Dark-adaptation in the eyes of a lake and a sea population of opossum shrimp (Mysis relicta): retinoid isomer dynamics, rhodopsin regeneration, and recovery of light sensitivity.

We have studied dark-adaptation at three levels in the eyes of the crustacean Mysis relicta over 2-3 weeks after exposing initially dark-adapted animals to strong white light: regeneration of 11-cis retinal through the retinoid cycle (by HPLC), restoration of native rhodopsin in photoreceptor membranes (by MSP), and recovery of eye photosensitivity (by ERG). We compare two model populations ("Sea", Sp, and "Lake", Lp) inhabiting, respectively, a low light and an extremely dark environment. 11-cis retinal reached 60-70% of the pre-exposure levels after 2 weeks in darkness in both populations. The only significant Lp/Sp difference in the retinoid cycle was that Lp had much higher levels of retinol, both basal and light-released. In Sp, rhodopsin restoration and eye photoresponse recovery parallelled 11-cis retinal regeneration. In Lp, however, even after 3 weeks only ca. 25% of the rhabdoms studied had incorporated new rhodopsin, and eye photosensitivity showed only incipient recovery from severe depression. The absorbance spectra of the majority of the Lp rhabdoms stayed constant around 490-500 nm, consistent with metarhodopsin II dominance. We conclude that sensitivity recovery of Sp eyes was rate-limited by the regeneration of 11-cis retinal, whilst that of Lp eyes was limited by inertia in photoreceptor membrane turnover.

Effect of intracameral phenylephrine 1.0%-ketorolac 0.3% on postoperative cystoid macular edema, iritis, pain, and photophobia after cataract surgery.

PURPOSE: To assess the effectiveness of intracameral phenylephrine-ketorolac during cataract surgery compared with postoperative topical steroids in reducing the incidence of postoperative clinical cystoid macular edema (CME) confirmed via optical coherence tomography (OCT), breakthrough iritis, pain, and photophobia. SETTING: Ambulatory surgical center/clinical practice. DESIGN: Retrospective 2-cohort study. METHODS: This study of cataract surgery patients compared the incidence of postoperative CME, breakthrough iritis, pain, and photophobia between patients receiving either intracameral phenylephrine 1.0%-ketorolac 0.3% during surgery or topical loteprednol 0.5% 2 days preoperatively, tapered postoperatively. Patients with prior CME or at high risk for postoperative CME, combined cataract/glaucoma surgery, and medication protocols different from those studied here were excluded. All eyes received bromfenac 2 days preoperatively and 10 weeks postoperatively. RESULTS: The study enrolled 2218 eyes (n = 1402). The phenylephrine/ketorolac treatment group included 1334 eyes (n = 830) and the topical loteprednol control group included 884 eyes (n = 572). The groups were comparable in age, race, gender, and perioperative characteristics. Clinical CME incidence was significantly lower in the phenylephrine-ketorolac group (0.52% vs 1.47%, P = .021). The phenylephrine-ketorolac group also had significantly lower breakthrough iritis (1.72% vs 4.86%, P < .001) and pain (1.27% vs 4.19%, P < .001) than the topical loteprednol group. The incidence of photophobia trended lower for the phenylephrine/ketorolac group relative to the topical loteprednol group (0.90% vs 1.13%, respectively, P = .590) but was not statistically significant. CONCLUSIONS: Intracameral phenylephrine/ketorolac and topical nonsteroidal antiinflammatory drugs (NSAIDs) without postoperative topical steroids significantly reduced postoperative clinical CME, breakthrough iritis, and pain after cataract surgery when compared with conventional perioperative topical steroids and NSAIDs.

Carbon Black Tinted Contact Lenses for Reduction of Photophobia in Cystinosis Patients.

PURPOSE: To examine if current development on using contact lenses for drug delivery of cysteamine to treat ocular symptoms of cystinosis can be tinted to mitigate photophobia common in patients by reducing transmittance Methods: Commercial contact lenses were placed in a carbon black solution to examine loading after lens synthesis. Silicone hydrogel contact lenses were also synthesized with carbon black added prior to UV curing. Transmittance was measured using UV-vis spectrophotometry over the range of 190-1190 nm and compared to unmodified contact lenses. Lens parameters of refractive index, ion permeability, and Young's modulus were measured using a refractometer, release of sodium chloride, and the cantilever method. Cysteamine release was measured by loading lenses into 5% cysteamine solution and then monitoring the release of the drug using UV-vis spectrophotometry. Vitamin E diffusion barriers were also added to lenses via ethanol solution, and the release of cysteamine from these modified lenses was also examined. RESULTS: No leeching of carbon black was detected during experiments. Loading of pre-made contact lenses led to uneven distribution of carbon black throughout lens. Adding 0.3% carbon black to lens monomer solution prior to UV-curing led to even distribution and a transmittance reduction of approximately 50%. Ion permeability was reduced from 6.19 ± 0.90 x 10-3 to 1.28 ± 0.06 x 10-3 mm2 min-1, and Young's modulus was decreased from 1.58 ± 0.08 to 1.29 ± 0.06 MPa. Cysteamine releases from carbon black lenses with and without vitamin E were comparable to controls, although the loading solution of vitamin E/ethanol had to be tripled to achieve a similar mass loading to control. CONCLUSIONS: Carbon black increases the softness of contact lenses, but a loading of 0.3% maintains lens parameters required for wear. The release of cysteamine is also possible with carbon black lenses, albeit requiring a higher loading concentration of vitamin E to achieve similar release times.

Comparison of the Lotrafilcon B and Comfilcon A Silicone Hydrogel Bandage Contact Lens on Postoperative Ocular Discomfort After Photorefractive Keratectomy.

OBJECTIVES: To compare the lotrafilcon B and comfilcon A silicone hydrogel bandage contact lenses after photorefractive keratectomy (PRK). METHODS: One hundred twenty eyes of 60 patients who underwent PRK were included in this randomized clinical trial study. In the end of the surgery, the lotrafilcon B (Air Optix; Ciba Vision, Duluth, GA) was used in one eye and the comfilcon A (Biofinity; Coopervision, Fairport, NY) was used in the fellow eye randomly. Pain and discomfort were assessed on the first and third day after surgery by visual analogue scale. RESULTS: The mean pain score was 3.75±3.32 and 4.47±3.60 on the first day (P=0.253) and 3.63±3.48 and 4.16±3.60 on the third day (P=0.416) after the use of the lotrafilcon B and comfilcon A, respectively. The results showed no significant difference between the two groups (P=0.823). The mean score of foreign body sensation was 4.31±3.38 and 5.49±3.04 on the first day (P=0.045) and 4.44±3.34 and 5.13±3.23 on the third day (P=0.250) after the use of the lotrafilcon B and comfilcon A, respectively. The comfilcon A lens caused a more severe foreign body sensation only on the first day. There was no significant difference in photophobia, epiphora, and blurred vision between the two lenses (P>0.05). CONCLUSIONS: Both lotrafilcon B and comfilcon A silicone hydrogel bandage contact lenses reduce clinical symptoms after PRK effectively. We found no difference in pain control and discomfort between them. However, the patients using the lotrafilcon B lens showed less foreign body sensation on the first day postoperatively.

Colored Glasses to Mitigate Photophobia Symptoms Posttraumatic Brain Injury.

CONTEXT: After a concussion or mild traumatic brain injury (mTBI), patients often suffer from light sensitivity, or photophobia, which contributes to decreased quality of life post-mTBI. Whereas sunglasses may provide some relief from photophobia, they are not practical indoors or in low light. A light-mitigation strategy can be easily used indoors as needed to optimize the relief. We have found that many photophobic patients experience relief using colored sunglasses. OBJECTIVE: To provide the athletic trainer with a means and method to assess whether an athlete is suffering from photophobia after concussion and to determine if colored glasses provide relief. DESIGN: Cross-sectional study. SETTING: Rehabilitation clinic. PATIENTS OR OTHER PARTICIPANTS: Fifty-one patients being treated after concussion. INTERVENTION(S): We assessed postconcussion patients for visual symptoms including photophobia and photosensitivity. Off-the-shelf glasses were used to determine whether specific colors provided relief from photophobia. Screening was done using a penlight and multiple pairs of colored glasses. MAIN OUTCOME MEASURE(S): Self-reported mitigation of photophobia symptoms and the specific color frequency that reduced symptoms in each individual. RESULTS: Of the 39 patients studied who had visual symptoms, 76% complained of photophobia. Using glasses of 1 or more colors, symptoms were relieved in 85% of patients reporting photophobia. The colors that provided the most relief were blue, green, red, and purple. No adverse events were reported. CONCLUSIONS: An empirical assessment of frequency-specific photophobia is easy to perform. A traditional penlight is used to elicit photophobia and then the colored glasses are tested for optimal relief. Frequency-specific photophobia can be reduced with a strategy of light-mitigation therapy, including colored glasses, sunglasses, hats, and light avoidance. This, we believe, helps to improve the patient's quality of life and may aid in the recovery process. More work is needed to identify the best colors and methods of mitigating frequency-specific photophobia.

Ghrelin attenuates hyperalgesia and light aversion-induced by nitroglycerin in male rats.

Systemic administration of nitroglycerin (NTG) consistently provokes spontaneous-like migraine attacks in migraine sufferers, and in rat it induces hyperalgesia and allodynia. In the present study we modeled migraine headache by intraperitoneal (i.p.) injection of a single dose of NTG, which produced widespread thermal allodynia and mechanical hyperalgesia, photophobia, and increased anxiety-like behaviors and serum concentration of cortisol. Results suggest that the effects of NTG can be largely reversed by administration of ghrelin, which mimics the effects of sumatriptan used as relevant positive therapeutic control in this study. These findings suggest that ghrelin may alleviate some of the negative emotional states associated with migraine and may hold therapeutic potential in treating migraine headache.

Thin-film optical notch filter spectacle coatings for the treatment of migraine and photophobia.

Previous evidence suggests optical treatments hold promise for treating migraine and photophobia. We designed an optical notch filter, centered at 480nm to reduce direct stimulation of intrinsically photosensitive retinal ganglion cells. We used thin-film technology to integrate the filter into spectacle lenses. Our objective was to determine if an optical notch filter, designed to attenuate activity of intrinsically photosensitive retinal ganglion cells, could reduce headache impact in chronic migraine subjects. For this randomized, double-masked study, our primary endpoint was the Headache Impact Test (HIT-6; GlaxoSmithKline, Brentford, Middlesex, UK). We developed two filters: the therapeutic filter blocked visible light at 480nm; a 620nm filter was designed as a sham. Participants were asked to wear lenses with one of the filters for 2weeks; after 2weeks when no lenses were worn, they wore lenses with the other filter for 2weeks. Of 48 subjects, 37 completed the study. Wearing either the 480 or 620nm lenses resulted in clinically and statistically significant HIT-6 reductions. However, there was no significant difference when comparing overall effect of the 480 and 620nm lenses. Although the 620nm filter was designed as a sham intervention, research published following the trial indicated that melanopsin, the photopigment in intrinsically photosensitive retinal ganglion cells, is bi-stable. This molecular property may explain the unexpected efficacy of the 620nm filter. These preliminary findings indicate that lenses outfitted with a thin-film optical notch filter may be useful in treating chronic migraine.

Artificial iris devices: benefits, limitations, and management of complications.

PURPOSE: To discuss limitations and benefits of a custom-made foldable artificial iris (Artificialiris) in the management of acquired iris defects. SETTING: Hochkreuzklinik Eye Hospital, Bonn, and the Department of Ophthalmology, University of Cologne, Germany. DESIGN: Case series. METHODS: We reviewed the clinical course and surgical management in eyes with sight-compromising complications after phakic anterior chamber implantation of synthetic iris devices between November 2011 and January 2012. RESULTS: Three eyes of 2 patients were reviewed. One patient developed cataract and corneal decompensation after anterior chamber artificial iris implantation in the left eye to treat post-uveitic mydriasis. Further treatment included artificial iris removal, cataract surgery, iridoplasty, and Descemet membrane endothelial keratoplasty (DMEK). By the 6-month follow-up, visual acuity had increased from 20/50 to 20/25. The second patient presented with bilateral secondary glaucoma, cataract, corneal edema, and iris atrophy after implantation of Newiris devices for cosmetic reasons. He consecutively had binocular explantation of the cosmetic devices, cataract surgery, artificial iris implantation, and DMEK in both eyes and Ahmed valve implantation in the right eye. During the 6-month follow-up, the intraocular pressure remained sufficiently adjusted in both eyes. Photophobia was eliminated, and visual acuity improved to 20/32 in the right eye and 20/20 in the left eye. CONCLUSIONS: In patients with major iris defects ineligible for pupilloplasties, the artificial iris allows functionally and esthetically satisfactory anterior segment reconstruction. To prevent secondary complications, the artificial iris should only be implanted in aphakic or pseudophakic eyes and placed in the posterior chamber.

The influence of dietary lutein and zeaxanthin on visual performance.

The idea that normal constituents of the diet can influence visual function is not new. As early as 1782, Buzzi identified the yellow of the macula and Schulze (1866) specifically postulated that the yellow pigments led to improvements in human vision. These pigments were later found to be derived from dietary lutein and zeaxanthin that are known to be oxygenated carotenoids (xanthophylls). Walls and Judd (1933) postulated that these yellow intraocular pigments could improve visual performance by absorbing light scattered both within (for example, glare) and outside of the eye (increasing visual range by absorbing blue light scattered in the atmosphere), and by improving spatial vision through enhancing contrast and reducing chromatic blur. In this article, evidence for these ideas is reviewed with particular emphasis towards more recent data on glare effects.

Long-term outcome of black diaphragm intraocular lens implantation in traumatic aniridia.

AIM: To evaluate the long-term outcome of black diaphragm intraocular (BDI) lens implantation in traumatic aniridia and investigate the possible cause of long-term complications. METHODS: Medical records of 18 patients (18 eyes), who had BDI lens implantation for traumatic aniridia at Shandong Eye Institute from January 1999 to December 2007, were retrospectively reviewed. Ultrasound biomicroscopy was used to observe the position of lens haptics. The difference between the eyes with and without long-term complications was compared. RESULTS: During the follow-up of 41 months (range 12-72), 12 eyes showed a satisfactory visual function, no capsule membrane was present because of pars plana vitrectomy performed before or with lens implantation, and the haptics of BDI lenses were located at the sulcus or trans-sclerally fixed. Four eyes developed refractory glaucoma at 6-36 months after the BDI lens implantation, and three of these had an intact capsule membrane, with the sulcus fixation of the lens haptics in two and trans-scleral fixation in one. Corneal decompensation occurred in six eyes, including the four with glaucoma. CONCLUSIONS: BDI lens implantation is safe and effective in most traumatic eyes. Glaucoma and corneal decompensation appear to be the major long-term complications. The position of BDI lens is crucial for the long-term outcome.

Dental inflammation and central retinitis--it is important to protect the retina from the harmful sunlight.

During 3-year study of 73 patients with dental inflammation, sinusitis, otitis and 5 cases with granuloma, in 9 cases we observed the development of central retinitis. All patients were medicated with the same antibiotics and parabulbar depo of Prednisolonacetate. To 50% of these patients, we suggested eye protection with Yellow Medical filters during two months. In the first group with medication we observed better vision in 69%, but in the second group with eye protection with Yellow Medical filters we observed normalization of vision in 100%.

Hyoscine skin patches for drooling dilate pupils and impair accommodation: spectacle correction for photophobia and blurred vision may be warranted.

Hyoscine skin patches diminish salivation by their anticholinergic action. The aim of reporting this case series is to present the ophthalmic side effects in children, and to highlight the precautions to take. Five children (two males, three females; age range 8-18y) with quadraplegic cerebral palsy (Gross Motor Function Classification System Level V) and profound intellectual impairment, wearing hyoscine skin patches to control excessive salivation, were examined. Binocular visual acuity, pupil reaction, pupil diameter, and dynamic retinoscopy were recorded before and after instilling guttae cyclopentolate 1%. The accommodative responses were compared with the expected norms. Spectacle correction was provided for refractive error and to compensate for lack of accommodation. Tinted lenses were provided for photophobia. Visual assessment was repeated 6 months later. All children had dilated pupils with a mean diameter of 7.8mm (range 7-9mm) before instilling guttae cyclopentolate. Mean pupil constriction to bright light was only 1.8mm (range 1-2mm). Mean resting accommodation was 0.45 dioptres (D; range 0-1D) and no accommodative responses were detected on dynamic retinoscopy. Three children were photophobic. Visual behaviour was seen to improve after the use of appropriate spectacles. Photophobia was relieved by tinted lenses. The anticholinergic effects of hyoscine skin patches can cause photophobia and impair vision due to pupil dilatation and paralysis of accommodation. Appropriate spectacles are recommended.

Crossover, double-blind clinical trial comparing almotriptan and ergotamine plus caffeine for acute migraine therapy.

In this randomized, double-blind, crossover clinical trial, adult patients treated two migraine attacks: one with almotriptan 12.5 mg and the other with ergotamine 2 mg plus caffeine 200 mg. Treatment with almotriptan was associated with a significantly greater proportion of patients achieving 2-h pain free (20.9% vs. 13.7%; P < 0.05) and 2-h pain relief (57.7% vs. 44.5%; P < 0.01) compared with ergotamine plus caffeine therapy; significant differences were not seen at 1 h. Rates for sustained pain free and sustained pain free plus no adverse events (AEs) also were significantly greater after almotriptan treatment than after the use of ergotamine plus caffeine (P < 0.05). Almotriptan was associated with a significantly lower rate of photophobia at 90 min (P < 0.05), phonophobia at 60, 90, and 120 min (P < 0.05 to <0.01), and nausea and vomiting at 90 and 120 min (P < 0.01) compared with ergotamine plus caffeine. A significantly greater proportion of patients were more satisfied with almotriptan than with ergotamine plus caffeine (P < 0.05). Sixteen patients reported adverse events during almotriptan treatment and 27 patients reported AEs during the ergotamine plus caffeine therapy. Most AEs were mild-to-moderate and did not result in treatment-related discontinuations. In conclusion, almotriptan was associated with significantly greater efficacy for treating migraine compared with ergotamine plus caffeine, was generally well tolerated and was associated with greater rate of treatment satisfaction.

Transient light-sensitivity syndrome after laser in situ keratomileusis with the femtosecond laser Incidence and prevention.

PURPOSE: To describe the incidence of transient light-sensitivity syndrome (TLSS) after laser in situ keratomileusis (LASIK) with the femtosecond laser and to identify preventive strategies. SETTING: Hospital NISA Virgen del Consuelo, Valencia, Spain. METHODS: The first 765 eyes operated on with the 15 KHz femtosecond laser were prospectively analyzed for subjective complaints and clinical findings compatible with TLSS. Intraoperative settings, postoperative treatment, and development of complications were analyzed. RESULTS: Overall, TLSS developed in 10 eyes (incidence 1.3%). However, the incidence decreased from 2.8% to 0.4% when aggressive topical steroids were used during the first 3 postoperative days. Postoperative interface inflammation and postoperative use of a low-dose topical steroid regimen were associated with a higher incidence of TLSS. CONCLUSIONS: Transient light-sensitivity syndrome is a relatively uncommon complication related to the use of the femtosecond laser. Postoperative interface inflammation may increase the probability of developing TLSS, whereas an aggressive postoperative steroid regimen seemed to provide protection against it.

[Changes of retinal light sensitivity after YAG-laser capsulotomy]. / Veränderungen der Lichtunterschiedsempfindlichkeit (LUE) der Netzhaut nach der YAG-Laser-Kapsulotomie.

BACKGROUND: The aim of this prospective study was firstly to investigate the changes of retinal light sensitivity of the central visual field in patients with posterior capsule opacification (PCO) after YAG-laser capsulotomy and secondly to determine the correlation between changes in retinal light sensitivity and patient's age and the diameter of posterior laser capsulotomy. PATIENTS AND METHODS: Our study includes 25 eyes (25 patients) with PCO after phacoemulsification and intraocular lens implantation. In all patients YAG-laser capsulotomy was performed. In all patients, a threshold visual field analysis was carried out with the C 30 - 2 programme of the automated Humphrey Field Analyzer before and one month after the procedure. RESULTS: In all patients a significant improvement of visual acuity was observed one month after capsulotomy (p = 0,00003). One month after YAG-laser treatment, a significant improvement of retinal light sensitivity in the central visual field was also observed. The average MD (mean deviation) before the procedure was - 6.05 db (+/- 3.2, max. - 11.7, min. + 2.17) and after the procedure - 3.61 db (+/- 3.7, max. - 10.87, min. + 0.71). Before laser capsulotomy obvious areas of reduced retinal sensitivity in 19 of 25 eyes (76 %) were found with MD p values of less than 5 %. One month after the procedure the MD p values were less than 5 % only in 8 eyes (32 %). The improvement in MD was statistically significant (p = 0,0002). No correlation was established between the improvement of retinal light sensitivity and patient's age or the size of the capsulotomy. CONCLUSIONS: Our study shows that the improvement of retinal light sensitivity is significant after YAG-laser capsulotomy and not depends on patient age or capsulotomy size.

Autoimmune retinal dysfunction in sarcoid chorioretinopathy.

BACKGROUND: Visual loss, photophobia and night-blindness in a middle-aged patient with a previous history of cancer are highly suggestive of cancer-associated retinopathy. HISTORY AND SIGNS: A 63-year-old man complained of slowly progressive bilateral visual loss, photophobia and night-blindness. His past medical history was remarkable for surgical and medical treatment of a carcinoma of the base of his tongue nine years earlier. Visual acuity was 0.3 RE and 0.15 LE, with constricted visual field in both eyes. Ocular examination and fluorescein angiography were non-relevant. Electroretinography revealed diffuse cone and rod dysfunction. ICG angiography showed multiple small widespread hyperfluorescent spots. A chest CT scan revealed multiple focal lesions which were biopsied. Histological diagnosis was sarcoidosis. THERAPY AND OUTCOME: Upon systemic steroid therapy, visual function gradually improved, and ICG anomalies disappeared. Vision recovered to 1.0 RE and 0.8 LE with normal visual field in both eyes. CONCLUSION: Sarcoidosis may present as an autoimmune retinal dysfunction with photophobia and night blindness as the presenting symptoms.

Ophtec iris reconstruction lens United States clinical trial phase I.

PURPOSE: To determine the safety and efficacy of the Ophtec model 311 iris reconstruction lens for treatment of visual disturbances, such as glare or photophobia, related to partial or total absence of the human iris. DESIGN: Phase I multicenter, nonrandomized, investigational device study. PARTICIPANTS: Ten iris reconstruction lenses were placed in 10 subjects at 6 sites. METHODS: Iris reconstruction lenses were placed in 9 patients who had lost all or part of their iris from trauma and in 1 patient who lacked iris pigmentation due to congenital albinism. Patients were examined preoperatively, intraoperatively, and postoperatively at day 1; week 1; and months 1, 3, 6, and 12. MAIN OUTCOME MEASURES: Efficacy measures were uncorrected visual acuity (UCVA), glare, starbursts, and photophobia. Safety measures were best-corrected visual acuity (VA), surgical complications, and adverse events. RESULTS: Uncorrected VA improved in all eyes after implantation of the iris reconstruction lens. Best-corrected VA did not change significantly (P = 0.24). Postoperative photophobia was reduced in all 9 eyes that experienced moderate to severe preoperative photophobia. Likewise, postoperative glare was reduced in all 6 eyes with moderate to severe preoperative glare. There were no surgical complications. Adverse events included 2 cases of iritis and 1 case of macular edema. CONCLUSIONS: Preliminary results suggest that the Ophtec model 311 iris reconstruction lens can improve UCVA and reduce glare and photophobia in patients with partial or total absence of the iris or iris pigmentation.