Morphometric parameters of the optic disc in normal and glaucomatous eyes based on time-domain optical coherence tomography image analysis.

BACKGROUND AND OBJECTIVE: Assessment of optic disc morphology is essential in diagnosis and management of visual impairment. The aim of this study was to evaluate associations between optic disc morphometric parameters, i.e., size and shape, and age, gender, and ocular axial length in normal and glaucomatous eyes based on time-domain optical coherence tomography image analysis. MATERIALS AND METHODS: It was a case-control study of 998 normal and 394 eyes with primary open angle glaucoma that underwent an ophthalmological examination and time-domain optical coherence topography scanning. Areas and shapes of the disc, cup, and neuroretinal rim were analyzed. RESULTS: The shape of the optic disc did not differ between the study groups, i.e., normal and glaucomatous case groups, but the disc area of the primary open angle glaucoma group was significantly larger. The shape of the small disc was significantly different, but the shape of the medium and the large disc did not differ between the study groups. The central area of the disc, i.e., cup area was significantly larger in the case group and its shape was significantly different between the study groups. No significant differences in the area of the cup and its shape, nerve fibers on the edge of the disc, i.e., neuroretinal rim area, were found between the study groups of the small discs. There were significant associations between age, gender, and ocular axial length and morphometric parameters of the optic disc. CONCLUSIONS: Informative results with regard to the size and shape due to various ocular characteristics between the healthy control group and patients suffering with primary open angle glaucoma were obtained. Both study groups were significant in size, which makes the findings interesting and important contribution in the field.

Coats' retinitis or retinoblastoma in a 3-year-old girl: a case report.

Coats' disease is an idiopathic disorder defined by an abnormal development of retinal vessels with a progressive deposition of intraretinal or subretinal exudates, leading to exudative retinal detachment. The most difficult task is to differentiate Coats' disease from retinoblastoma. We present a rare case of Coats' disease diagnosed in a 3-year-old girl. From the age of 6 months, the girl was followed up 2 times a year at the Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences, due to congenital convergent strabismus and refractive errors. At the age of 3.6 years, a routine examination of the fundus of the right eye revealed hard exudates, telangiectasia and tortuosity, gray color lesion below the optic nerve disc, submacular exudation in the inferior nasal part of the retina, and exudative retinal detachment, which extended from the 7-o'clock position to the 4-o'clock position. Before this examination, no abnormalities were found in the fundus of her both eyes. The girl was not treated with laser photocoagulation, cryocoagulation, or intravitreal injections, as the diagnosis of retinoblastoma could not be excluded; therefore, only eye drops were prescribed. In order to exclude the diagnosis of retinoblastoma, ultrasonography, magnetic resonance imaging, and computed tomography were carried out, and an appointment to see an ophthalmic oncologist was scheduled. Due to early and appropriate treatment, the progression of Coats' disease in patients could be arrested. However, in some cases, when the diagnosis is ambiguous, it is better to follow up the patient and to treat only with eye drops.

Correlations between digital planimetry and optical coherence tomography, confocal scanning laser ophthalmoscopy in assessment of optic disc parameters.

OBJECTIVE AND AIM: In routine clinical practice, laser methods for the evaluation of optic disc parameters are expensive and not accessible for all ophthalmologists; therefore, there is a need for less expensive technique. The aim of this study was to assess correlations between the parameters of the optic disc measured by digital planimetry (DP), optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy (CSLO) in healthy and glaucoma patients with the normal biometric parameters of the eye. MATERIAL AND METHODS: This case-control study enrolled 40 patients with glaucoma and 32 healthy patients with the normal biometric parameters of the eye. All subjects underwent full ophthalmologic examination, digital color optic disc photography, OCT, and CSLO at the same visit. The optic disc was morphometrically analyzed by DP, OCT, and CSLO. Seven optic disc parameters were evaluated. RESULTS: In the glaucoma group, the optic disc and cup areas (r=0.7-0.8, P<0.001) and cup-to-optic disc and rim-to-optic disc area ratios (r=0.7, P<0.001) measured by DP were strongly correlated with those measured by OCT and CSLO, while the horizontal and vertical cup-to-optic disc diameter ratios were found to be moderately correlated (r=0.6-0.7, P<0.001). In healthy patients, the optic disc and cup areas were strongly correlated (r=0.7-8.0, P<0.001). Significant differences in all optic disc parameters, except for the optic disc area, measured by DP, OCT, and CSLO were found between glaucoma and healthy patients. CONCLUSIONS: Strong correlations between the parameters of the optic disc measured by DP, OCT, and CSLO were found. There were significant differences in the parameters between healthy and glaucoma eyes measured using DP; therefore, this technique may be used for diagnosis, management, and screening of glaucoma.

Acute and chronic effects of soccer game on the retinal vessel diameters in middle-aged adults.

BACKGROUND: Although changes in retinal vessel diameter is a new biomarker for the evaluation of cardiovascular risk factors, limited information is available regarding the effects of endurance exercises on retinal microcirculation. Thus, we aimed to evaluate both chronic and acute effects of soccer game on the diameters of retinal vessels in middle-aged players. METHODS: Retinal vessel diameters were measured in 12 middle-aged amateur players (44.4±7.0 years of age) with more than four years of soccer playing experience and 12 age-matched sedentary adults (49.7±7.1 years of age). In soccer players, diameters were also measured immediately after the soccer game. Cardiovascular risk profiles (anthropometry and body composition and blood pressure [BP]) and physical activity levels were also measured. RESULTS: Soccer players had wider retinal vessels than controls (P<0.05), resulting in greater arteriolar-to-venular diameter ratio (AVR) (P<0.05). Greater sports-related physical activity, lower body mass index (BMI) and fat mass were observed for soccer players compared to the controls (P<0.05), whereas BP did not differ. Physical activity level correlated positively with temporal retinal arteriolar (TRA) diameter and with AVR (P<0.05), whereas TRA diameter correlated negatively with BMI and fat mass (P<0.05). A significant correlation between temporal retinal venule (TRV) diameter and TRA diameter (P<0.05) was observed. The acute soccer game increased BP (P<0.05) and induced TRV dilatation (P<0.05). CONCLUSIONS: In middle-aged amateur soccer players, improvement of the retinal microcirculation was observed. Cardiovascular risk factors and physical inactivity were associated with adverse retinal microvascular alterations. In terms of acute effects, soccer play causes venular, but not arteriolar dilatation for middle-aged adults.

[Severe open-globe eye injuries: socio-demographic aspects and risk factors]. / Sunkiu atvirojo tipo akiu traumu socialiniai ir demografiniai aspektai bei rizikos veiksniai.

THE AIM OF STUDY: To evaluate sociodemographic aspects and risk factors of severe open-globe ocular injuries. MATERIAL AND METHODS: We present data from prospective study of 315 patients with severe open-globe ocular injuries, meeting inclusion criteria. RESULTS: The patients in our series were predominantly male (92.70%). The male to female ratio was 12.7:1. Almost 27% of the patients were from the age group of 30-39 years. Home (53.65%), streets and highways (19.05%) were the most common place of injury, followed by industrial premises (11.11%), agricultural activities (8.25%), recreation and sports (5.40%); 15.56% of cases were work-related. Sharp objects (43.17%) and hammering on metal (24.44%) were the two major causes of injury. Alcohol intoxication was observed in 13.65% of cases. Severe open-globe eye injuries were classified into four categories: penetrating injuries (56.83%), perforating injuries (2.54%), globe ruptures (12.38 %), and IOFB injuries (28.25%). Males suffered significantly more often than females in the age of 20-29 (OR=1.39+/-95% CI 1.10-1.75, P<0.01) and 30-39-year (OR=1.75+/-95% PI 1.45-2.22, P<0.01). Risk factors of severe open-globe eye injuries for male gender were living in urban setting (P=0.001), alcohol use (P=0.001), occupation--unemployed (P=0.001) and retired persons (P=0.011). CONCLUSIONS: Risk factors for male gender to sustain severe open-globe eye injury were living in urban setting, alcohol use, and occupation (unemployed and retired persons).

The use of information technologies for diagnosis in ophthalmology.

In 2003, a health IT programme for clinical decision support started in Lithuania. An initial goal was to create databases for ophthalmology images and to develop processing algorithms to extract diagnostically valuable information from images. We have investigated how vectors, consisting of the parameters derived from fundus images, are distributed and whether they form specific groups. When analysing the multidimensional patient data vectors, comprising all the 27 image parameters, it was impossible to separate the healthy eyes from the diseased ones. However, it was possible to simplify the system by eliminating redundant parameters and introducing new ones that represent a subset of parameters from the initial group. Thus it may prove possible to identify glaucoma using this system of parameters.

The relationship of the intensity of lens opacity with physical activity.

OBJECTIVE: To study the character and the intensity of lens opacity and the visual acuity in cataract patients and controls and to determine the association of these indices with the subjects' physical activity. MATERIAL AND METHODS: The lens opacity in 110 eyes of patients (n=110) aged 60.3+/-0.4 (mean+/-SEM) years admitted to the Clinic of Eye Diseases of Kaunas University of Medicine Hospital for cataract surgery and the lens opacity of 100 eyes of controls (n=50) aged 59.8+/-0.4 (mean+/-SEM) (p>0.05) years hospitalized in the Clinic of Skin and Venereal Diseases was evaluated according to the Lens Opacity Classification System, version III. Visual acuity was investigated using the Snellen chart. Physical activity in metabolic equivalent minutes per week (MET-minutes/week) was evaluated according to the International Physical Activity Questionnaire. RESULTS: The means of the intensity of lens opacity of patients with cataract were significantly higher, and the means of visual acuity and physical activity were significantly lower, compared to controls (p<0.01-0.001). For less active patients (<5900 MET-minutes/week) with the right eye examined, the odds ratio of cataract was by 7.00 (95% confidence interval 2.93-16.74, p<0.001) and for those with the left eye studied by 4.43 (95% confidence interval 1.97-9.98, p<0.001) times higher, compared to physically active (>5900 MET-minutes/week) patients. Physical activity was inversely correlated (r=-0.452, p<0.05) with the lens opacity in the cortex in physically active (>5900 MET-minutes/week) subjects with cataract who underwent the examination of the left eye. CONCLUSION: The intensity of lens opacity and cataract are statistically significantly related to physical activity.

[Association of metabolic syndrome components with cataract]. / Metabolinio sindromo ir jo komponentu rysys su katarakta.

UNLABELLED: The aim of the study was to evaluate the association of metabolic syndrome and its components with cataract among the middle-aged Kaunas population in relation to gender and age. MATERIAL AND METHODS: The epidemiological examination was carried out in Kaunas, Lithuania, during 2001-2002. Health survey has been carried out according to the protocol of Monitoring of Trends and Determinants in Cardiovascular disease (MONICA) study. Analysis was performed for 1,267 persons aged 35-64 years (571 men and 696 women). Metabolic syndrome was defined by criteria of World Health Organization and The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Cataract was defined by color photography according to the Lens Opacities Classification System (LOCS III) methods. RESULTS: After dividing of total cohort into three age groups (35-44, 45-54 and 55-64 years), relationship between metabolic syndrome and cataract was found in 55-64 years old men and 45-54 and 55-64 years old women: the prevalence of cataract was higher in men's and women's groups with metabolic syndrome than in groups of same the age and gender without metabolic syndrome, but significant difference was observed only in women's group. After evaluation of the relationship of every component of metabolic syndrome with cataract it was established that an increased prevalence of cataract was observed among men with hyperglycemia and central obesity and among women with all five components of metabolic syndrome. CONCLUSION: This survey shows that metabolic syndrome was significantly associated with an increased prevalence of cataract in women of Kaunas city population aged 45-64 years.

[Prevalence of cataract in 35-64 years old Kaunas city population]. / Kataraktos paplitimas tarp 35-64 metu Kauno miesto gyventoju

UNLABELLED: The aim of the study was to determine the prevalence of lens opacity among 35-64 years old Kaunas population as well as to evaluate the stage and type of age-related cataract and its distribution in the groups of age and gender. MATERIAL AND METHODS: The material of our study was Kaunas city population aged 35 to 64 years who participated in the scientific Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA-4) study during 2001-2002 in the Laboratory of Population Researches, Institute of Cardiology of Kaunas University of Medicine. During this study random sampling method was used for grouping of 1354 persons according to the age and gender (596 males and 759 females). A total of 2708 lens were examined using the Lens Opacity Classification System (LOCS III) after dilatation of pupils. All the investigated persons were divided into decade age groups: 35-44, 45-54 and 55-64 years. All of them were divided into two groups: with cataract and without. Those who had cataract were divided into three groups according to the three stages of disease. All lenses were divided into seven groups: clear lens, posterior subcapsular, nuclear, cortical and mixed cataract, aphakia and pseudophakia. RESULTS: The lens opacities were present in 106 (17.8%) males and 141 (18.6%) females. The lens opacities of both eyes were observed in 91.3% of investigated persons. In all groups with cataract, the 1st stage comprised 71.6%, 2nd--22.5% and 3rd--6.0% of cases. The prevalence of cataract in decade aged groups according to the stages, respectively in men and women was: among 35-44 years old--1st stage cataract 4.0% and 3.5%, 2nd--unidentified in both groups, 3rd stage--1.0% and unidentified; 45-54 years old--1st stage 9.7% and 9.7%, 2nd--1.0% and 1.1%, 3rd--1.5% and 0.4%; among aged of 55-64 years--the 1st stage as 23.8% and 26.0%, 2nd--9.9% and 11.8%, 3rd--2.0% and 1.5%. In both groups the nuclear cataract dominated (68.2%); in male group--72.4% and female--65.0%. Mixed type comprised 18.3% of cases, respectively 17.9% in males and 18.6% in females, cortical--10.7%, respectively--7.7% and 12.9%; posterior subcapsular--2.8%, respectively--2.8% and 3.4%. CONCLUSIONS: The lens opacities were found in 17.8% of males and 18.6% of females among investigated 35-64 years old population of Kaunas city. In the groups of both genders domination of nuclear cataract and the 1st stage of all forms of cataract was observed. The incidence of cataract increases significantly with age.

Ultrasonic and biochemical evaluation of human diabetic lens.

OBJECTIVE: To evaluate the ultrasonic attenuation and amount of soluble proteins of human diabetic lens. MATERIALS AND METHODS: The examination was performed in the Clinic of Eye Diseases of Kaunas University of Medicine. The study included 4 groups of patients (110 eyes). The first group consisted of healthy subjects (32 eyes), the second group--of patients with initial senile cataract (13 eyes), the third group--patients with type I diabetes mellitus (24 eyes) and the fourth group--patients with type II diabetes mellitus (41 eyes). In vivo examination of human lenses was carried out by Mentor A/B ultrasonic imaging system using 7 MHz A-mode probe and the ultrasound attenuation coefficient was calculated. The phacoemulsification technique has been used for cataract extraction. Gel chromatography of the supernatant fraction on the Sepharose CL 6B column was used for fractionation of soluble lens proteins. Protein concentration was determined by the method of Lowry using bovine serum as standard. RESULTS: The least mean lens thickness of 3.58+/-0.18 mm was found in the healthy patients' group. There was a significant difference (p<0.05) between the thicknesses of the lenses in the healthy group and in the type I diabetic group. The difference between senile cataract and type II diabetic cataract was insignificant (p>0.05). The mean ultrasound attenuation coefficient in the groups of healthy and type I diabetic cataract was nearly the same, as so as in the groups of senile cataract and type II diabetic cataract. The significant difference (p<0.001) in the values of attenuation coefficient was found between the groups of type I and type II diabetics. The amount of soluble proteins was lowest in cataractous lenses of patients with type II diabetes (0.053+/-0.007 mg/1 mg tissue) and highest in the lenses of patients with type I diabetes (0.063+/-0.004 mg / 1 mg tissue), but those differences were statistically insignificant. Distribution of soluble proteins into the different molecular mass fractions in the group of type I diabetic lenses was found to be similar to the type II diabetic lenses and to the patients with senile cataract. CONCLUSIONS: The diabetic changes stronger influence the thickness of lenses of young people; in the elder age the difference between the thickness of senile and diabetic cataract is not so distinct. Ultrasound attenuation coefficient has a tendency to be higher in patients with senile and type II diabetic cataract. Human lens crystallins of patients with type I diabetes and type II diabetes are damaged at the same degree, the amount of soluble proteins decrease with age and biochemical changes of the lens.

The influence of hypodynamic stress on ultrastructure of the cortical layer cells of eye lens.

The aim of the study was to determine the influence of 48-day hypodynamic stress on the ultrastructure of the cortical layer cells of eye lens. Hypodynamic stress was induced in Chinchilla male rabbits (weight 2.5-3.0 kg; n=8) by placing them in metal hutches for 48 days. Rabbits (n=8) of the control group (non-stressed) were kept under normal vivarium conditions. Following the hypodynamic regime (after 48 days) the rabbits (stressed and control) were anaesthetized using thiopental sodium (35 mg/kg). On removing their eyes, the cortical partes of lenses were prepared and immersed into a fixative solution containing 2% paraformaldehyde and 2.5% glutaraldehyde in 0.1 M cacodylate buffer (pH 7.4) for more than 4 hours at room temperature or overnight at 4 degrees C. The specimens were then postfixed, dehydrated and embedded in a mixture of Epon 812 and Araldite. Ultrathin sections stained with uranyl acetate and lead citrate were evaluated by electron microscopy (Philips-300). Microscopical examination of the cortical layer cells of lenses showed extensive cellular vacuolization, calcification, and formation of a light scattering center. Cortical fibers were found to be compacted along their length, and elongated with decreased interdigitations.

[Association of age-related maculopathy with ischemic heart disease and its risk factors in middle-aged population of Kaunas city]. / Su amziumi susijusios makulopatijos rysys su isemine sirdies liga ir rizikos veiksniais vidutinio amziaus kaunieciu populiacijoje.

AIM: To determine the prevalence of age-related maculopathy in a sample of Lithuanian middle-aged population and to assess the relationship between age-related maculopathy and ischemic heart disease and its risk factors, including smoking, arterial hypertension, obesity, hyperglycemia, and dyslipidemias. MATERIAL AND METHODS: A random sample of urban population of 1357 adults (ranging from 35-64 years of age; 597 males and 760 females) living in Kaunas, Lithuania was examined during the interval from 2001 to 2002. Each participant underwent a comprehensive examination that included an ophthalmic examination. The presence of age-related maculopathy was determined by grading from fundus examination by indirect ophthalmoscopy, slit lamp examination, and color fundus photographs. The history, physical examination findings, and fasting blood samples provided data on possible risk factors. Age-adjusted logistic regression analysis was performed to determine the risk factors for age-related maculopathy. RESULTS: Early age-related maculopathy was detected for 44 males and 40 females. The prevalence of age-related maculopathy increased steadily with age without significant difference between males and females. Multiple logistic regression analysis showed that increased diastolic blood pressure, obesity, hyperglycemia, ischemic ECG-abnormalities and history of myocardial infarction were significantly associated with age-related maculopathy in males aged 40-64 years. Current smoking and hyperglycemia were significantly associated with age-related maculopathy in females aged 40-64 years. CONCLUSIONS: Our study suggests that arterial hypertension, obesity, hyperglycemia, current smoking and positive history of cardiovascular disease are relevant risk factors for age-related maculopathy in middle-aged urban population.

[Prevalence and risk factors of age-related maculopathy among middle aged people]. / Vidutinio amziaus zmoniu sergamumas makulopatija, susijusia su amziumi, ir jos rizikos veiksniai.

OBJECTIVE: To investigate the prevalence of age-related maculopathy and the relationships of age-related maculopathy to age, sex, ocular factors, education, work exposures. A population-based cohort study included 1357 subjects (35-64 years of age) living in Kaunas (Lithuania), who were examined during the interval from 2001 to 2002. The diagnosis of age-related maculopathy was based on ophthalmoscopic findings or on fundus photographs. The prevalence of early age-related maculopathy was 7.3% in persons 40-64 years of age. No late age-related maculopathy (AMD) was found. Prevalence of early age-related maculopathy was strongly related to age (P<0.001). No significant prevalence differences were between the sexes. The frequency of age-related maculopathy was higher in eyes with light iris color but association was not significant. No associations were found between cataract or cataract type and ARM. There was no association between education and age-related maculopathy. Exposure to harmful work was found to be related to the presence of early age-related maculopathy in all. The prevalence of age-related maculopathy was significantly higher between men working in high temperature.

Age-related maculopathy and consumption of fresh vegetables and fruits in urban elderly.

The purpose of this study was to investigate the rate of age-related maculopathy among elderly males and females in relation to frequency of consumption of fresh vegetables and fruit. During ophthalmological investigation of Kaunas city inhabitants aged 65-74 years (240 males and 206 females) age-related maculopathy (early and late) was determined for 22.1% of males and 20.4% of females. Frequency of usage of fresh (uncooked) vegetables and fruits in winter-spring and in summer-autumn seasons by investigated persons was determined, using food frequency questionnaire. In this work an association between age-related maculopathy and usage of vegetables and fruits has been investigated in 170 males and 181 females aged 65-74 years without diabetes who never smoked; age-related maculopathy was found for 18.8% of males and 17.7% of females. Obtained data have demonstrated an inverse association between consumption of vegetables during winter-spring season and age-related maculopathy: usage of vegetables two times a week or more versus usage less than two times a week decreases prevalence of age-related maculopathy 2.0 times among males (OR=0.42; 95% CI 0.18-1.0; p=0.05) and 2.2 times among females (OR=0.37; 95% CI 0.15-0.9; p=0.02). Data have demonstrated a tendency that increasing consumption of fresh vegetables and fruits during both seasons can reduce risk of age-related maculopathy among females. In conclusion, characteristic for Lithuanian urban elderly rare usage of fresh vegetables during winter-spring season can increase risk of age-related maculopathy independently from other risk factors.