Daily variation of UV-A and UV-B solar radiation on the Adriatic Sea.

During the summer months, from June thru September, in Opatija and island of Rab area, we conducted UVA and UVB measurements using a professional detector: Solar Light Co., Inc. USA. Ordering: PMA2110 UV-A and PMA2101 UV-B detector. We conducted global UVA and UVB measurements in the 2006 to 2011 period. Results of the measurements show June to September daily, 10 am to 3 pm, UVA and UVB variations to be above allowed values especially in the maritime area. The measurements were performed in cooperation with "Dr. B. Vojnikovic" Daily eye clinic and the University of Applied Sciences Velika Gorica, Velika Gorica, Croatia.

Solar spectral lines ("solar halo")--healing or harmful for the retina?

The sungazing method has been known for thousands of years as healing method based on chromotherapeutic principle. Our examinations on the island of Rab show that it is acceptable only if applied 10 min before the sunset. Gazing has to be directed towards the green-yellow part of the spectrum, since the remaining part of the sun halo contains harmful energy. However, authors suggest that it would be preferable to use spectacles with medical filters transmitting wavelight of green-yellow colour, especially for treatment of macular degeneration.

Medical perspective: macular degeneration (AMD) and human sight in the future.

The author concisely presents the results of his 30-year investigations about the harmful influence of the higher sun radiation on the eyes. The investigations were carried out among the population of the Island of Rab, situated in the northern part of the Adriatic sea. This geographical region has been characterized by higher doses of the global sun radiation compared with the remaining part of the Republic of Croatia, and partly with the rest of the Mediterranean. The author proved it by his own measurements of UV-B, UV-A and the global sun radiation. The number of the diseased from the macular degeneration (AMD), cataract and precancerous pterygium has been significantly increased in those inhabitants being more exposed to the sun radiation. Investigating the retinal threshold, of the macula and peripherally--meridian thresholds, even the children more exposed to the sun radiation without protection, are established to have the increased excitation threshold of the retina, making later the basis and risk factor for the earlier AMD development. The author also points out that the periphery of retina and the macula are damaged in AMD. Later stages of macular degeneration transfer to the clinical form of the optic nerve atrophy. The author pathohistologically proved that the whole retina has been degeneratively involved in AMD, not only the photoreceptors and the retinal pigment. Therefore, the author pleads for the idea of children protection from the higher sun radiation to become a national problem of each country, and the coordination must be with the World Health Organization (WHO).

What associates Charles Bonnet syndrome with age-related macular degeneration?

Charles Bonnet syndrome (CBS) is a condition related to patients with visual loss due to age related macular degeneration or glaucoma that are having complex visual hallucinations. The CBS was first described by Swiss physician Charles Bonnet in 1760. Affected patients, who are otherwise mentally healthy people with significant visual loss, have vivid, complex recurrent visual hallucinations (VHs). One characteristic of these hallucinations is that they usually are "Lilliputian hallucinations" as patients experience micropsia (hallucinations in which the characters or objects are distorted and much smaller than normal). The prevalence of Charles Bonnet Syndrome has been reported to be between 10% and 40%; a recent Australian study has found the prevalence to be 17.5%. The high incidence of non-reported CBS is thought to be as a result of patient's fear to report the symptoms as they could be labeled as mentally insane since those type of visual hallucinations could be found in variety of psychiatric and neurological disorders such as drug or alcohol abuse (delirium tremens), Alice in Wonderland syndrome (AIWS), psychosis, schizophrenia, dementia, narcolepsy, epilepsy, Parkinson disease, brain tumors, migraine, as well as, in long term sleep deprivation. VHs can also be presented as the initial sign of the Epstein-Barr virus infection in infectious mononucleosis. Patients who suffer from CBS usually possess insight into the unreality of their visual experiences, which are commonly pleasant but may sometimes cause distress. The hallucinations consist of well-defined, organized, and clear images over which the subject has little control. It is believed that they represent release phenomena due to deafferentiation of the visual association areas of the cerebral cortex, leading to a form of phantom vision. Cognitive defects, social isolation, and sensory deprivation have also been implicated in the etiology of this condition. This study was conducted on 350 patients diagnosed with Age-Related Macular Degeneration (AMD) and shows incidence of CBS in 13% of patients with AMD. Furthermore, we have found higher incidence of CBS in patients with massive loss of vision in peripheral visual field which is not age related.

Focused high risk--population screening for carotid stenosis and retinal microangiopathia after radiotherapy for laryngeal carcinoma.

Carotid artery stenosis (CAS) is one of the major complications of external irradiation (radiotherapy, RT) for laryngeal carcinoma. Considering amaurosis fugax is often one of the first signs of significant CAS our focus was to determine weather patients with post-irradiation CAS also develop ocular microangiopathy as a result of insufficient ophthalmic circulation. In our study Carotid Duplex ultrasound scans revealed that 33.33% of patients had significant radiation-induced CAS. The majority (over 85.71%) of radiation-induced CAS had more than one atherosclerotic plaque including any degree of stenosis in the RT group, and had significantly more than that of the control group. Microangiopathic changes were documented only with the patients that have had an increased cerebrovascular risk (diabetes mellitus and arterial hypertension).

Chromotherapy of macular degeneration with transitions lenses and green-yellow medical filters and special programme for psychoorganic disturbances.

Optical spectrum of the sunlight consists of visible or chromatic spectrum, with the range of wavelengths of electromagnetic vibrations from 7700 to 3900 AU, and the invisible spectrum: infrared and ultraviolet. Chromatic spectrum gives rise to the sensation of colour, capable for simulating specialized retinal photoreceptors and is perceptible as light. This rule of perception of the particular range of the optical spectrum goes mainly for man, while particular deviations, more or less, are applicable to the rest of animal and plant life. The optical part of the spectrum belongs to nonionizing radiation. It created the life on the Earth, maintaining it nowadays and even threatening the human organ of vision, because the retina had not been yet adequately accommodated through evolution with its photoreactive metabolism. Human retina is very sensitive about possible harmful influence of ultraviolet and blue light even today in evolution, but also phototoxic on complete strong visible light. In their clinical and experimental work on animals, the authors prove with their own patent (P 20020077A)-Vojnikovic B&D, and in collaboration with Essilor Optic Austria GmbH, that particular medical filters in the range of green-yellow colour especially (565 to 570 nm), and in combination with "Transitions" successfully threat macular degeneration-AMD, slowing down its progression and having positive psychoorganic effect on the depressive mood of such patients with threatened sight. Full attention has been paid to the design of medical filter, so the periphery of the lens plays a positive role in blood concentration of melatonin, while the central part stimulates the sight and the concentration of serotonine. Thus the physiological balance of melatonin and serotonin and the stability of psychophysical disturbances have been achieved.

Intravitreal bevacizumab with or without triamcinolone for refractory diabetic macular oedema.

We evaluate the effect of intravitreal injections of Bevacizumab (IVB) alone or combined with triamcinolone (IVT) in the first injection for treatment of refractory diabetic macular oedema (DME). Sixty eyes of sixty patients with refractory DME were included. Half of the receive injections of IVB (1.25 mg/0.05 mL) or combined IVB and IVT (1.25 mg/0.05 mL and 2 mg/0.05 mL respectively). The primary outcome measure was change in central macular thickness (CMT). Secondary outcome measures were change in best-corrected logMAR visual acuity (BCVA) and incidence of potential adverse events. Central macular thickness was reduced significantly in both the IVB and IVB/IVT groups. At week 24, CMT change compared to the baseline was -95.7 microm (95% CI, -172.2 to -19.26) in the IVB group and -92.1 pm (95% CI, -154.4 to -29.7) in the IVB/IVT group. There was not a significant difference between the IVB and the IVB/IVT groups (p = 0.022). Improvement of BCVA was initiated at weeks 6 and 12 in the IVB/IVT and IVB groups respectively. In terms of BCVA change compared to the baseline at 24 weeks, the differences between the IVB and the IVB/IVT groups (p = 0.006) were significant. Anterior Chamber reaction was noticed in six (20%) and six (20%) eyes respectively in the IVB and IVB/IVT groups the day after injection, and it resolved with no sequel. Elevation of IOP occurred in two eyes (6%) in the IVB/ IVT group. Intravitreal injections of Bevacizumab had a beneficial effect on refractory DME in terms of CMT reduction and BCVA improvement. Addition of triamcinolone in the injection seemed to induce earlier visual improvement; however, it did not show any significant additive effect later during follow-up.