Optical development in the murine eye lens of accelerated senescence-prone SAMP8 and senescence-resistant SAMR1 strains

The eye lens is responsible for focusing objects at various distances onto the retina and its refractive power is determined by its surface curvature as well as its internal gradient refractive index (GRIN). The lens continues to grow with age resulting in changes to the shape and to the GRIN profile. The present study aims to investigate how the ageing process may influence lens optical development. Murine lenses of accelerated senescence-prone strain (SAMP8) aged from 4 to 50 weeks; senescence-resistant strain (SAMR1) aged from 5 to 52 weeks as well as AKR strain (served as control) aged from 6 to 70 weeks were measured using the X-ray interferometer at the SPring-8 synchrotron Japan within three consecutive years from 2020 to 2022. Three dimensional distributions of the lens GRIN were reconstructed using the measured data and the lens shapes were determined using image segmentation in MatLab. Variations in the parameters describing the lens shape and the GRIN profile with age were compared amongst three mouse strains. With advancing age, both the lens anterior and posterior surface flattens and the lens sagittal thickness increase in all three mouse strains (Anterior radius of curvature increase at 0.008 mm/week, 0.007 mm/week and 0.002 mm/week while posterior radius of curvature increase at 0.002 mm/week, 0.007 mm/week and 0.003 mm/week respectively in AKR, SAMP8 and SAMR1 lenses). Compared with the AKR strain, the SAMP8 samples demonstrate a higher rate of increase in the posterior curvature radius (0.007 mm/week) and the thickness (0.015 mm/week), whilst the SAMR1 samples show slower increases in the anterior curvature radius (0.002 mm/week) and its thickness (0.013 mm/week). There are similar age-related trends in GRIN shape in the radial direction (in all three types of murine lenses nr2 and nr6 increase with age while nr4 decrease with age consistently) but not in the axial direction amongst three mouse strains (nz1 of AKR lens decrease while of SAMP8 and SAMR1 increase with age; nz2 of all three models increase with age; nz3 of AKR lens increase while of SAMP8 and SAMR1 decrease with age). The ageing process can influence the speed of lens shape change and affect the GRIN profile mainly in the axial direction, contributing to an accelerated decline rate of the optical power in the senescence-prone strain (3.5 D/week compared to 2.3 D/week in the AKR control model) but a retardatory decrease in the senescence-resistant strain (2.1 D/week compared to the 2.3D/week in the AKR control model).

The Effect of Lens Shape, Zonular Insertion and Finite Element Model on Simulated Shape Change of the Eye Lens

The process of lens shape change in the eye to alter focussing (accommodation) is still not fully understood. Modelling approaches have been used to complement experimental findings in order to determine how constituents in the accommodative process influence the shape change of the lens. An unexplored factor in modelling is the role of the modelling software on the results of simulated shape change. Finite element models were constructed in both Abaqus and Ansys software using biological parameters from measurements of shape and refractive index of two 35-year-old lenses. The effect of zonular insertion on simulated shape change was tested on both 35-year-old lens models and with both types of software. Comparative analysis of shape change, optical power, and stress distributions showed that lens shape and zonular insertion positions affect the results of simulated shape change and that Abaqus and Ansys show differences in their respective models. The effect of the software package used needs to be taken into account when constructing finite element models and deriving conclusions.

Model of zonular forces on the lens capsule during accommodation

How the human eye focuses for near; i.e. accommodates, is still being evaluated after more than 165 years. The mechanism of accommodation is essential for understanding the etiology and potential treatments for myopia, glaucoma and presbyopia. Presbyopia affects 100% of the population in the fifth decade of life. The lens is encased in a semi-elastic capsule with attached ligaments called zonules that mediate ciliary muscle forces to alter lens shape. The zonules are attached at the lens capsule equator. The fundamental issue is whether during accommodation all the zonules relax causing the central and peripheral lens surfaces to steepen, or the equatorial zonules are under increased tension while the anterior and posterior zonules relax causing the lens surface to peripherally flatten and centrally steepen while maintaining lens stability. Here we show with a balloon capsule zonular force model that increased equatorial zonular tension with relaxation of the anterior and posterior zonules replicates the topographical changes observed during in vivo rhesus and human accommodation of the lens capsule without lens stroma. The zonular forces required to simulate lens capsule configuration during in vivo accommodation are inconsistent with the general belief that all the zonules relax during accommodation.

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

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.

Finite element analysis of zonular forces

To determine the effect of zonular forces on lens capsule topography, a finite element (FE) analyses of lens capsules with no lens stroma and constant and variable thickness with anterior capsulotomies of 1.5 mm-6.5 mm were evaluated when subjected to equatorial (Ez), anterior (Az) and posterior (Pz) zonular forces. The lens capsule was considered in the unaccommodated state when the total initial zonular force was 0.00075 N or 0.3 N. From the total 0.00075 N zonular force, the Ez force was increased in 0.000125 N steps for a maximum force of 0.03 N and simultaneously the Az plus Pz force was reduced in 0.000125 N steps to zero. In addition, the force of all the zonules was reduced from 0.00075 N and separately from 0.3 N in 0.000125 N steps to zero. Only when Ez force was increased as Az and Pz force was reduced did the capsule topography simulate in vivo observations with the posterior capsule pole bowing posteriorly. The posterior bowing was directly related to Ez force and capsulotomy size. Whether the total force of all the zonules in the unaccommodated state was 0.00075 N or 0.3 N and reduced in steps to zero, the lens capsule topography did not emulate the in vivo observations. The FE analysis demonstrated that Ez tension increases while the Az and Pz tension decreases and that all the zonules do not relax during ciliary muscle contraction.

Influence of design parameters and capsulorhexis on intraocular lens stabilities: A 3D finite element analysis

BACKGROUND

Current treatment of cataract widely used in clinics is by removal of the opacified content from the lens capsule which is followed by insertion of an artificial intraocular lens (IOL). The IOL needs to remain stabilized in the capsular bag for the eye to achieve desired optical quality. The present study aims to investigate how different design parameters of the IOL can influence the axial and rotational stabilities of IOLs using Finite Element Analysis.

METHODS

Eight designs of IOL with variations in types of optics surface, types of haptics and haptic angulation were constructed using parameters obtained from an online IOL databank (IOLs.eu). Each IOL was subjected to compressional simulations both by two clamps and by a collapsed natural lens capsule with an anterior rhexis. Comparisons were made between the two scenarios on axial displacement, rotation, and distribution of stresses.

RESULTS

The clamps compression method set out by ISO does not always produce the same outcome as the in-the-bag analysis. The open-loop IOLs show better axial stability while the closed-loop IOLs show better rotational stability when compressed by two clamps. Simulations of IOL in the capsular bag only demonstrate better rotational stability for closed-loop designs.

CONCLUSIONS

The rotational stability of an IOL is largely dependent on its haptic design whilst the axial stability is affected by the appearance of the rhexis to the anterior capsule which has a major influence on designs with a haptic angulation.

Oxysterol Compounds in Mouse Mutant αA- and αB-Crystallin Lenses Can Improve the Optical Properties of the Lens

Purpose

To investigate how cataract-linked mutations affect the gradient refractive index (GRIN) and lens opacification in mouse lenses and whether there is any effect on the optics of the lens from treatment with an oxysterol compound.

Methods

A total of 35 mice including wild-type and knock-in mutants (Cryaa-R49C and Cryab-R120G) were used in these experiments: 26 mice were treated with topical VP1-001, an oxysterol, in one eye and vehicle in the other, and nine mice were untreated controls. Slit lamp biomicroscopy was used to analyze the lens in live animals and to provide apparent cataract grades. Refractive index in the lenses of 64 unfixed whole mouse eyes was calculated from measurements with X-ray phase tomography based on X-ray Talbot interferometry with a synchrotron radiation source.

Results

Heterozygous Cryaa-R49C lenses had slightly irregularly shaped contours in the center of the GRIN and distinct disturbances of the gradient index at the anterior and posterior poles. Contours near the lens surface were denser in homozygous Cryab-R120G lenses. Treatment with topical VP1-001, an oxysterol, showed an improvement in refractive index profiles in 61% of lenses and this was supported by a reduction in apparent lens opacity grade by 1.0 in 46% of live mice.

Conclusions

These results indicate that α-crystallin mutations alter the refractive index gradient of mouse lenses in distinct ways and suggest that topical treatment with VP1-001 may improve lens transparency and refractive index contours in some lenses with mutations.

Nanoceria Prevents Glucose-Induced Protein Glycation in Eye Lens Cells

Cerium oxide nanoparticles (nanoceria) are generally known for their recyclable antioxidative properties making them an appealing biomaterial for protecting against physiological and pathological age-related changes that are caused by reactive oxygen species (ROS). Cataract is one such pathology that has been associated with oxidation and glycation of the lens proteins (crystallins) leading to aggregation and opacification. A novel coated nanoceria formulation has been previously shown to enter the human lens epithelial cells (HLECs) and protect them from oxidative stress induced by hydrogen peroxide (H2O2). In this work, the mechanism of nanoceria uptake in HLECs is studied and multiple anti-cataractogenic properties are assessed in vitro. Our results show that the nanoceria provide multiple beneficial actions to delay cataract progression by (1) acting as a catalase mimetic in cells with inhibited catalase, (2) improving reduced to oxidised glutathione ratio (GSH/GSSG) in HLECs, and (3) inhibiting the non-enzymatic glucose-induced glycation of the chaperone lens protein α-crystallin. Given the multifactorial nature of cataract progression, the varied actions of nanoceria render them promising candidates for potential non-surgical therapeutic treatment.

Single function crystalline lens capable of mimicking ciliary body accommodation

The lens is a complex optical component of the human eye because of its physiological structure: the surface is aspherical and the structural entities create a gradient refractive index (GRIN). Most existent models of the lens deal with its external shape independently of the refractive index and, subsequently, through optimization processes, adjust the imaging properties. In this paper, we propose a physiologically realistic GRIN model of the lens based on a single function for the whole lens that accurately describes different accommodative states simultaneously providing the corresponding refractive index distribution and the external shape of the lens by changing a single parameter that we associate with the function of the ciliary body. This simple, but highly accurate model, is incorporated into a schematic eye constructed with reported experimental biometric data and accommodation is simulated over a range of 0 to 6 diopters to select the optimum levels of image quality. Changes with accommodation in equatorial and total axial lens thicknesses, as well as aberrations, are found to lie within reported biometric data ranges.

Optical development in the zebrafish eye lens

The optics of the eye is the key to a functioning visual system. The exact nature of the correlation between ocular optics and eye development is not known because of the paucity of knowledge about the growth of a key optical element, the eye lens. The sophisticated optics of the lens and its gradient of refractive index provide the superior optical quality that the eye needs and which, it is thought, has a major influence on the development of proper visual function. The nature of a gradient refractive index lens, however, renders accurate measurements of its development difficult to make and has been the reason why the influence of lens growth on visual function remains largely unknown. Novel imaging techniques have made it possible to investigate growth of the eye lens in the zebrafish. This study shows measurements using X-ray Talbot interferometry of three-dimensional gradient index profiles in eye lenses of zebrafish from late larval to adult stages. The zebrafish lens shows evidence of a gradient of refractive index from the earliest stages measured and its growth suggests an apparent coincidence between periods of rapid increase in refractive index in the lens nucleus and increased expression of a particular crystallin protein group.

Big Data and diabetes: the applications of Big Data for diabetes care now and in the future

We review current applications of Big Data in diabetes care and consider the future potential by carrying out a scoping study of the academic literature on Big Data and diabetes care. Healthcare data are being produced at ever-increasing rates, and this information has the potential to transform the provision of diabetes care. Big Data is beginning to have an impact on diabetes care through data research. The use of Big Data for routine clinical care is still a future application. Vast amounts of healthcare data are already being produced, and the key is harnessing these to produce actionable insights. Considerable development work is required to achieve these goals.

Image registration of the human accommodating eye demonstrates equivalent increases in lens equatorial radius and central thickness

AIM

To compare the results of in vivo human high resolution image registration studies of the eye during accommodation to the predictions of mathematical and finite element models of accommodation.

METHODS

Data from published high quality image registration studies of pilocarpine induced accommodative changes of equatorial lens radius (ELR) and central lens thickness (CLT) were statistically analyzed.

RESULTS

The mean changes in ELR and CLT were 6.76 µm/diopter and 6.51 µm/diopter, respectively. The linear regressions, reflecting the association between ELR and accommodative amplitude (AAELR) was: slope=6.58 µm/diopter, r2 =0.98, P<0.0001 and between CLT and AACLT was: slope=6.75 µm/diopter, r2 =0.83, P<0.001. On the basis of these relationships, the CLT slope and the AAELR were used to predict the measured change in ELR (ELRpredicted). There was no statistical difference between ELRpredicted and the measured ELR as demonstrated by a Student's paired t-test: P=0.96 and linear regression analysis: slope=0.97, r2 =0.98, P<0.00001.

CONCLUSION

Image registration with invariant positional references demonstrates that ELR and CLT equivalently minimally increase ∼7.0 µm/diopter during accommodation. The small equivalent increases in ELR and CLT are associated with a large accommodative amplitude. These findings are consistent with the predictions of mathematical and finite element models that specified the stiffness of the lens nucleus is the same or greater than the lens cortex and that accommodation involves a small force (<5 g).

A Modeling Approach for Investigating Opto-Mechanical Relationships in the Human Eye Lens

OBJECTIVE

The human visual system alters its focus by a shape change of the eye lens. The extent to which the lens can adjust ocular refractive power is dependent to a significant extent on its material properties. Yet, this fundamental link between the optics and mechanics of the lens has been relatively under-investigated. This study aims to investigate this opto-mechanical link within the eye lens to gain insight into the processes of shape alteration and their respective decline with age.

METHODS

Finite Element models based on biological lenses were developed for five ages: 16, 35, 40, 57, and 62 years by correlating in vivo measurements of the longitudinal modulus using Brillouin scattering with in vitro X-ray interferometric measurements of refractive index and taking into account various directions of zonular force.

RESULTS

A model with radial cortical Young's moduli provides the same amount of refractive power with less change in thickness than a model with uniform cortical Young's modulus with a uniform stress distribution and no discontinuities along the cortico-nuclear boundary. The direction of zonular angles can significantly influence curvature change regardless of the modulus distribution.

CONCLUSIONS

The present paper proposes a modelling approach for the human lens, coupling optical and mechanical properties, which shows the effect of parameter choice on model response.

SIGNIFICANCE

This advanced modelling approach, considering the important interplay between optical and mechanical properties, has potential for use in design of accommodating implant lenses and for investigating non-biological causes of pathological processes in the lens (e.g., cataract).

Contributions of shape and stiffness to accommodative loss in the ageing human lens: a finite element model assessment

Ageing changes to the various components of the accommodative system of the eye lens contribute to the loss of focusing power. The relative contributions of each ageing component, however, are not well defined. This study investigates the contribution of geometric parameters and material properties on accommodation, simulated using models based on human lenses aged 16, 35, and 48 years. Each model was tested using two different sets of material properties and a range of zonular fiber angles and was compared to results from in vivo measurements. The geometries and material parameters of older and younger lens models were interchanged to investigate the role of shape and material on accommodative capacity. Results indicate that geometry has the greater role in accommodation.

Maximum human objectively measured pharmacologically stimulated accommodative amplitude

Purpose

To measure the maximum, objectively measured, accommodative amplitude, produced by pharmacologic stimulation.

Methods

Thirty-seven healthy subjects were enrolled, with a mean age of 20.2±1.1 years, corrected visual acuity of 20/20, and mean spherical equivalent refraction (SER) =-0.83±1.60 diopters. For each subject, the right pupil was dilated with phenylephrine 10%. After 30 minutes, the pupil was measured, the left eye was patched, and the right eye was autorefracted. Pilocarpine 4% was then instilled in the right eye, followed by phenylephrine. At 45 minutes after the pilocarpine, autorefraction and pupil size were again measured.

Results

Mean pupil size pre- and postpilocarpine was 8.0±0.8 mm and 4.4±1.9 mm, respectively. Pre- and postpilocarpine, the mean SER was -0.83±1.60 and -10.55±4.26 diopters, respectively. The mean pilocarpine-induced accommodative amplitude was 9.73±3.64 diopters. Five subjects had accommodative amplitudes ≥14.00 diopters. Accommodative amplitude was not significantly related to baseline SER (p-value =0.24), pre- or postpilocarpine pupil size (p-values =0.13 and 0.74), or change in pupil size (p-value =0.37). Iris color did not statistically significantly affect accommodative amplitude (p-value =0.83).

Conclusion

Following topically applied pilocarpine, the induced objectively measured accommodation in the young eye is greater than or equal to the reported subjectively measured voluntary maximum accommodative amplitude.

A critique of the regulation of data science in healthcare research in the European Union

The EU offers a suitable milieu for the comparison and harmonisation of healthcare across different languages, cultures, and jurisdictions (albeit with a supranational legal framework), which could provide improvements in healthcare standards across the bloc. There are specific ethico-legal issues with the use of data in healthcare research that mandate a different approach from other forms of research. The use of healthcare data over a long period of time is similar to the use of tissue in biobanks. There is a low risk to subjects but it is impossible to gain specific informed consent given the future possibilities for research. Large amounts of data on a subject present a finite risk of re-identification. Consequently, there is a balancing act between this risk and retaining sufficient utility of the data. Anonymising methods need to take into account the circumstances of data sharing to enable an appropriate balance in all cases. There are ethical and policy advantages to exceeding the legal requirements and thereby securing the social licence for research. This process would require the examination and comparison of data protection laws across the trading bloc to produce an ethico-legal framework compatible with the requirements of all member states. Seven EU jurisdictions are given consideration in this critique.

Gradient moduli lens models: how material properties and application of forces can affect deformation and distributions of stress

The human lens provides one-third of the ocular focussing power and is responsible for altering focus over a range of distances. This ability, termed accommodation, defines the process by which the lens alters shape to increase or decrease ocular refractive power; this is mediated by the ciliary muscle through the zonule. This ability decreases with age such that around the sixth decade of life it is lost rendering the eye unable to focus on near objects. There are two opponent theories that provide an explanation for the mechanism of accommodation; definitive support for either of these requires investigation. This work aims to elucidate how material properties can affect accommodation using Finite Element models based on interferometric measurements of refractive index. Gradients of moduli are created in three models from representative lenses, aged 16, 35 and 48 years. Different forms of zonular attachments are studied to determine which may most closely mimic the physiological form by comparing stress and displacement fields with simulated shape changes to accommodation in living lenses. The results indicate that for models to mimic accommodation in living eyes, the anterior and posterior parts of the zonule need independent force directions. Choice of material properties affects which theory of accommodation is supported.

Alteration in refractive index profile during accommodation based on mechanical modelling

The lens of the eye has a gradient refractive index (GRIN). Ocular accommodation, which alters the shape of the lens in response to visual demand, causes a redistribution of the internal structure of the lens leading to a change in the GRIN profile. The nature of this redistribution and the consequence of change in the GRIN profile are not understood. A modelling approach that considers how the GRIN profile may change with accommodation needs to take into account optical and mechanical parameters and be cognisant of individual variability in the shape and size of lenses. This study models the normalised axial GRIN profile during accommodation using reduced modelling and incorporating finite element analysis to connect inhomogenous mechanical characteristics of the lens to optical performance. The results show that simulated stretching changes the length of the plateau but does not alter the cortical gradient, which supports clinical findings. There is a very small change to the accommodated and non-accommodated profiles when normalised, yet this yields measurable changes in aberrations with around 11% and almost 13% difference in spherical aberration and astigmatism respectively. The results can be used in reconstruction of the refractive index and for investigating gradual changes with age.

Composite modified Luneburg model of human eye lens

A new lens model based on the gradient-index Luneburg lens and composed of two oblate half spheroids of different curvatures is presented. The spherically symmetric Luneburg lens is modified to create continuous isoindicial contours and to incorporate curvatures that are similar to those found in a human lens. The imaging capabilities of the model and the changes in the gradient index profile are tested for five object distances, for a fixed geometry and for a fixed image distance. The central refractive index decreases with decreasing object distance. This indicates that in order to focus at the same image distance as is required in the eye, a decrease in refractive power is needed for rays from closer objects that meet the lens surface at steeper angles compared to rays from more distant objects. This ensures a highly focused image with no spherical aberration.

The Effect of Cataract on Early Stage Glaucoma Detection Using Spatial and Temporal Contrast Sensitivity Tests

BACKGROUND

To investigate the effect of cataract on the ability of spatial and temporal contrast sensitivity tests used to detect early glaucoma.

METHODS

Twenty-seven glaucoma subjects with early cataract (mean age 60 ± 10.2 years) which constituted the test group were recruited together with twenty-seven controls (cataract only) matched for age and cataract type from a primary eye care setting. Contrast sensitivity to flickering gratings at 20 Hz and stationary gratings with and without glare, were measured for 0.5, 1.5 and 3 cycles per degree (cpd) in central vision. Perimetry and structural measurements with the Heidelberg Retinal Tomograph (HRT) were also performed.

RESULTS

After considering the effect of cataract, contrast sensitivity to stationary gratings was reduced in the test group compared with controls with a statistically significant mean difference of 0.2 log units independent of spatial frequency. The flicker test showed a significant difference between test and control group at 1.5 and 3 cpd (p = 0.019 and p = 0.011 respectively). The percentage of glaucoma patients who could not see the temporal modulation was much higher compared with their cataract only counterparts. A significant correlation was found between the reduction of contrast sensitivity caused by glare and the Glaucoma Probability Score (GPS) as measured with the HRT (p<0.005).

CONCLUSIONS

These findings indicate that both spatial and temporal contrast sensitivity tests are suitable for distinguishing between vision loss as a consequence of glaucoma and vision loss caused by cataract only. The correlation between glare factor and GPS suggests that there may be an increase in intraocular stray light in glaucoma.

Analytical and physicochemical characterisation of the senile cataract drug dipeptide β-alanyl-L-histidine (carnosine)

This study presents a simple but sensitive HPLC chromatographic method with a stability-indicating assay for determination and physicochemical characterisation of L-carnosine, a promising senile cataract prophylactic agent. Chromatographic analysis was conducted using a reverse phase (RP)-HPLC system and an isocratic mobile phase of 98% v/v trifluoroacetic acid (0.1% v/v) and 2% v/v acetonitrile with detection at 220 nm. L-carnosine was subjected to stress conditions to force its degradation using chemical and thermal agents and was subsequently detected from its degradation products using ESI-MS. The lipophilicity of the drug and 1:1 drug to phospholipid complex (PC) mol/mol was determined by estimating the partition coefficient (P). Lipophilicity was greatly enhanced when L-carnosine was formulated as a phospholipid complex using the solvent evaporation method. L-carnosine-phospholipid complex could be a promising approach for effective delivery to the human lens as offers a potential novel treatment for senile cataract.

Adjustable internal structure for reconstructing gradient index profile of crystalline lens

Employing advanced technologies in studying the crystalline lens of the eye has improved our understanding of the refractive index gradient of the lens. Reconstructing and studying such a complex structure requires models with adaptable internal geometry that can be altered to simulate geometrical and optical changes of the lens with aging. In this Letter, we introduce an optically well-defined, geometrical structure for modeling the gradient refractive index profile of the crystalline lens with the advantage of an adjustable internal structure that is not available with existing models. The refractive index profile assigned to this rotationally symmetric geometry is calculated numerically, yet it is shown that this does not limit the model. The study provides a basis for developing lens models with sophisticated external and internal structures without the need for analytical solutions to calculate refractive index profiles.

Crystallin distribution patterns in Litoria infrafrenata and Phyllomedusa sauvagei lenses

The eye lens remains transparent because of soluble lens proteins known as crystallins. For years γ-crystallins have been known as the main lens proteins in lower vertebrates such as fish and amphibians. The unique growth features of the lens render it an ideal structure to study ageing; few studies have examined such changes in anuran lenses. This study aimed to investigate protein distribution patterns in Litoria infrafrenata and Phyllomedusa sauvagei species. Lenses were fractionated into concentric layers by controlled dissolution. Water-soluble proteins were separated into high (HMW), middle (MMW) and low molecular weight (LMW) fractions by size-exclusion HPLC and constituents of each protein class revealed by 1DE and 2DE. Spots were selected from 2DE gels on the basis of known ranges of subunit molecular weights and pH ranges and were identified by MALDI-TOF/TOF MS following trypsin digestion. Comparable lens distribution patterns were found for each species studied. Common crystallins were detected in both species; the most prominent of these was γ-crystallin. Towards the lens centre, there was a decrease in α- and β-crystallin proportions and an increase in γ-crystallins. Subunits representing taxon-specific crystallins demonstrating strong sequence homology with ζ-crystallin/quinone oxidoreductase were found in both L. infrafrenata and P. sauvagei lenses. Further work is needed to determine which amphibians have taxon-specific crystallins, their evolutionary origins, and their function.

Age variations in intraocular pressure in a cohort of healthy Austrian school children

PURPOSE

Limited data exist detailing the normal range of intraocular pressure (IOP) for healthy school age children. This study aims to describe the mean and normal range of IOP measurements that may be expected using the Icare rebound tonometer and to examine associations between visual function measures and IOP.

METHODS

Six measurements of IOP from each eye were obtained from 211 normal children aged 6-15 years (79 females and 132 males) using the Icare tonometer. Other measures of visual function obtained included: visual acuity, non-cycloplegic retinoscopy, amplitude of accommodation, accommodative facility, and accommodative response.

RESULTS

Statistical analysis (Mann-Whitney U test) demonstrated that the male subjects were more likely to have higher IOP measurements than the female subjects (mean IOP males 15.02 mm Hg (SD 2.19), mean IOP females 14.44 (SD 2.01) P=0.041). Analysis (Spearman's rho) showed a statistically significant association between age and IOP (right eye) in males (P<0.001) but no association for females (P=0.459). Using Spearman's rank analysis, statistically significant associations were found between IOP and amplitude of accommodation in males, for the whole data set (P=0.09) and for data up to age 11 (P<0.001). For females no statistically significant association was found for the whole data set (P=0.253) or for data up to age 11 (P=0.08). IOP was not significantly associated with visual acuity, refractive error, accommodative facility, or accommodative response.

CONCLUSION

This study provides useful normative IOP data using the Icare tonometer for a European cohort of school age children.

An evaluation of clinical treatment of convergence insufficiency for children with reading difficulties

Background

The present study investigates two different treatment options for convergence insufficiency CI for a group of children with reading difficulties referred by educational institutes to a specialist eye clinic in Vienna.

Methods

One hundred and thirty four subjects (aged 7-14 years) with reading difficulties were referred from an educational institute in Vienna, Austria for visual assessment. Each child was given either 8Δ base-in reading spectacles (n = 51) or computerised home vision therapy (HTS) (n = 51). Thirty two participants refused all treatment offered (clinical control group). A full visual assessment including reading speed and accuracy were conducted pre- and post-treatment.

Results

Factorial analyses demonstrated statistically significant changes between results obtained for visits 1 and 2 for total reading time, reading error score, amplitude of accommodation and binocular accommodative facility (within subjects effects) (p < 0.05). Significant differences were also demonstrated between treatment groups for total reading time, reading error score and binocular accommodative facility (between subjects effects) (p < 0.05).

Conclusions

Reading difficulties with no apparent intellectual or psychological foundation may be due to a binocular vision anomaly such as convergence insufficiency. Both the HTS and prismatic correction are highly effective treatment options for convergence insufficiency. Prismatic correction can be considered an effective alternative to HTS.

The current limitations on tissue banking from an academic perspective

For research on human physiology and pathologies the most relevant results come from human tissue, necessitating the creation of more tissue banks. This need is acknowledged by academics, clinical researchers and the pharmaceutical industry. For academics, the major obstacles to establishing tissue banks are the somewhat cumbersome ethical procedures, a perceived lack of demand for human tissue and insufficient knowledge about supply and its demographic differences. The causes are inter-related: confusing and time-consuming ethics applications cause some researchers to avoid human tissue work and expend research efforts on animal studies, leading to a false presumption of a lower level of demand for human tissue. Lack of knowledge about why rates of donation are low, and why there are differences in donation for different organs, leads to an uncertainty about supply. This too poses a problem for tissue bank establishment, and further research into this area is required.

Dynamic iris biometry: a technique for enhanced identification

BACKGROUND

The iris as a unique identifier is predicated on the assumption that the iris image does not alter. This does not consider the fact that the iris changes in response to certain external factors including medication, disease, surgery as well as longer term ageing changes. It is also part of a dynamic optical system that alters with light level and focussing distance. A means of distinguishing the features that do not alter over time from those that do is needed. This paper applies iris recognition algorithms to a newly acquired database of 186 iris images from four subjects. These images have greater magnification and detail than iris images in existing databases. Iris segmentation methods are tested on the database. A new technique that enhances segmentation is presented and compared to two existing methods. These are also applied to test the effects of pupil dilation in the identification process.

FINDINGS

Segmentation results from all the images showed that using the proposed algorithm accurately detected pupil boundaries for 96.2% respectively of the images, which was an increase of 88.7% over the most commonly used algorithm. For the images collected, the proposed technique also showed significant improvement in detection of the limbal boundary compared to the detection rates using existing methods. With regard to boundary displacement errors, only slight errors were found with the proposed technique compared to extreme errors made when existing techniques were applied. As the pupil becomes more dilated, the success of identification is increasingly more dependent on the decision criterion used.

CONCLUSIONS

The enhanced segmentation technique described in this paper performs with greater accuracy than existing methods for the higher quality images collected in this study. Implementation of the proposed segmentation enhancement significantly improves pupil boundary detection and therefore overall iris segmentation. Pupil dilation is an important aspect of iris identification; with increasing dilation, there is a greater risk of identification failure. Choice of decision criterion for identification should be carefully reviewed. It needs to be recognised that differences in the quality of images in different databases may result in variations in the performance of iris recognition algorithms.

A survey of visual function in an Austrian population of school-age children with reading and writing difficulties

Background

To describe and compare visual function measures of two groups of school age children (6-14 years of age) attending a specialist eyecare practice in Austria; one group referred to the practice from educational assessment centres diagnosed with reading and writing difficulties and the other, a clinical age-matched control group.

Methods

Retrospective clinical data from one group of subjects with reading difficulties (n = 825) and a clinical control group of subjects (n = 328) were examined.

Statistical analysis was performed to determine whether any differences existed between visual function measures from each group (refractive error, visual acuity, binocular status, accommodative function and reading speed and accuracy).

Results

Statistical analysis using one way ANOVA demonstrated no differences between the two groups in terms of refractive error and the size or direction of heterophoria at distance (p > 0.05). Using predominately one way ANOVA and chi-square analyses, those subjects in the referred group were statistically more likely to have poorer distance visual acuity, an exophoric deviation at near, a lower amplitude of accommodation, reduced accommodative facility, reduced vergence facility, a reduced near point of convergence, a lower AC/A ratio and a slower reading speed than those in the clinical control group (p < 0.05).

Conclusions

This study highlights the high proportions of visual function anomalies in a group of children with reading difficulties in an Austrian population. It confirms the importance of a full assessment of binocular visual status in order to detect and remedy these deficits in order to prevent the visual problems continuing to impact upon educational development.

Nanoceria have no genotoxic effect on human lens epithelial cells

There are no treatments for reversing or halting cataract, a disease of the structural proteins in the eye lens, that has associations with other age-related degenerative conditions such as Alzheimer's disease. The incidence of cataract and associated conditions is increasing as the average age of the population rises. Protein folding diseases are difficult to assess in vivo as proteins and their age-related changes are assessed after extraction. Nanotechnology can be used to investigate protein changes in the intact lens as well as for a potential means of drug delivery. Nanoparticles, such as cerium oxide (CeO(2)) which have antioxidant properties, may even be used as a means of treating cataract directly. Prior to use in treatments, nanoparticle genotoxicity must be tested to assess the extent of any DNA or chromosomal damage. Sister chromatid exchanges were measured and DNA damage investigated using the alkaline COMET assay on cultured human lens epithelial cells, exposed to 5 and 10 microg ml(-1) of CeO(2) nanoparticles (nanoceria). Nanoceria at these dosages did not cause any DNA damage or significant increases in the number of sister chromatid exchanges. The absence of genotoxic effects on lens cells suggests that nanoceria, in the doses and exposures tested in this study, are not deleterious to the eye lens and have the potential for use in studying structural alterations, in developing non-surgical cataract treatments and in investigating other protein folding diseases.

Referrals to ophthalmology: optometric and general practice comparison

PURPOSE

To assess referrals from primary care practitioners to an ophthalmological practice in order to determine whether any differences exist between the two primary care groups in the types of conditions referred, and in concurrence between reasons for referral and ophthalmological diagnosis.

METHODS

This study investigated patient referrals from general practitioners and optometrists to an ophthalmologist's practice in Belfast, over a period of 3 months from January 2007 to the end of March 2007. Anonymised data were divided into two groups depending on the referring practitioner. Within the two groups, patient numbers were sub-divided into 15 categories covering the range of diagnoses made. Preliminary diagnoses or reasons for referral were compared with the definitive diagnoses made by the ophthalmologist.

RESULTS

Optometrists contributed the greatest number of referrals (323) with 243 patients referred by general practitioners. Cataract was the most common condition referred by optometrists, and the second most common condition referred by general practitioners: agreement with ophthalmological diagnosis was high for both groups of primary care practitioners. Concurrence of referral reason with ophthalmological diagnosis for glaucoma was lower for general practitioners (56%) than for optometrists (76%), but optometrists referred more false positive patients for glaucoma than did general practitioners. The opposite was true for lid/tear duct/conjunctival conditions, the most common basis for referral by general practitioners.

CONCLUSIONS

The differences between the two primary care practitioner groups may reflect variations in training, skills and practice. Further investigation of the particular strengths of both groups, and how they can be optimised to promote effective shared care, is required.

The elasticity and rigidity of the outer coats of the eye

AIMS

The aim of this study was to measure the elastic moduli of the cornea and sclera and the rigidity of the eyeball.

METHODS

Elastic moduli of the cornea and sclera were measured on 22 fresh intact porcine eyes using the relationship between elasticity and changes in pressure and volume applicable to pressure vessel models. Rigidity was determined from the relationship between changes in volume and intraocular pressure (IOP). Induced volume changes were up to 300 mul and within the physiological range of IOP (12-25 mm Hg). IOP readings taken with a transducer were used in calculations. Tonometric values were taken for comparison.

RESULTS

For cornea and sclera, the relationship between circumferential stress and volumetric strain (which defines the elastic modulus) was closely approximated to linear (R(2) = 0.96), but better fitted with a second order polynomial (R(2) = 1.00). Elastic moduli ranged from 0.05 to 0.24 MPa and 0.15 to 0.83 MPa for the cornea and sclera, respectively. The mean value of ocular rigidity was found to be 0.0024. The effect of increasing IOP on the average corneal radius of curvature was not statistically significant, but it altered the scleral radius of curvature by 0.07 mm/mmHg.

CONCLUSION

The elasticity of the porcine cornea and sclera could be approximated to constant over the physiological range, but showed a tendency to non-linearity. The modulus of elasticity for the sclera is 3 to 3.5 times that of the cornea. The cornea is more resistant than the sclera to IOP changes within the physiological range.

Effect of material properties of the eyeball coat on optical image stability

The dynamics of the eyeball, most notably the changes in intraocular pressure, need to be stabilized optically to prevent noticeable changes in image quality. This control depends on the rheological properties of the eyeball coats and how the elasticity of the cornea, sclera, and limbus vary relative to one another. Nonlinear finite element modeling shows that image quality can be preserved over a range of elastic moduli. For intraocular pressure variations from 8 to 40 mm Hg, optical image stability is best for an elastic secant modulus of the cornea of 0.267 MPa. Optimal quality is achieved when the elastic moduli of the limbus and sclera are, respectively, 3.6 and 4 times that of the corneal modulus.

What is presumed when we presume consent?

BACKGROUND

The organ donor shortfall in the UK has prompted calls to introduce legislation to allow for presumed consent: if there is no explicit objection to donation of an organ, consent should be presumed. The current debate has not taken in account accepted meanings of presumption in law and science and the consequences for rights of ownership that would arise should presumed consent become law. In addition, arguments revolve around the rights of the competent autonomous adult but do not always consider the more serious implications for children or the disabled.

DISCUSSION

Any action or decision made on a presumption is accepted in law and science as one based on judgement of a provisional situation. It should therefore allow the possibility of reversing the action or decision. Presumed consent to organ donation will not permit such reversal. Placing prime importance on the functionality of body organs and their capacity to sustain life rather than on explicit consent of the individual will lead to further debate about rights of ownership and potentially to questions about financial incentives and to whom benefits should accrue. Factors that influence donor rates are not fully understood and attitudes of the public to presumed consent require further investigation. Presuming consent will also necessitate considering how such a measure would be applied in situations involving children and mentally incompetent adults.

SUMMARY

The presumption of consent to organ donation cannot be understood in the same way as is presumption when applied to science or law. Consideration should be given to the consequences of presuming consent and to the questions of ownership and organ monetary value as these questions are likely to arise should presumed consent be permitted. In addition, the implications of presumed consent on children and adults who are unable to object to organ donation, requires serious contemplation if these most vulnerable members of society are to be protected.

Optical coherence tomography measurements of the fresh porcine eye and response of the outer coats of the eye to volume increase

Corneal and scleral thickness and anterior chamber dimensions are required for understanding developmental and pathological processes. Parameters of the eyeball are also required to calculate optical and material properties. As the eyeball resembles a pressure vessel, it has been suggested that elasticity of the cornea and sclera could be calculated from the measurements of thickness. Baseline corneal and scleral thicknesses and anterior chamber dimensions and how these change with incremental increases of intraocular fluid are measured in fresh porcine eyes using the Visante OCT (optical coherence tomography). At baseline, corneal thickness is almost constant. Anterior scleral thickness is variable, decreasing from 0.91+/-0.07 mm near the limbus to a minimum of 0.58+/-0.13. Posterior scleral thickness is more constant with an average of 0.78+/-0.09 mm. Near the optic nerve the thickness increases to 1.00+/-0.09 mm. Average baseline anterior chamber angle, diameter, and depth were found to be 33.15+/-4.91 deg, 13.60+/-0.38 mm, and 2.13+/-0.22 mm, respectively. After fluid injections, maximum changes in corneal and scleral thicknesses were 9 to 10 and 1 to 3%, respectively. Anterior chamber angle and depth decreased slightly but significantly. Changes in the eyeball coats with fluid injections, indicate that the pressure vessel model can be applied to the eye to calculate corneal and scleral elasticities.

Diffusion of nanoparticles into the capsule and cortex of a crystalline lens

The purpose of this study is to determine the ability of fluorescent nanoparticles to diffuse into a crystalline lens. Intact porcine lenses from five-month-old pigs, intact human lenses obtained from three donors aged 41, 42 and 45 years, and sections of human lens cortex obtained from four donors aged 11, 19, 32, and 34 years were incubated for 72 h at 7 °C in aqueous solutions of green (566 nm) and red (652 nm) fluorescent water soluble cadmium tellurium (CdTe) nanoparticles. As demonstrated by fluorescent and confocal microscopy, the CdTe nanoparticles diffused into the porcine and human lens capsule and into human cortical lens fibres; however, the nanoparticles did not pass through the intact lens capsule. Nanoparticles can be used as a method for studying intracellular structure and biochemical pathways within the lens capsule and cortical lens fibres to further understand cataractogenesis and may serve as a carrier for chemotherapeutic agents for the potential treatment of primary and secondary cataracts.

Children, Gillick competency and consent for involvement in research

This paper looks at the issue of consent from children and whether the test of Gillick competency, applied in medical and healthcare practice, ought to extend to participation in research. It is argued that the relatively broad usage of the test of Gillick competency in the medical context should not be considered applicable for use in research. The question of who would and could determine Gillick competency in research raises further concerns relating to the training of the researcher to make such a decision as well as to the obvious issue of the researcher's personal interest in the project and possibility of benefiting from the outcome. These could affect the judgment of Gillick competency if the researcher is charged with making this decision. The above notwithstanding, there are two exceptional research situations in which Gillick competency might be legitimately applied: (1) when the research is likely to generate significant advantages for the participants while exposing them to relatively minor risks, and (2) when it is likely to generate great societal benefit, pose minimal risks for the participants and yet raise parental objection. In both cases, to ensure that autonomy is genuinely respected and to protect against personal interest, Gillick competency should be assessed by an individual who has no interest or involvement in the research.