumulation of lamellae is greater in the anterior cortex than in the posterior, yielding a more variable anterior chamber depth in the visual axis. The plasticity of the zonule and connective tissue distribution inside the lens produces an adjustable configuration. Thus, tight linkage between the dynamism of the capsule with interaction of the lenticular flexibility provides a novel understanding of accommodation. Anat Rec, 298:630–636, 2015.
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Affiliation(s)
- Mari Hiraoka
- Central Eye Infirmary, 1-24-15 Nukui-kitamachi, Koganei, Tokyo, Japan; Systems Neuroscience Section, Primate Research Institute, Kyoto University, Inuyama, Japan
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Evaluation of the mechanical behaviour and estimation of the elastic properties of porcine zonular fibres. J Biomech 2014; 47:3264-71. [PMID: 25242131 DOI: 10.1016/j.jbiomech.2014.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/31/2014] [Accepted: 08/21/2014] [Indexed: 11/21/2022]
Abstract
The mechanical behaviour of zonular fibres greatly affects the accommodation process in mammalian eyes. This paper introduces a detailed measurement procedure for the purpose of obtaining the force-displacement diagram necessary to evaluate the mechanical properties of porcine zonular fibres in situ. It is a complex technique, keeping the integrity of the zonular bundles between the crystalline lens and the ciliary muscle cells. We present a brief description of the measurement procedure both in theory and in practice, along with the force-displacement diagrams acquired from a porcine sample group. The strengths of this newly developed method are the unequivocal force transmission between the sample and the transducer, and the intact connection between the ciliary body and the crystalline lens via zonular fibres. With the aid of these measurements, we define an estimated material model for the zonular apparatus both analytically and using the finite element method. The two different evaluation methods show close agreement in the calculated Young's modulus for the zonular fibres. The range of the calculated elastic modulus is 200-250 kPa. This new measuring method is adaptable to human specimens. Despite its complexity, the entire procedure and the evaluation part are reproducible. The constitutive model aims to shed light on the mechanics of the accommodation process.
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Croft MA, Nork TM, McDonald JP, Katz A, Lütjen-Drecoll E, Kaufman PL. Accommodative movements of the vitreous membrane, choroid, and sclera in young and presbyopic human and nonhuman primate eyes. Invest Ophthalmol Vis Sci 2013; 54:5049-58. [PMID: 23745005 DOI: 10.1167/iovs.12-10847] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We report, for the first time to our knowledge, dynamic movements of the vitreous membrane and peripheral choroid during accommodation, and age-related changes in the anterior sclera. METHODS We studied 11 rhesus monkeys (ages 6-27 years) and 12 human subjects (ages 19-65 years). Accommodation was induced pharmacologically in human subjects and by central electrical stimulation in the monkeys. Ultrasound biomicroscopy, endoscopy, and contrast agents were used to image various intraocular structures. RESULTS In the monkey, the anterior hyaloid membrane bows backward during accommodation in proportion to accommodative amplitude and lens thickening. A cleft exists between the pars plicata region and the anterior hyaloid membrane, and the cleft width increases during accommodation from 0.79 ± 0.01 mm to 1.01 ± 0.02 mm in young eyes (n = 2, P < 0.005), as fluid from the anterior chamber flows around the lens equator toward the cleft. In the older eyes the cleft width was 0.30 ± 0.19 mm, which during accommodation increased to 0.45 ± 0.20 mm (n = 2). During accommodation the ciliary muscle moved forward by approximately 1.0 mm, pulling forward the choroid, retina, vitreous zonule, and the neighboring vitreous interconnected with the vitreous zonule. Among the humans, in the older eyes the scleral contour bowed inward in the region of the limbus, compared to the young eyes. CONCLUSIONS The monkey anterior hyaloid bends posteriorly during accommodation in proportion to accommodative amplitude and the sclera bows inward with increasing age in both species. Future descriptions of the accommodative mechanism, and approaches to presbyopia therapy, may need to incorporate these findings.
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Affiliation(s)
- Mary Ann Croft
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin 53792-3220, USA.
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