Factors associated with serum/plasma concentrations of vitamins A, C, E and carotenoids in older people throughout Europe: the EUREYE study.

PURPOSE: To report on plasma/serum levels of antioxidant vitamin and carotenoids in older adults resident in multiple countries in Europe and examine relationships with potential modifiers. METHODS: Population-based cross-sectional European Eye Study in 7 centres from northern to southern Europe. In total, 4,133 participants aged 65 years or over, collected by random sampling, were recruited. Questionnaires relating to diet, lifestyle and medical history were administered. Non-fasting blood samples were analysed in a single laboratory for vitamins A, C and E and a panel of carotenoids. Associations were analysed by bootstrapped multivariable regression analysis. RESULTS: Centre and season influenced the serum and plasma concentrations of all antioxidant vitamins and carotenoids. Gender, BMI, smoking, age, education, alcohol consumption and supplement use were also significantly associated with some, but not all, of the antioxidant vitamins and carotenoids examined. The proportion of variance explained ranged from 4.8 % for retinol to 25.2 % for zeaxanthin. CONCLUSIONS: In older people, antioxidant vitamin and carotenoid status varies by centre and season, but is also associated with other behavioural and lifestyle variables. Studies aiming to demonstrate an association between antioxidant vitamins and carotenoid status and chronic disease risk should consider these potential confounders.

Cigarette smoking and age-related macular degeneration in the EUREYE Study.

OBJECTIVE: To examine the association between cigarette smoking and age-related maculopathy (ARM) including age-related macular degeneration (AMD) in the European population. DESIGN: Cross-sectional study. PARTICIPANTS: Four thousand seven hundred fifty randomly sampled > or =65-year-olds from 7 study centers across Europe (Norway, Estonia, United Kingdom, France, Italy, Greece, and Spain). METHODS: Participants underwent an eye examination and digital retinal photography. The images were graded at a single center. Smoking history was ascertained by a structured questionnaire administered by trained fieldworkers. Multinomial and binary logistic regressions were used to examine the association between smoking history and ARM grade and type of AMD, taking account of potential confounders and the multicenter study design. MAIN OUTCOME MEASURES: Photographic images were graded according to the International Classification System for ARM and stratified using the Rotterdam staging system into 5 exclusive stages (ARM 0-3 and ARM 4, also known as AMD). Age-related macular degeneration also was classified as neovascular AMD or geographic atrophy (GA). RESULTS: One hundred fifty-eight cases were categorized as AMD (109 neovascular AMD and 49 GA); 2260 had no signs of ARM (ARM 0). Current smokers had increased odds of neovascular AMD (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4-4.8) or GA (OR, 4.8; 95% CI, 2.1-11.1), whereas for ex-smokers the odds were around 1.7. Compared with people with unilateral AMD, those with bilateral AMD were more likely to have a history of heavy smoking in the previous 25 years (OR, 5.1; 95% CI, 1.3-20.0). The attributable fraction for AMD due to smoking was 27% (95% CI, 19%-33%). There was no consistent association with ARM grades 1 to 3 and smoking. CONCLUSIONS: These findings highlight the need for increasing public awareness of the risks associated with smoking and the benefit of quitting smoking. Patients with unilateral disease who are current smokers should be advised of the risk of second-eye disease.

Subconjunctival injections. Preservative-related changes in the corneal endothelium.

The morphologic effects on rabbit corneal endothelium of several common ophthalmic vehicle constituents were examined following subconjunctival administration. Profound dose-dependent changes consisting of intercellular vacuolization and thickening of the endothelial layer were noted within 1 day following administration of solutions that contained sodium bisulfite or methylparaben and propylparaben. These changes persisted for at least 5 days except in those eyes treated with the lowest concentration of sodium bisulfite. In contrast, administration of sodium citrate and creatinine or unpreserved normal saline resulted in only minimal effects. These changes are of concern because these agents are present in many preparations used to treat a wide variety of eye diseases.

Hemiretinal differences in speed of light detection in esotropic amblyopes.

Nine esotropic amblyopes were tested monocularly in a simple reaction time (RT) paradigm with brief suprathreshold flashes of light presented at various eccentricities along the horizontal meridian of the nasal or temporal hemiretinae. All were clinically amblyopic in one eye only. RT was significantly longer in the amblyopic than in the other eye at 1, 5 and 10 deg but not at 25 and 35 deg from the fovea. Another clearcut finding concerned hemiretinal differences: in the non-amblyopic eye, as in control subjects, RT was faster in the nasal than in the temporal hemiretina and such a difference increased with the eccentricity of stimulus presentation. In the amblyopic eye, however, the only significant hemiretinal effect was at 10 deg with a temporal retina advantage and at 35 deg with a nasal retinal advantage. Furthermore, unlike in normal control subjects and the non-amblyopic eye of our esotropes, in the amblyopic eye there was no increase in RT with the eccentricity of stimulus presentation, except for the most peripheral visual field positions. It can be concluded that esotropic amblyopia affects the speed of suprathreshold light detection in the most central 10 deg of visual field and that the nasal hemiretina is clearly more impaired than the temporal hemiretina.

Tuberculoma of the anterior optic pathways. Case report.

A tuberculoma, encasing the anterior optic pathways in a neoplastiform growth, was found in a 25-year-old man complaining of severe visual loss, diabetes insipidus, and sexual impotence following tuberculous meningitis. Following biopsy and anti-tuberculosis treatment, a satisfactory restoration of sight in one eye allowed the patient to resume an almost normal life.

Eye injuries in childhood: a retrospective investigation of 88 cases from 1988 to 2000.

PURPOSE: To assess the frequency, causes, mechanisms, and functional outcomes of eye injuries in childhood. METHODS: A retrospective analysis of the hospital files of patients younger than 12 years admitted to the Institute of Ophthalmology of Verona University for eye injuries from January 1, 1988, to December 31, 2000. RESULTS: Eighty-eight cases of eye injuries (69 [78%] boys, 19 [22%] girls) were identified. The mean age at admission was 7.2 years. The most frequent causes of eye injuries were domestic accidents in patients younger than 6 years (25%) and accidents at play in those older than 6 years (35%). Scissors were the most frequent causative agents in children under 6 and toys, stones, and ball injuries in those over 6. Diagnoses, therapies implemented, ocular complications, and outcomes are reported. CONCLUSIONS: The major causes of eye injuries in childhood are preventable; thus more adequate adult supervision and educational and legislative measures are necessary and useful in order to reduce prevalence and morbidity of these accidents.

Ophthalmologic follow-up of premature twins and triplets.

PURPOSE: To assess the influence of multiple gestation on the visual apparatus and on the general state of health of premature infants and to investigate the condition of the twin or triplet with the lowest birth weight compared to multiple gestation siblings. METHODS: Seventy-seven premature twins or triplets (8 to 54 months of age) were monitored at the Verona University Ophthalmology Department from November 1995 to November 1999. In another 12 subjects (younger than 8 months), only the neonatal disease records were examined; these subjects were excluded from the ophthalmologic follow-up because they were too young to be tested reliably. The study sample was compared with 120 premature singletons monitored from January 1996 to March 1998. Visual acuity, ocular motility, strabismus, refraction defects, dioptric media, and fundus oculi were assessed. RESULTS: The incidence of retinopathy of prematurity, refraction defects, or strabismus was not significantly different between premature twins or triplets and premature singletons. The twin or triplet with the lowest birth weight was more frequently affected by eye morbidity and the diseases typical of prematurity. This difference, however, was not statistically significant. CONCLUSIONS: Premature infants are at a disadvantage compared to those born at term, irrespective of multiple birth status; multiple gestation adds no risk beyond that due to prematurity.

Radiation-induced fibrosarcoma of the mandible following treatment for bilateral retinoblastoma.

A case of fibrosarcoma of the mandible following radiotherapy for bilateral retinoblastoma and occurring in an 11-year-old female child is described. After a clinical description of the case, reported with histological documentation, problems connected with the pathogenesis of the malignancies are dealt with. Besides irradiation, genetic mutation as a carcinogenetic co-factor is taken into consideration.

Association of diabetes with age-related macular degeneration in the EUREYE study.

OBJECTIVE: To examine the association between self-reported diabetes history and early or late age-related macular degeneration (AMD) in the European population. METHODS: Participants aged 65 years and over in the cross-sectional population-based EUREYE study underwent an eye examination including digital retinal photography. The images were graded at a single centre. A structured questionnaire was administered by trained field workers for putative risk factors for AMD including history of diabetes mellitus. Logistic regression models were used to examine the association between diabetes and stages of AMD, taking account of potential demographic, behavioural, dietary and medical (history of cardiovascular disease) confounders. MAIN OUTCOME MEASURES: Photographic images were graded according to the modified International Classification System for AMD and stratified into five exclusive stages from no signs of AMD (AMD stage 0), early AMD (Stages 1-3) and late AMD (Stage 4). Late AMD was subdivided in neovascular AMD (NV-AMD) or geographic atrophy (GA). RESULTS: Data on diabetes history and potential confounders were available in 2117 control subjects without AMD, 2182 with early AMD, 49 with GA and 101 with NV-AMD. Of all participants, 13.1% reported a history of diabetes. After adjusting for potential confounders, subjects with neovascular AMD compared with controls had increased odds for diabetes (odds ratio 1.81; 95% confidence interval, 1.10 to 2.98, p = 0.02). Subjects with AMD grades 1 to 3 or GA had no increased odds for diabetes compared with those without AMD. CONCLUSIONS: In the EUREYE study, after multiple adjustments, positive association of diabetes mellitus with neovascular AMD was found. The hypothesis that diabetes is associated with neovascular AMD but not with geographic atrophy may suggest a different pathogenesis of the two advanced forms of the disease and needs to be further evaluated.

Thymoxamine and intraocular pressure.

Topical treatment with 1% thymoxamine produces in rabbit and human eyes a small but real miotic and tension-lowering effect. The latter is more evident using two different models of experimental ocular hypertension in rabbits. In human open-angle glaucoma eyes, tonographic measurements indicate that the outflow facility is left unchanged by the drug.

An improved model of experimentally induced ocular hypertension in the rabbit.

A model of experimentally induced ocular hypertension for the evaluation of antiglaucoma drugs in the unanesthetized rabbit is described. It is based on the intravenous infusion of suitable amounts of 5 per cent glucose solution, and advantageously substitutes the oral water load. The method is sensitive to drugs acting both on the outflow facility (2 per cent pilocarpine) and an aqueous humor formation (10 per cent guanethidine).

Evaluation of the 701 interzeag lens opacity meter.

The Interzeag 701 Lens Opacity Meter was used to study the lenses of 122 cataract eyes and 73 healthy eyes with clear lenses. The readings taken separately in 67 eyes by two different operators did not significantly differ. Statistically significant differences were found between the readings taken by the same operator when the pupil size was different in all types of cataract and also in eyes with transparent lenses. Opacity Meter readings correlate well with the visual acuity of eyes with nuclear and mixed cataracts, but no correlation was found in eyes with cortical or posterior subcapsular cataracts. In healthy eyes with clear lens, a correlation was found between the instrument readings and age.

Evaluation of Keeler Pulsair non-contact tonometry: reliability and reproducibility.

Intraocular pressure was evaluated in 414 eyes using Keeler Pulsair tonometry in comparison with values obtained by Goldmann tonometry. No statistically significant differences were found between the two techniques. Landis K statistical analysis was used to evaluate the measurements obtained by two operators in 125 eyes, with the results indicating good reproducibility. In 20 eyes, a statistically significant difference was found between values obtained with patients in the seated vs supine positions, whereas measurements made with subjects' heads in a supported or unsupported position yielded no statistically different values.

Visual acuity disturbances in chronic renal failure.

Patients affected by chronic renal failure often complain of blurred vision when submitted to hemodialysis. Refraction, visual acuity and lens transparency have been evaluated in 36 eyes of 18 patients who underwent hemodialysis, before and after the treatment. Student's t test did not prove any statistically significant difference between the considered parameters. However, a change in refraction was noted in 64% of the eyes, always in hyperopic mean. Corrective glasses had to be changed to ensure the same visual acuity as before the hemodialytic treatment. Particular care must be taken in lens prescription in those patients who could undergo dialysis for chronic renal failure.

Epidemiology of endogenous uveitis in north-eastern Italy. Analysis of 655 new cases.

PURPOSE: To report the results of a retrospective analysis among endogenous uveitis patients in the north-eastern area of Italy. METHODS: The authors reviewed a series of 655 new cases treated between October 1986 and December 1993. The incidence of endogenous uveitis was calculated based on a 100,000 patient population. RESULTS: The average incidence was 11.40/100,000. The majority of patients were between the ages of 20 and 70 years (74.43%). A probable diagnosis was determined in 55.57% of cases; anterior uveitis was diagnosed in 58.01% of cases, posterior uveitis in 26.11%, panuveitis in 12.98%, and intermediate uveitis in 2.9% of cases. The authors observed recurrences in 25.49% of cases. While the first cases are almost equally distributed in the various months, the recurrences seem to be significantly more frequent in the cold (from November to February; mean air temperature <8 degrees) and transitional months (October and from March to May; mean air temperature from 8 degrees C to 18 degrees C) than in the warm months (from June to September; mean air temperature >18 degrees C). Respectively p=0.003 and p=0.029. CONCLUSION: The incidence in this series is lower than in other European and American studies. Despite the high rate of idiopathic cases in this study, the authors support that the presentation of single case experiences may allow improved multi-centric analysis and a greater understanding of the epidemiology of uveitis.

Does nerve fiber layer thickness correlate with visual field defects in glaucoma? A study with the nerve fiber analyzer.

The Nerve Fiber Analyzer, a confocal scanning laser ophthalmoscope, was used to measure the thickness of the retinal nerve fiber layer (NFL) in a glaucoma population. The authors studied the correlation between NFL thickness and the perimetric defects. The NFL was found to be statistically thinner in comparison to a normal control group of subjects. The correlation between the perimetric index MD and the NFA was statistically significant only for the lower quadrant of retinal NFL. The correspondence between thinner NFL and perimetric defects was investigated.

Visual field defects and normal nerve fiber layer: may they coexist in primary open-angle glaucoma?

The retinal nerve fiber layer (RNFL) is the anatomical structure most sensitive to glaucoma injury. Before a functional loss such as a visual field defect is displayed, a large number of nerve fibers can be damaged. However, there are glaucoma patients in which an apparently normal RNFL coexists with evident visual field defects. A total of 54 eyes affected with primary open-angle glaucoma were studied. Visual field was examined with the Humphrey Field Analyzer (Zeiss) using program 30-2. The Nerve Fiber Analyzer II (Laser Diagnostic Technologies) was used to study the RNFL of these patients. Mean deviation of the visual field ranged from 6 to 31 dB in all eyes that were examined. The average thickness of the RNFL ranged from 20 to 90 microm. According to our previous experience 75 microm was fixed as the cutoff between normal and pathological values of RNFL thickness. We identified 5 eyes with a RNFL thickness over 75 microm and a visual field with a mean deviation over 6 dB; 9% of the studied eyes were found to have a visual field defect with no changes in RNFL. We conclude that not all subjects have the same number of fibers at birth and that it is therefore possible to underestimate the RNFL changes. Our study illustrates that the concept of normal and altered has to be considered as a relative one for all the aspects characterizing the glaucomatous disease.

Mycotic keratitis by Fusarium moniliforme.

We report on a case of keratitis with hypopion by Fusarium monilinforme, in a patient with palpebral retraction and light exophthalmos caused by hyperthyroidism. We emphasize the importance of the microscopic examination of bioptic material and the identification of fungal species: the first permits an early diagnosis, the second the adoption of a targeted and effective therapy. In our case, the ocular infection was successfully treated with antimycotic drugs used topically.