Effect of dietary modification and antioxidant supplementation on intraocular pressure and open-angle glaucoma

The Effects of Antioxidant Cocktail on Ophthalmological Changes Induced by a 60-Day Head-Down Bed Rest in a Randomized Trial

Neuro-ophthalmological changes have been reported after prolonged exposure to microgravity; however, the pathophysiology remains unclear. Furthermore, several countermeasures have been suggested to counteract the side effects of microgravity. The objectives of the present study were twofold: (1) to assess the neuro-ophthalmological impact of 60 days of head-down bed rest (HDBR) and (2) to determine the potential effects of an antioxidant cocktail. In this case, 20 healthy male subjects completed a 60-day HDBR and were randomly allocated into two groups: a control condition without an antioxidant cocktail (CON) and a condition with an antioxidant cocktail (NUT). The retinal nerve fibre layer thickness (RNFLT) and central retinal thickness (CRT) were assessed with spectral domain optical coherence tomography. The optic nerve sheath diameter (ONSD) was measured by ocular ultrasonography and used to assess indirect changes in the intracranial pressure (ICP). The intraocular pressure (IOP) was assessed by Goldmann applanation tonometry. The CRT tended to be reduced after HDBR. The ONSD was increased at the end and after HDBR. The IOP tended to decrease after HDBR. Finally, the antioxidant cocktail had minor impacts on the ophthalmological changes induced by HDBR. It is worth noting that two participants presented peripapillary edema.

The potential impact of a vegetarian diet on glaucoma

Treatment of primary open-angle glaucoma has centered on the lowering of intraocular pressure that damages the optic nerve; however, this strategy is not uniformly successful, especially in normal tension glaucoma, and there is interest in antioxidant, anti-inflammatory, and other neuroprotective strategies. Vegetarian diets are known to be rich in antioxidant and anti-inflammatory components and have a number of established health benefits. Thus, it would be reasonable to assume that vegetarian diets would be beneficial in glaucoma, but this approach has not been well studied. We examine the possible role of vegetarian diets and their components in the incidence and progression of glaucoma.

The Presence of Ovarian Cancer and the Incidence of Subsequent Open-Angle Glaucoma: A Population-Based Cohort Study

We aim to explore the possible association between ovarian cancer and the subsequent development of open-angle glaucoma (OAG) using the Taiwan Longitudinal Health Insurance Database (LHID) 2000. A retrospective cohort study was executed, and individuals with ovarian cancer were enrolled and age-matched (with a 1:4 ratio) to non-ovarian cancer individuals. A total of 4990 and 19,960 patients were put into the ovarian cancer and control groups. The main outcome was the presence of OAG according to the LHID 2000 codes. The Cox proportional hazard regression was adopted to demonstrate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) of OAG between the ovarian cancer and control groups. There were a total of 241 and 1029 OAG cases observed in the ovarian cancer group and the control group, respectively. The incidence of OAG was significantly higher in the ovarian cancer group than in the control group according to multivariable analysis (aHR: 1.18, 95% CI: 1.02-1.37, p = 0.022). The ovarian cancer patients older than 60 years showed a significantly higher risk of OAG compared to the non-ovarian cancer individuals of the same age (aHR: 1.39, 95% CI: 1.16-1.63, p = 0.001). Additionally, ovarian cancer individuals with a disease interval of more than two years presented a significantly higher incidence of OAG than the non-ovarian cancer group (p < 0.05). In conclusion, ovarian cancer positively correlates with a high rate of subsequent OAG, especially in elderly persons with a long disease interval.

Wild and cultivated olive trees: Nutraceutical insights of extra virgin olive oils in cardiovascular and ocular diseases

Extra virgin olive oil (EVOO) from Olea europaea (cultivated olive tree) and the oil obtained from the wild olive variety or acebuche (ACE oil from Olea oleaster) contain an extraordinary number of bioactive molecules. These include oleic acid, sterols, tocopherols, triterpene compounds, and polyphenols. Both oils are known for their healthy properties and are considered to be a nutraceutical tool against cardiovascular diseases, including arterial hypertension, preeclampsia, and ocular diseases such as glaucoma or diabetic retinopathy. The benefits of EVOO and ACE oil stem from their anti-inflammatory, antioxidant, and anti-cancer properties. They also have potential as prebiotic compounds. In this update, we synthesise and illustrate the various characteristics and beneficial effects of olive oils from different varieties of olive trees, with special emphasis on Olea oleaster, also known as Olea europaea, L. var. sylvestris.

Novel frontiers in neuroprotective therapies in glaucoma: Molecular and clinical aspects

In the last years, neuroprotective therapies have attracted the researcher interests as modern and challenging approach for the treatment of neurodegenerative diseases, aimed at protecting the nervous system from injuries. Glaucoma is a neurodegenerative disease characterized by progressive excavation of the optic nerve head, retinal axonal injury and corresponding vision loss that affects millions of people on a global scale. The molecular basis of the pathology is largely uncharacterized yet, and the therapeutic approaches available do not change the natural course of the disease. Therefore, in accordance with the therapeutic regimens proposed for other neurodegenerative diseases, a modern strategy to treat glaucoma includes prescription of drugs with neuroprotective activities. With respect to this, several preclinical and clinical investigations on a plethora of different drugs are currently ongoing. In this review, first, the conceptualization of the rationale for the adoption of neuroprotective strategies for retina is summarized. Second, the molecular aspects highlighting glaucoma as a neurodegenerative disease are reported. In conclusion, the molecular and pharmacological properties of most promising direct neuroprotective drugs used to delay glaucoma progression are examined, including: neurotrophic factors, NMDA receptor antagonists, the α2-adrenergic agonist, brimonidine, calcium channel blockers, antioxidant agents, nicotinamide and statins.

The use of Nicotinamide and Nicotinamide riboside as an adjunct therapy in the treatment of glaucoma

Glaucoma is an optic neuropathy characterized by death of retinal ganglion cells (RGCs), which leads to progressive visual field loss and may result in blindness. Currently, the only available treatment to avoid or delay progression in glaucoma patients is to decrease intraocular pressure (IOP). However, despite adequate IOP control, approximately 25% of the patients continue to progress. To delay or prevent optic nerve damage in glaucoma, two forms of vitamin B3, nicotinamide (NAM) and nicotinamide riboside (NR) are emerging as viable adjuvant therapies. These compounds are nicotinamide adenine dinucleotide (NAD) precursors. NAD is essential for proper cell functioning and is involved in several metabolic activities, including protection against reactive oxygen species, contribution to the performance of various enzymes, and maintenance of mitochondrial function. Due to its beneficial effects and to the evidence of the reduction of NAD bioavailability with aging, researchers are seeking ways to replenish the cellular NAD pool, by administrating its precursors (NAM and NR), believing that it will reduce the RGC vulnerability to external stressors, such as increased IOP. This article attempts to analyze the current knowledge regarding the use of NAM and NR for the prevention and/or treatment of glaucoma.

Uric acid and glaucoma: a systematic review and meta-analysis

Background

Glaucoma, the leading cause of irreversible blindness, is a common disorder that contributes to gradual optic nerve degeneration. The beneficial impacts of uric acid (UA) have been reported in some neurodegenerative conditions such as Parkinson's disease, Alzheimer's disease, and amyotrophic lateral sclerosis. But the results of current studies about the association between serum UA level and glaucoma are conflicting. The present meta-analysis was conducted to provide a better understanding of the association between serum UA level and glaucoma.

Methods

We searched the databases of PubMed, Scopus, Web of Science, and Google Scholar systematically until November 20, 2022 to identify case-control studies, comparing the serum UA concentrations of the patients with glaucoma and controls. The mean ± standard division difference was used to assess the difference in serum UA concentrations between the glaucoma patients and controls.

Results

Six studies involving 1,221 glaucoma patients and 1,342 control group were included in the present meta-analysis. This meta-analysis using a random effect model indicated that the mean UA level in glaucoma patients was 0.13 (I2 = 91.92%, 95% CI = -0.42 to 0.68) higher than the controls; however, it was not statistically significant.

Conclusions

Our findings provide evidence that glaucoma patients have a higher serum UA level compared to the controls, but this difference is not statistically significant. Prospective studies are needed to determine the possible association between increased UA and glaucoma pathogenesis.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022364055, identifier: CRD42022364055.

The effect of body mass index reduction on intraocular pressure in a large prospective cohort of apparently healthy individuals in Israel

PURPOSE

To investigate the effect of change in body mass index (BMI) on intraocular pressure (IOP) in a large cohort of apparently healthy volunteers who underwent an annual comprehensive screening examinations.

METHODS

This study included individuals who were enrolled in the Tel Aviv Medical Center Inflammation Survey (TAMCIS) and had IOP and BMI measurements at their baseline and follow up visits. Relationships between BMI and IOP and the effect of change in BMI on IOP were investigated.

RESULTS

A total of 7,782 individuals had at least one IOP measurement at their baseline visit, and 2,985 individuals had ≥2 visits recorded. The mean (SD) IOP (right eye) was 14.6 (2.5) mm Hg and mean (SD) BMI was 26.4 (4.1) kg/m2. IOP positively correlated with BMI levels (r = 0.16, p<0.0001). For individuals with morbid obesity (BMI≥35 kg/m2) and ≥2 visits, a change in BMI between the baseline and first follow-up visits correlated positively with a change in the IOP (r = 0.23, p = 0.029). Subgroup analysis of subjects who had a reduction of at least 2 BMI units showed a stronger positive correlation between change in BMI and change in IOP (r = 0.29, p<0.0001). For this subgroup, a reduction of 2.86 kg/m2 of BMI was associated with a reduction of 1 mm Hg in IOP.

CONCLUSIONS

BMI loss correlated with reduction in IOP, and this correlation was more pronounced among morbidly obese individuals.

Glaucoma through Animal’s Eyes: Insights from the Evolution of Intraocular Pressure in Mammals and Birds

Simple Summary

Understanding how a disease evolved across the animal kingdom could help us better understand the disease and might lead to novel methods for treatment. Here, we studied the evolution of glaucoma, an irreversible eye disease, in mammals and birds, by studying the evolution of intraocular pressure (IOP), a central driver of glaucoma, and searching for associations between life history traits and IOP. Our results revealed that IOP is a taxa-specific trait that is higher in some species than in others. Higher IOPs appear to have evolved multiple times in mammals and birds. Higher IOPs were found in mammals with higher body mass and in aquatic birds. We also found that higher IOPs evolved through stabilizing selection, with the optimum IOP in mammals and birds being 17.67 and 14.31 mmHg, respectively. This supports the hypothesis that higher IOPs may be an adaptive trait for certain animals. Focusing on species with higher IOPs but no evidence of glaucoma may help identify glaucoma-resistant adaptations, which could be developed into human therapies.

Abstract

Glaucoma, an eye disorder caused by elevated intraocular pressure (IOP), is the leading cause of irreversible blindness in humans. Understanding how IOP levels have evolved across animal species could shed light on the nature of human vulnerability to glaucoma. Here, we studied the evolution of IOP in mammals and birds and explored its life history correlates. We conducted a systematic review, to create a dataset of species-specific IOP levels and reconstructed the ancestral states of IOP using three models of evolution (Brownian, Early burst, and Ornstein–Uhlenbeck (OU)) to understand the evolution of glaucoma. Furthermore, we tested the association between life history traits (e.g., body mass, blood pressure, diet, longevity, and habitat) and IOP using phylogenetic generalized least squares (PGLS). IOP in mammals and birds evolved under the OU model, suggesting stabilizing selection toward an optimal value. Larger mammals had higher IOPs and aquatic birds had higher IOPs; no other measured life history traits, the type of tonometer used, or whether the animal was sedated when measuring IOP explained the significant variation in IOP in this dataset. Elevated IOP, which could result from physiological and anatomical processes, evolved multiple times in mammals and birds. However, we do not understand how species with high IOP avoid glaucoma. While we found very few associations between life history traits and IOP, we suggest that more detailed studies may help identify mechanisms by which IOP is decoupled from glaucoma. Importantly, species with higher IOPs (cetaceans, pinnipeds, and rhinoceros) could be good model systems for studying glaucoma-resistant adaptations.

Magnesium and Its Role in Primary Open Angle Glaucoma; A Novel Therapeutic?

Glaucoma is the leading cause of irreversible blindness globally, with Primary open angle glaucoma (POAG) being the commonest subtype. POAG is characterized by an increase in intraocular pressure (IOP), leading to optic nerve damage and subsequent visual field defects. Despite the clinical burden this disease poses, current therapies aim to reduce IOP rather than targeting the underling pathogenesis. Although the pathogenesis of POAG is complex, the culprit for this increase in IOP resides in the aqueous humour (AH) outflow pathway; the trabecular meshwork (TM) and Schlemm's canal. Dysfunction in these tissues is due to inherent mitochondrial dysfunction, calcium influx sensitivity, increase in reactive oxygen species (ROS) production, TGFβ-2 induction, leading to a sustained inflammatory response. Magnesium is the second most common intracellular cation, and is a major co-factor in over 300 reactions, being highly conserved within energy-dependent organelles such as the mitochondria. Magnesium deficiency has been observed in POAG and is linked to inflammatory and fibrotic responses, as well as increased oxidative stress (OS). Magnesium supplementation been shown to reduce cellular ROS, alleviate mitochondrial dysregulation and has further antifibrotic and anti-inflammatory properties within ocular tissues, and other soft tissues prone to fibrosis, suggesting that magnesium can improve visual fields in patients with POAG. The link between magnesium deficiency and glaucoma pathogenesis as well as the potential role of magnesium supplementation in the management of patients with POAG will be explored within this review.

Literature Review on Artificial Intelligence Methods for Glaucoma Screening, Segmentation, and Classification

Artificial intelligence techniques are now being applied in different medical solutions ranging from disease screening to activity recognition and computer-aided diagnosis. The combination of computer science methods and medical knowledge facilitates and improves the accuracy of the different processes and tools. Inspired by these advances, this paper performs a literature review focused on state-of-the-art glaucoma screening, segmentation, and classification based on images of the papilla and excavation using deep learning techniques. These techniques have been shown to have high sensitivity and specificity in glaucoma screening based on papilla and excavation images. The automatic segmentation of the contours of the optic disc and the excavation then allows the identification and assessment of the glaucomatous disease's progression. As a result, we verified whether deep learning techniques may be helpful in performing accurate and low-cost measurements related to glaucoma, which may promote patient empowerment and help medical doctors better monitor patients.

Use of complementary and alternative therapies by patients with eye diseases: a hospital-based cross-sectional study from Palestine

BACKGROUND

Generally, complementary and alternative therapies (CAT) are accepted methods of treatment by patients with various types of conditions. Their use is becoming especially prevalent among patients with eye problems even in developed countries. Thus, we aimed to determine the pattern of use of CAT in this patient population, to identify the patient characteristics associated with the use of CAT, and to assess the types of CAT used.

METHODS

A descriptive, cross-sectional study was conducted in Palestine at An-Najah National University Hospital between the time periods of October 2019 to May 2020, using questionnaire-based face to face interviews. Data were collected through convenience sampling. Patients responded to the questionnaire, which was focused on information adapted from previous research in this area, covering socio-demographic and clinical characteristics, types of CAT, source of information, and side effects on CAT use.

RESULTS

A total of 86 patients were interviewed for our study. Over two thirds, 67% reported using CAT for the specific purpose of improving their eye condition, and about one third (29.1%) received more than one therapy. The most common therapies reported were duea' (i.e. supplication) (47.1%) and herbal therapies (24.1%). It was shown that patients with bilateral involvement of their eyes were almost twice more likely to describe using CAT than patients with unilateral eye pathology (p = 0.006). Also, patients who underwent surgery as their route of treatment were significantly less likely to use CAT (p = 0.043). Most of our study participants mentioned a non-physician source as their source of information regarding CAT with family members being the most frequently mentioned (30.2%) followed by the internet (25.6%) and friends (19.8%).

CONCLUSIONS

The prevalence of CAT use among patients with eye disease is somewhat high in our study population. Because CAT may trigger adverse reactions, influence the progression of the disease, and interfere with conventional treatment, the ophthalmologist should frequently be asked patients with such diagnostics regarding the use of these therapies. Further work is required to analyze the mechanisms of action and to establish realistic guidelines for the use of these modalities.

Retrospective investigation of peripheric blood sampling in pediatric chalazion patients

PURPOSE

To compare serum thyroid hormone, vitamin B12, vitamin D3, folic acid, and ferritin levels between pediatric chalazion patients and healthy children.

METHODS

Under 18-year-old chalazion patients and age- and sex-matched healthy controls were included into this retrospective case-control study. The peripheric blood sampling results obtained within six months from ophthalmological examination were investigated for statistical analysis. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), vitamin B12, vitamin D3, folic acid, and ferritin levels of the chalazion and control groups were compared.

RESULTS

The male-to-female ratio was 8/28 in the chalazion group and 22/48 in the control group (p > 0.05). The mean age was 13.891 ± 3.924 years (3-17) and 12.346 ± 3.963 years (4-17) in the groups, respectively (p > 0.05). The mean time between ophthalmological examination and peripheric blood sampling was 3.012 ± 2.201 months (0-6) and 2.092 ± 1.906 months (0-6) in the groups, respectively (p > 0.05). The mean value of ferritin was 18.641 ± 8.971 μg/L (5.900-38.600) in the chalazion group and 35.455 ± 24.561 μg/L (11.850-106.100) in the control group (p = 0.019). The mean values of FT3, FT4, TSH, vitamin B12, vitamin D3, and folic acid levels were similar between the groups (p > 0.05 for all).

CONCLUSION

This study reports that pediatric chalazion patients have lower serum ferritin level than healthy children.