Genistein-Opportunities Related to an Interesting Molecule of Natural Origin.

Nowadays, increasingly more attention is being paid to a holistic approach to health, in which diet contributes to disease prevention. There is growing interest in functional food that not only provides basic nutrition but has also been demonstrated to be an opportunity for the prevention of disorders. A promising functional food is soybean, which is the richest source of the isoflavone, genistein. Genistein may be useful in the prevention and treatment of such disorders as psoriasis, cataracts, cystic fibrosis, non-alcoholic fatty liver disease and type 2 diabetes. However, achievable concentrations of genistein in humans are low, and the use of soybean as a functional food is not devoid of concerns, which are related to genistein's potential side effects resulting from its estrogenic and goitrogenic effects.

[Properly managing the cataract patients with diabetes mellitus].

The recent years has witnessed the fast growing number of cataract patients with diabetes mellitus (DM). The complexity and diversity of DM-related ocular complications has made the cataract treatment of such patients intractable and easily ignored. Cataract surgery has become an essential part of the comprehensive treatment of diabetic ophthalmopathy. Therefore, it is more necessary to implement proper perioperative management. In this article, we discuss the preoperative blood glucose control and the prevention of infective endophthalmitis. Moreover, the importance of ocular surface health and the strategy-making in the patients with diabetic retinopathy are elaborated. We also emphasize the details of surgical techniques and postoperative follow-up. We strive to create a holistic concept throughout the process of diagnosis and treatment with an individualized and standardized view, so that the concurrence of cataract and DM may not be a challenge in the future. (Chin J Ophthalmol, 2020, 56: 325-329).

The quest for homeopathic and nonsurgical cataract treatment.

PURPOSE OF REVIEW: Age-related cataract occurs when crystallin proteins in the lens partially unfold and subsequently aggregate. Physicians and traditional healers alike have been exploring pharmacologic cataract treatment for hundreds of years. Currently, surgery is the only effective treatment. However, there are an abundance of homeopathic and alternative remedies that have been suggested as treatment for cataract. This article reviews the current understanding of cataract development and discusses several homeopathic remedies purported to treat age-related cataract. Additionally, we will present an overview of evidence regarding the development of pharmacologic cataract reversal therapies. RECENT FINDINGS: Some homeopathic therapies have been shown to prevent cataract development in experimental models. More studies are required to elucidate the potential medicinal and toxic properties of the various alternative therapies. However, in recent years, scientists have begun to investigate substances that address cataract by reversing lens protein aggregation. One such compound, lanosterol, was reported to reverse cataract opacity in vitro and in animal models. Subsequently, 25-hydroxycholesterol and rosmarinic acid were identified as having similar properties. SUMMARY: Although challenges and uncertainties remain, further research has the potential to lead to the development of a nonsurgical therapeutic option for age-related cataract.

[Effects of acupuncture, tuina combined with phacoemulsification for cataract with glaucoma].

OBJECTIVE: To observe the effects of acupuncture combined with phacoemulsification for cataract with glaucoma. METHODS: Sixty-eight patients with cataract and angle-closure glaucoma were randomly divided into an observation group and a control group, 34 cases in each one. The patients in the control group were treated with phacoemulsification. Based on the treatment in the control group, the patients in the observation group were treated with tuina and acupuncture at acupoints around eyes; the treatment was given once every other day, and 15-day treatment constituted a course, and 2 courses (60 days) were given. The intraocular pressure (IOP), visual acuity, pain severity, aqueous outflow (F value) and clinical symptoms were observed in the two groups before treatment and after 1 d, 7 d, 30 d and 60 d of treatment. RESULTS: The IOP after 1 d, 7 d, 30 d and 60 d of treatment in the observation group was lower than that in the control group (all P<0.05), while the visual acuity after 7 d, 30 d and 60 d of treatment in the observation group was higher than that in the control group (all P<0.05). Compared before treatment, the IOP was significantly decreased after 1 d, 7 d, 30 d and 60 d of treatment in the two groups, and the visual acuity was significantly increased after 7 d, 30 d and 60 d of treatment in the two groups (all P<0.05). The pain scores and F value after 7 d, 30 d and 60 d of treatment in the observation group were lower than those in the control group (all P<0.05). Compared before treatment, the pain scores and F value after 7 d, 30 d and 60 d of treatment were significantly reduced in the two groups (all P<0.05). After 60 d of treatment, the number of patients who presented general clinical symptoms in the observation group was significantly lower than that in the control group (P<0.05). CONCLUSION: Based on phacoemulsification, acupuncture and tuina could significantly reduce the IOP and F value, relieve pain and improve visual acuity in patients with cataract and glaucoma.

Health policy regulations pertaining to advanced surgical devices-their socio-economic effects on ophthalmology practice.

The Israel Ministry of Health enacted regulations that aim to reduce private expenditure on healthcare services and mitigate social inequality. According to the modified rules, which went into effect in the second half of 2016, patients who undergo surgery in a private hospital and are covered by their healthcare provider's supplemental insurance (SI) make only a basic co-payment.The modified regulations limited the option of self-payment for advanced devices not covered by national health basket, meaning that patients for whom such devices are indicated had to pay privately for the entire procedure. These regulations applied to all medical and surgical devices not covered by national health insurance (NHI).Toric intraocular lenses (IOLs) are a case in point. These advanced lenses are implanted during cataract surgery to correct corneal astigmatism and, in indicated cases, obviate the need for complex eyeglasses postoperatively. Toric IOL implantation has been shown to be highly cost-effective in both economic and quality-of-life terms. Limitations of the use of these advanced IOLs threatened to increase social inequality.In 2017, further adjustments of the regulations were made which enabled supplemental charges for these advanced IOLs, performed through the SI programs of the healthcare medical organizations (HMOs). Allowing additional payment for these lenses at a fixed pre-set price made it possible to apply a supplemental part of the insurance package to the surgery itself. In mid 2018 these IOLs were included without budget in the national health basket, allowing for self-payment for the additional cost in addition to the basic coverage for all patients with NHI.This case study suggests that, in their efforts to enhance health care equity, policymakers may benefit if exercising due caution when limiting the extent to which SI programs can charge co-payments. This is because, when a service or product is not available via the basic NHI benefits package, limiting SI co-payments can sometimes result in a boomerang effect - leading to an increase in inequality rather than the sought-after decrease in inequality.

Evaluation of content and cost of traditional eye medication in a resource-poor country - Implications for eye care practice and policy.

BACKGROUND: Cataract, glaucoma, and conjunctivitis are common causes of ocular morbidity in Nigeria. A major obstacle in reducing the burden of ocular morbidity in rural areas is access to eye care services. Up to 80% of the population in developing countries use traditional medications for their primary healthcare needs because they are accessible, available, and affordable. The aim of this study is to evaluate the content and cost of commercialized traditional medications used in the treatment of common eye conditions in Nigeria. PATIENTS AND METHODS: All the registered traditional healers (THs) at an International Trade Fair in Enugu who treated eye problems were identified. Data on their location and scope of their practice were collected by the researchers. Proxy patients consulted THs in the trade fair with simulated cataract, glaucoma, and bacterial conjunctivitis, and treatment was sought. Medication for the treatment of the simulated disorders was paid for and procured. The mode of administration and the cost of the drugs were recorded by proxy patients. Each medication was labeled with a code and sent to the laboratories of the National Agency for Drug Administration and Control for analysis. Data were entered into a database on Microsoft Access and transferred to STATA V12.1 (StataCorp) for analysis. RESULTS: Cataract was treated by 87.5% of all the traditional eye healers interviewed. A total of 32 samples were collected and analyzed. These comprised mainly oral (53.1%) and topical traditional medications (43.8%). The pH of the topical samples ranged from 3.5 to 10, while the mean microbiological load per topical solution was 3.3 × 104 cfu/mL ± 0.96. The cost of treatment of cataract ranged from 4 to 70 USD. CONCLUSION: The content of the majority of the samples of traditional eye medications in this study had high extremes of pH and/or had a high microbial content. The practice of THs should be regulated.

Biosynthesis, characterization and cytotoxicity of gold nanoparticles and their loading with N-acetylcarnosine for cataract treatment.

The present work showed the biofabrication and characterization of gold nanoparticles (Au NPs) using Coccinia grandis bark extract. The fabricated NPs were well characterized by using different microscopic an spectroscopic techniques such as transmission electron microscopy (TEM), Ultra violet - visible spectroscopy (UV-Vis), X-ray diffraction (XRD), Energy dispersive spectroscopy (EDS) and Fourier transform spectroscopy (FTIR). TEM results showed that the prepared AuNPs are spherical in shape with uniformity in size. The calculated average size of the AuNPs is 20 nm. The NAC drug molecule that is used for cataract treatment was successfully encapsulated into Au NPs to increase its bioavailability. Also, the in-vitro cytotoxicity of NAC and NAC - Au NPs were studied against fibroblast cells, and the results showed that encapsulation of NAC into Au NPs did not showed cytotoxicity after encapsulation. NAC molecules do not exhibit toxicity at lower concentrations, While, there is a reduction in the number of viable cells at higher concentration of NAC. Also, the encapsulation of the drug onto Au NPs is considerably increased biocompatibility and bioavailability. In future, this research results may be helpful for the development of drugs for treatment of cataract with high stability and reactivity.

Antibiotic susceptibility profiles of ocular and nasal flora in patients undergoing cataract surgery in Taiwan: an observational and cross-sectional study.

OBJECTIVE: To investigate the conjunctival and nasal flora and the antibiotic susceptibility profiles of isolates from patients undergoing cataract surgery. DESIGN: Observational and cross-sectional study. SETTING: A single-centre study in Taiwan. PARTICIPANTS: 128 consecutive patients precataract surgery. PRIMARY AND SECONDARY OUTCOME MEASURES METHODS: Conjunctival and nasal cultures were prospectively obtained from 128 patients on the day of cataract surgery before instillation of ophthalmic solutions in our hospital. Isolates and antibiotic susceptibility profiles were identified through standard microbiological techniques. Participants were asked to complete a questionnaire on healthcare-associated factors. RESULTS: The positive culture rate from conjunctiva was 26.6%, yielding 84 isolates. Coagulase-negative Staphylococci were the most commonly isolated organisms (45.2%), and 35% of staphylococcal isolates were methicillin-resistant. Among staphylococcal isolates, all were susceptible to vancomycin, and 75%-82.5% were susceptible to fluoroquinolones. Methicillin-resistant isolates were significantly less susceptible than their methicillin-sensitive counterparts to tobramycin, the most commonly used prophylactic antibiotic in our hospital (28.6% vs 69.2%; p=0.005). The positive culture rate from nares for Staphylococcus aureus was 21.9%, and six isolates were methicillin-resistant. No subjects had S. aureus colonisation on conjunctiva and nares simultaneously. There were no associated risk factors for colonisation of methicillin-resistant Staphylococci. CONCLUSION: The most common conjunctival bacterial isolate of patients undergoing cataract surgery was coagulase-negative Staphylococci in Taiwan. Because of predominant antibiotic preferences and selective antibiotic pressures, Staphylococci were more susceptible to fluoroquinolones but less to tobramycin than in other reports. Additionally, methicillin-resistant Staphylococci exhibited co-resistance to tobramycin but not to fluoroquinolones.

[Systematic Review of the Application of Complementary and Alternative Medicine and their Potential Therapeutic Benefits in the Treatment of Ophthalmology Patients]. / Ergebnisse eines systematischen Reviews zu Einsatz und berichtetem therapeutischem Nutzen komplementärmedizinischer Methoden in der Augenheilkunde.

Purpose A systematic review was carried out of the reported therapeutic effects of complementary and alternative medicine methods as supplementary or primary treatments for patients suffering from glaucoma, cataract or age-related macular degeneration (AMD). Material and Methods For the years 1990 to 2013, the following databases were screened for reports of the application of complementary and alternative treatments: PubMed, Cochrane Library, EMBASE, CAMbase and AMED. Both randomised and prospective non-randomised patient trials were included in the review; results were evaluated in the following classes: "phytotherapy", "acupuncture/acupressure", "biofeedback" and "other alternative treatments". The studies were evaluated by measures of clinical effect, statistical significance (p value and/or confidence interval) and the underlying trial design. Results 30 clinical trials were included, including 13 on glaucoma, 5 on cataract and 12 on AMD patients. These trials were based on patient numbers of 6 - 332, 27 - 157 and 6 - 328 patients, respectively. Phytotherapy was applied in 14 trials, including 6 on glaucoma patients (all 6 with a controlled design, and 3 of which reporting statistically significant results); 5 trials were on cataract patients (3 with a controlled design and 2 with a significant result) and 3 on AMD patients (only 1 with a controlled design, with a significant result). Acupuncture/acupressure was investigated in 9 trials, 5 on glaucoma patients (3 with a controlled design, 1 with a significant result); no acupuncture/acupressure trial was found in cataract patients, but 4 trials in AMD patients (none with a controlled design). Biofeedback was studied in 4 trials, all on AMD patients (only one with a controlled design, without statistically significant findings). Conclusion Despite its rigorous inclusion criteria, this review identified several clinical trials on complementary and alternative medicine in ophthalmological patients. Phytotherapeutic methods gave significant results in half of the reported controlled trials, whereas there were few significant benefits with acupuncture or acupressure.

Vision Loss in Older Adults.

Vision loss affects 37 million Americans older than 50 years and one in four who are older than 80 years. The U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in adults older than 65 years. However, family physicians play a critical role in identifying persons who are at risk of vision loss, counseling patients, and referring patients for disease-specific treatment. The conditions that cause most cases of vision loss in older patients are age-related macular degeneration, glaucoma, ocular complications of diabetes mellitus, and age-related cataracts. Vitamin supplements can delay the progression of age-related macular degeneration. Intravitreal injection of a vascular endothelial growth factor inhibitor can preserve vision in the neovascular form of macular degeneration. Medicated eye drops reduce intraocular pressure and can delay the progression of vision loss in patients with glaucoma, but adherence to treatment is poor. Laser trabeculoplasty also lowers intraocular pressure and preserves vision in patients with primary open-angle glaucoma, but long-term studies are needed to identify who is most likely to benefit from surgery. Tight glycemic control in adults with diabetes slows the progression of diabetic retinopathy, but must be balanced against the risks of hypoglycemia and death in older adults. Fenofibrate also slows progression of diabetic retinopathy. Panretinal photocoagulation is the mainstay of treatment for diabetic retinopathy, whereas vascular endothelial growth factor inhibitors slow vision loss resulting from diabetic macular edema. Preoperative testing before cataract surgery does not improve outcomes and is not recommended.

Action spectrum for photobleaching of human lenses by short wavelength visible irradiation.

PURPOSE: Cataract is the world-leading cause of blindness. In search for a new treatment of cataract we have found that the yellow discolouration of aged human lenses can be photobleached using a non-invasive, infra-red, femtosecond laser treatment. These results were presented in an earlier PlosOne publication. The objective of the study was to characterize the single-photon photobleaching action spectrum of the aged human lens in vitro. METHODS: Ninety-one human donor lenses were irradiated with continuous wave laser light at 375, 405, 420, 445, 457 or 473 nm. Photobleaching was monitored by photography and transmission measurements. RESULTS: The action spectrum peaked at 420 nm followed by, in order of decreasing effect, 445, 457, 473, 405 and 375 nm. Younger and less absorbent lenses showed smaller changes than older and more absorbent lenses. There was a dose-dependent increase in lens transmission with increasing laser irradiation. CONCLUSIONS: For a 75 year old lens an effect corresponding to elimination of 15 years or more of optical ageing was obtained. This study of the spectral characteristics and intensity needed to bleach the human lens with single-photon laser effects found an action-spectrum peak at 420 nm tailing gradually off toward longer wavelengths and more steeply toward shorter wavelengths. The results may be used to guide experiments with two-photon bleaching.

Patients' visual experience during phacoemulsification cataract surgery and associated fear.

BACKGROUND: Data from several published studies indicate that patients undergoing phacoemulsification cataract surgery can experience a variety of visual sensations which can result in fear. This phenomenon has not been studied in Pakistan to-date. We examined the visual experience and its associated fear among patients undergoing phacoemulsification cataract surgery under topical anaesthesia. METHODS: This cross-sectional study was carried out in Aga Khan University Hospital, a tertiary care hospital, in Karachi, Pakistan from August 2010 to July 2011. Adults >18 years of age scheduled to undergo cataract surgery (phacoemulsification with intraocular lens implantation) under topical anaesthesia by a single surgeon were included. A structured questionnaire was used to collect data on socio-demographics, intraoperative visual experiences and subsequent reaction to these sensations. Participants were asked if they experienced visual sensations such as colours, shapes and movements during surgery. Moreover, they were asked if they developed fear due to these sensations. RESULTS: Fifty three patients (mean age: 60.4 ± 12.4 years) were enrolled. Thirty (56.6%) of them were men and 23 (43.4%) were women. All of them reported having experienced visual sensations during surgery, the most common being light perception (100%), different colours (77.4%), movements of instruments or surgeon's hands (37.7%) and different shapes (7.5%) such as circles, clouds and patches. The most common colours perceived included white (46.2%), blue (35.8%), red (30.2%) and yellow (30.2%). One out of every four (26.4%) participants reported having developed fear due to these visual sensations. Only 4 (7.5%) reported having received preoperative counselling regarding such sensations. CONCLUSION: Patients in our study experienced a variety of visual sensations during cataract surgery under topical anaesthesia. The prevalence of frightening visual sensations is higher than that reported in all previous published studies on the subject and needs to be addressed through targeted interventions.

[Integrated therapy of congenital cataract to prevent blindness and low vision].

Congenital cataract is a major cause of treatable blindness in the pediatric population worldwide. Advances in microsurgical techniques have significantly increased the success rate of surgery. However, visual rehabilitation outcomes are not always satisfactory even after a successful surgery. Due to delayed surgery, irrational aphakic correction, and lack of amblyopic training, a large number of infants in China remain blind or low-visioned after cataract surgery. Appropriate timing of surgical intervention, rational surgical methodology as well as systematic optical correction and amblyopic training are critical for the prevention of blindness and low vision in congenital cataract.

Natural antioxidant biomolecules promises future nanomedicine based therapy for cataract.

Cataract is an eye disease of major human concern and its prevention is important to control the global incidences of blindness. The emergence of cataract in the eye lens by strong UV radiation and growing pollution could be effectively reduced by natural antioxidant biomolecules such as flavonoids, phenolic acids, carotenoids and vitamins. This goal can be achieved either by direct external use of antioxidant biomolecules in the form of topical application as an eye drops, food supplements or through nanobiotechnology based formulation without any side effects. In this manuscript, we have discussed the mechanisms of cataract formation and the preventive role of different classes of natural antioxidant biomolecules. Further, role of nanobiotechnology to enhance therapeutic potential of these natural antioxidant molecules by enhancing solubility, stability, bioavailability and sustained release has been briefly discussed.

Combined posterior chamber intraocular lens, vitrectomy, Retisert, and pars plana tube in noninfectious uveitis.

OBJECTIVE: To assess the safety and efficacy of combined cataract extraction, posterior chamber intraocular lens placement, pars plana vitrectomy, fluocinolone acetonide intravitreal implant (Retisert), and Ahmed valves with pars plana tube (CPR-PT) in eyes with chronic, posterior, noninfectious uveitis. METHODS: Retrospective study of patients who underwent CPR-PT. Outcome measures included visual acuity, intraocular pressure, inflammation, and complications. RESULTS: Eight eyes were included, with a mean follow-up of 18 months. Mean visual acuity improved from 1.89 to 0.14 logMAR (Snellen, counting fingers at 2 ft [0.6 m]) to 20/30; P=.01). Mean intraocular pressure remained stable at 16 to 17 mm Hg (P=.35). The number of glaucoma medications per eye decreased from 2.9 to 0.25 (P=.01). Systemic prednisone therapy was discontinued in all patients by 9 months postoperatively. Inflammation was well controlled in all eyes. CONCLUSION: The CPR-PT procedure allows rapid visual rehabilitation without major short-term complications.

Safety of prophylactic intracameral moxifloxacin use in cataract surgery.

PURPOSE: To evaluate posterior and anterior segment safety of an intracameral injection of moxifloxacin as prophylaxis for endophthalmitis in cataract surgery. METHODS: In this study, 60 eyes of 60 patients were included. In the first group, only 5% povidine iodine drop was administrated to 30 patients at the end of the surgery, while 30 patients were treated with intracameral moxifloxacin (250 µg/0.050 mL) additionally in the second group. Visual acuity, intraocular pressure, corneal pachymetry, corneal clarity, and edema and retinal thickness were evaluated preoperatively and for day 3 postoperatively for each group and were compared. RESULTS: Mean preoperative visual acuity was 0.7 ± 0.9 LogMAR in both groups 1 and 2, while mean postoperative visual acuity was 0.05 ± 1.00 LogMAR in both groups. Preoperative and postoperative intraocular pressure averaged 13.2 ± 2.0 and 13.2 ± 2.1 mmHg, respectively, in the first group, while preoperative and postoperative intraocular pressure was 14.9 ± 2.1 and 14.3 ± 2.0, respectively, in the second group. Preoperative and postoperative visual acuity changes and intraocular pressure changes were not significantly different between 2 groups. There was no single case of corneal edema. In the first group, preoperative pachymetry was 523 ± 44 and postoperative pachmetry was 536 ± 45 µm, while in the second group preoperative pachymetry was 527 ± 43 and postoperative pachymetry was 543 ± 42 µm. Preoperative and postoperative pachymetry changes were not significantly different between 2 groups. Mean preoperative macular thickness in the first group was 188 ± 7.73 µm, while it was measured as 189 ± 7.75 µm postoperatively. In the second group, mean preoperative macular thickness was 188 ± 8.89 µm, while it was 189 ± 9.61 µm postoperatively. Preoperative and postoperative optical coherence tomography (OCT) measure changes were not significantly different between the 2 groups. No study-related adverse events were noted. CONCLUSION: There was no increased safety risk associated with a 250 µm/0.050 mL intracameral injection of moxifloxacin, which appears to be safe in the prophylaxis of endophthalmitis after cataract surgery.

Traditional Arabic technique of couching for cataract treatment in Yemen.

PURPOSE: In Yemen, a number of cataract patients still receive sight-restoring surgery using a traditional Arabic couching procedure. In order to evaluate the relative effectiveness and outcomes of the traditional couching procedure, patients attending a teaching center in Sana'a who had the procedure were studied. METHODS: Fifty-five eyes of 50 patients treated by traditional couching were evaluated. All individuals were checked for best-corrected visual acuity, intraocular pressure, slit-lamp biomicroscopy and fundal examination. All were questioned regarding their clinical history, cost of the surgery, and their satisfaction with the procedure immediately following the operation and presently. RESULTS: There were 55 eyes of 50 patients treated by a traditional couching procedure by a local healer. A total of 32 (64%) were men and 18 (36%) were women. The traditional healer was often paid partially in kind and the price paid varied according to patientís ability and was on average 62 USD plus accommodation and meals in the village the healer visited. After aphakic correction of eyes, 1.8% (1/55) had good vision (VA > or = 6/18), 21.8% (12/55) had low vision (> or =3/60), and 76.4% (42/55) were still blind (<3/60). Complications noted were glaucoma (21), corneal opacity (14), uveitis (6), posterior capsule opacity (8), retinal detachment (7), and severe pain (14). CONCLUSIONS: In Yemen, cataract-blind persons are still treated by traditional healers. This study suggests that the couching method used is relatively expensive, ineffective, and dangerous, and most patients are not satisfied with the results.