Epidemiological Surveillance of Eye Disease and People Awareness in the Abruzzo Region, Italy.

Background and Objectives: Vision impairments and related blindness are major public health problems. The prevalence of eye disease and barriers to optimal care markedly vary among different geographic areas. In the Abruzzo region (central Italy), an epidemiological surveillance on the state of ocular health in the population aged over 50 years was performed in 2019. Materials and Methods: Participants were sampled to be representative of the region's inhabitants. Data were collected through a telephone interview and an eye examination. Prevalence of cataract, glaucoma, retinopathy, and maculopathy was assessed. The Cohen's kappa (k) was used to measure the agreement between the presence of eye disease and awareness of the disease by the participants. Results: Overall, 983 people with a mean age of 66.0 ± 9.5 years were included in the study. The prevalence of cataracts, glaucoma, maculopathy, and retinopathy was 52.6%, 5.3%, 5.6%, and 29.1%, respectively. Among the total of the affected people, those aware of their condition were 21.8% (k = 0.12, slight agreement) for cataract, 65.4% (k = 0.78, substantial agreement) for glaucoma, 7.1% (k = 0.10, slight agreement) for maculopathy, and 0% for retinopathy (k = -0.004, agreement lower than that expected by chance). Refractive defects were corrected in the vast majority of participants. Conclusion: In the Abruzzo region, about two thirds of citizens aged 50 years or over suffer from cataract, glaucoma, retinopathy, or maculopathy, which are recognized as leading causes of blindness. Many people with eye disease do not know they have it. These data can be used by clinicians and policymakers to undertake clinical, political, and social actions.

A New System for Assessing Visual Disability Using a Digital Visor.

BACKGROUND: Considering the lack of universally accepted visual requirements for driving and for defining various grades of visual disability, the aim of this study is to propose a new method that provides a numerical score resulting from a combined assessment of the visual field and visual acuity loss obtained using a digital technology visor. METHODS: This study presents a new system for calculating the percentage of visual disability by combining binocular visual acuity and binocular visual field assessments. A new Global Vision Evaluation System digital technology visor uses standardized, reproducible criteria to produce well-defined, numerically expressed test results. Through a specific algorithm, the device produces a numerical value expressing the percentage of visual disability. RESULTS: Eighty-six subjects with various types of visual impairment underwent visual acuity and visual field test examinations carried out employing both traditional methods and the new digital visor. The two methods provided homogeneously similar results regarding the positioning of the subjects on the visual disability scale. CONCLUSIONS: The new digital visor seems to be a valid method to ensure that visual disability assessments are more homogeneous and reliable, and that, consequently, the resources available for this purpose are more fairly distributed.

[Blindness and social security in Italy: critical issues and proposals.] / La cecità civile in Italia: criticità e proposte.

In Italy, blindness and low vision are ruled by Law 138/2001: two categories of blindness (corresponding to the one in the current WHO classification), receiving economical remuneration, and three categories of low vision, not directly remunerated. The problem ensues that low vision patients, who better gain from rehabilitation, have no economical contribution to undergo such care pathways; moreover, in Italy the evaluation has not yet shifted from "visual function" to "functional vision", thus lacking a holistic evaluation of visual dysfunction impact on the patient's daily life skills. To quantify the visual function of the examinee, only subjective performance (visual acuity and/or visual field) is evaluated in accordance with Law 138/2001, thus paving the way to malingerers: the "false blinds" phenomenon has recently reached the media. The Authors suggest that a correlation between the individual anatomical picture of the pathology/ies and the visual performance, obtained in patients with similar lesions undergoing controlled clinical studies reported in the ophthalmological literature, could offer more objective values to quantify the visual function.

Neurofibromatosis: an update of ophthalmic characteristics and applications of optical coherence tomography.

Neurofibromatosis (NF) is a multisystem disorder and tumor predisposition syndrome caused by genetic mutation on chromosome 17-17q11.2 in NF type 1 (NF1), and on chromosome 22-22q12.2 in NF type 2. The disorder is characterized by considerable heterogeneity of clinical expression. NF1 is the form with the most characteristic ocular manifestations. Lisch nodules of the iris are among the well-known diagnostic criteria for the disease. Glaucoma and associated globe enlargement have been described in a significant proportion of patients with NF1 and orbital-facial involvement. Optic nerve glioma may cause strabismus and proptosis, and palpebral neurofibroma may reach considerable size and occasionally show malignant transformation. Near infrared reflectance has greatly contributed to enhancing our knowledge on choroidal alterations in NF1. Indeed, some authors have proposed to include these among the diagnostic criteria. Optical coherence tomography has given new insight on retinal alterations and is a noninvasive tool in the management of optic nerve gliomas in children. Ocular manifestations in NF type 2 can range from early-onset cataracts in up to 80% of cases to optic nerve hamartomas and combined pigment epithelial and retinal hamartomas.

Spectral domain optical coherence tomography and B-scan ultrasonography in the evaluation of retinal tears in acute, incomplete posterior vitreous detachment.

BACKGROUND: The purpose of this study was to evaluate the extension and traction effects of posterior vitreous detachment (PVD) complicated with retinal tears using spectral domain optical coherence tomography (OCT) and B-scan ultrasonography. METHODS: Complete ophthalmological examination, B-scan ultrasonography and spectral domain OCT were performed in patients with acute PVD and retinal tears. Vitreous detachment was classified as complete or incomplete, based on extent of posterior pole or peripheral vitreous detachment. Retinal tear location and persistent traction on the retinal flap was evaluated with B-scan ultrasonography and OCT. Categorical data were evaluated with Fisher's exact test. Statistical significance was considered as P < 0.05. RESULTS: Twenty-six eyes of 25 patients were assessed. Four eyes (15 %) presented complete PVD with detachment at the posterior pole and periphery. 22 eyes (85 %) presented incomplete PVD with detachment in the periphery. Twenty eyes presented retinal tears in the superior quadrants with respect to only 6 in the inferior quadrants (p = 0.006). There was a higher incidence of retinal tears in the pre with respect to post-equatorial areas (19 vs 7 eyes, p = 0.019). B-scan ultrasonography and OCT revealed persistent traction on the retinal tear flap in 19 and 15 eyes, respectively. CONCLUSIONS: In acute PVD, retinal tears are prevalently associated with peripheral vitreous detachment. The impact of complete or incomplete PVD can be of clinical value when evaluating patients with retinal tears.

Ophthalmic Alterations in the Sturge-Weber Syndrome, Klippel-Trenaunay Syndrome, and the Phakomatosis Pigmentovascularis: An Independent Group of Conditions?

The phakomatoses have been traditionally defined as a group of hereditary diseases with variable expressivity characterized by multisystem tumors with possible malignant transformation. The Sturge-Weber syndrome, Klippel-Trenaunay syndrome, and the phakomatosis pigmentovascularis have the facial port-wine stain in common. Numerous pathophysiogenetic mechanisms have been suggested such as venous dysplasia of the emissary veins in the intracranial circulation, neural crest alterations leading to alterations of autonomic perivascular nerves, mutation of the GNAO gene in the Sturge-Weber syndrome, PIK3CA mutation in malformative/overgrowth syndromes such as the Klippel-Trenaunay syndrome, and the twin-spotting phenomenon in phakomatosis pigmentovascularis. Other features linked to the port-wine stain and typical to all of the three conditions are glaucoma and choroidal alterations. Glaucoma can be due to malformations of the anterior chamber or high episcleral venous pressure and in phakomatosis pigmentovascularis it can also be associated with angle hyperpigmentation. The choroid can be thickened in all diseases. Furthermore, choroidal melanocytosis in the phakomatosis pigmentovascularis can lead to malignant transformation. Although the multiple pathophysiological mechanisms still require clarification, similarities in ophthalmic manifestations make it reasonable to classify these diseases in an independent group.

Choroidal Thickness Changes After Intravitreal Antivascular Endothelial Growth Factor Therapy for Age-Related Macular Degeneration: Ranibizumab Versus Aflibercept.

PURPOSE: To compare the changes in subfoveal choroidal thickness (CT) in eyes with neovascular age-related macular degeneration (nAMD) treated with intravitreal ranibizumab or aflibercept. METHODS: In this retrospective case series, the medical records of 28 patients with nAMD treated with at least 3 consecutive monthly injections of ranibizumab (0.5 mg/0.05 mL) or aflibercept (2 mg/0.05 mL) between December 2013 and June 2014 and who were followed up for at least 3 months were reviewed. Subfoveal choroidal thickness was measured using enhanced depth imaging optical coherence tomography. RESULTS: Choroidal thickness decreased over time in the aflibercept group, but was unchanged throughout the study in the ranibizumab group. At each time point, the decrease was significantly greater in aflibercept-treated eyes compared with ranibizumab-treated eyes (P<0.05). No significant change in best-corrected visual acuity (BCVA) was seen in either group during follow-up. There was no correlation between change in choroidal thickness and age, sex, duration of previous antivascular endothelial growth factor treatment, number of previous injections, spherical equivalent, baseline choroidal thickness, and the BCVA outcome in either group. CONCLUSIONS: Subfoveal choroidal thickness appeared to decrease significantly in eyes with nAMD during 3 months of aflibercept treatment. No corresponding decrease in choroidal thickness occurred in ranibizumab-treated eyes.

Irritable eye syndrome: neuroimmune mechanisms and benefits of selected nutrients.

Previous studies showed comorbidity of some ocular, enteral, and affective symptoms comprising irritable eye syndrome. Aims of the present study were to learn more about the pathogenic mechanisms of this syndrome and to evaluate benefits of food supplements on these disorders. In in vitro assay, Lactobacillus acidophilus lysate inhibited interleukin (IL)-1ß and tumor necrosis factor (TNF)-α generation of lipopolysaccharide (LPS)-stimulated macrophages in dose- and size-dependent manner. For a prospective, open-label phase I/II controlled clinical trial, 40 subjects affected by ocular dysesthesia and hyperesthesia and comorbid enteral and anxiety-depression symptoms were randomly assigned either into the treated group, which received a composition containing probiotic lysate, vitamins A, B, and D and omega 3 fatty acids, or into the control group, which received vitamins and omega 3 fatty acids. For reference, 20 age- and sex-matched healthy subjects were also selected. White blood count (WBC) and lymphocyte and monocyte counts, as well as IL-6 and TNF-α levels, were significantly above the reference levels in both treated and control groups. After 8 weeks, WBC and lymphocyte and monocyte counts, and cytokine levels significantly decreased, and ocular, enteral, and anxiety-depression symptoms significantly improved in the treated group as compared to the control group. This proof-of-concept study suggested that subclinical inflammation may be a common mechanism connecting ocular, enteral, and anxiety/depression symptoms, and supplements affecting dysbiosis may be a new approach to treating this syndrome.

Choroidal thinning as a new finding in Alzheimer's disease: evidence from enhanced depth imaging spectral domain optical coherence tomography.

BACKGROUND: The involvement of retina and its vasculature has been recently described in Alzheimer's disease (AD). However, none of the previous works have yet investigated the choroid in vivo. OBJECTIVE: Spectral domain optical coherence tomography (SD-OCT) and enhanced depth imaging (EDI) technique is non-invasively used to assess choroidal thickness in patients with AD and to determine whether the peripapillary retinal nerve fiber layer (RNFL) and central retinal thickness are reduced compared to normal subjects. METHODS: Forty-two eyes of 21 patients (mean age, 73.1 ± 6.9 years) with a diagnosis of mild to moderate AD and 42 eyes of 21 age-matched control subjects (mean age, 70.3 ± 7.3 years) were included in this prospective, cross-sectional study. All the subjects underwent neuropsychological (MMSE, ADAS-Cog, and CDR) and ophthalmological evaluation. The SD-OCT images of the choroid were obtained by EDI modality. Choroidal thickness was assessed by manual measurement. The following parameters, measured automatically by the OCT software, were also analyzed for each eye: 1-mm central subfield (CSF) retinal thickness, peripapillary RNFL thickness. RESULTS: Choroidal thickness was significantly thinner in AD than in control eyes (p < 0.05). No difference in CSF retinal thickness was found between groups (p > 0.05). Mean peripapillary RNFL thickness in all four quadrants was similar between groups (p > 0.05). OCT measurements were not correlated with any of the tested psychometric parameters (p > 0.05). CONCLUSION: Compared with healthy subjects, patients with AD showed a significant reduction in choroidal thickness. Choroidal thinning may represent an adjunctive biomarker for the diagnosis and follow-up of this disease.

A solitary fibrous tumour of the eyelid.

OBJECTIVE: To report a case of palpebral solitary fibrous tumour (SFT). CLINICAL PRESENTATION AND INTERVENTION: An elderly man presented with a slow-growing painless mass in the lower conjunctival fornix in the left eye. The lesion was excised and it measured 0.9 cm in maximum diameter. The microscopic features were characteristic of a benign SFT, with immunohistochemical reactivity for vimentin, CD34 and Bcl-2 protein. Nuclear staining for progesterone receptor was also observed. CONCLUSION: This tumour displayed a benign course, with no recurrence after excision. CD34 immunohistochemistry proved to be a useful adjunct to the microscopic diagnosis.

Intravitreal anti-vascular endothelial growth factor for retinal angiomatous proliferation in treatment-naive eyes: long-term functional and anatomical results using a modified PrONTO-style regimen.

PURPOSE: To evaluate long-term outcome of intravitreal anti-vascular endothelial growth factor monotherapy in retinal angiomatous proliferation. METHODS: Twenty-one treatment-naive eyes were included in this prospective, interventional case series. Treatment was three monthly injections of bevacizumab and/or ranibizumab with a modified PrONTO-style regimen. Best-corrected visual acuity (BCVA) was evaluated. The influence of baseline BCVA and pretreatment pigment epithelial detachment on BCVA outcome or retreatment were assessed by Pearson correlation analysis. RESULTS: Results were evaluated at 2 years and 3 years for 21 and 13 eyes, respectively. Mean baseline BCVA improved significantly from 44.5 (± 11.0) (20/32) to 51.1 (± 9.7) (20/24) and 50.8 (± 10.4) letters (20/24) at 2 and 3 years, respectively (P = 0.02 and P = 0.049). Pigment epithelial detachment correlated negatively with BCVA outcome (r = -0.65, P = 0.002 and r = -0.67, P = 0.01 at 2 years and 3 years, respectively) and was significantly associated with retreatment (r = 0.62, P = 0.003 and r = 0.87, P < 0.0001 at 2 years and 3 years, respectively). Complete occlusion of the lesion was obtained in 71% and 69% of eyes at 2 years and 3 years, respectively, with a mean of 9.4 injections at 3 years. CONCLUSION: Intravitreal anti-vascular endothelial growth factor monotherapy was a valid option for retinal angiomatous proliferation. Stable or improved visual acuity was obtained in 95% and 100% of eyes at 2 years and 3 years, respectively.

Rehabilitative approach in patients with ring scotoma.

OBJECTIVE: To investigate the rehabilitative approach in patients with ring scotoma. A central scotoma is characteristic for patients with age-related macular degeneration (AMD). Sometimes patients with AMD maintain a residual central vision area within the scotoma (ring scotoma). DESIGN: Prospective, nonrandomized case series. PARTICIPANTS: Twenty-four patients with AMD. METHODS: A formal low-vision assessment was performed for all study patients. The assessment included best corrected visual acuity (BCVA), contrast sensitivity, reading speed, and microperimetry. All patients were provided a low-vision assessment to satisfy patients' needs. Devices were prescribed accordingly. RESULTS: The BCVA found was 0.4 logMAR (SD 0.1). All had central and stable fixation. Residual central retinal area size and sensitivity measured 2.4° (SD 0.8) and 3.1 dB (SD 0.8), respectively. Twenty patients achieved better vision with optical magnification in the eye with ring scotoma. Mean reading speed achieved was 50.2 words/min (SD 20.9). A linear correlation was found for reading speed with both central area sensitivity (r² = 0.5, p < 0.05) and contrast sensitivity (r² = 0.3, p < 0.05). CONCLUSIONS: In patients with AMD with ring scotoma, moderate amounts of magnification seem to provide satisfactory rehabilitation outcomes. Central retinal spared area sensitivity may predict reading speed outcomes, whereas residual central area size is likely to be useful in determining magnification.

Clinical and microperimetric predictors of reading speed in low vision patients: a structural equation modeling approach.

PURPOSE: To investigate the simultaneous association of several psychophysical measures with reading ability in patients with mild and moderate low vision attending rehabilitation services. METHODS: Standard measurements of reading ability (Minnesota Reading [MNREAD] charts), visual acuity (Early Treatment of Diabetic Retinopathy Study [ETDRS] charts), contrast sensitivity (Pelli-Robson charts), reading contrast threshold (Reading Explorer [REX] charts), retinal sensitivity, and fixation stability and localization (Micro Perimeter 1 [MP1] fundus perimetry) were obtained in 160 low vision patients with better eye visual acuity ranging from 0.3 to 1.0 logarithm of the minimum angle of resolution and affected by either age-related macular degeneration or diabetic retinopathy. RESULTS: All variables were moderately associated with reading performance measures (MNREAD reading speed and reading acuity and REX reading contrast threshold), as well as among each other. In a structural equation model, REX reading contrast threshold was highly associated with MNREAD reading speed (standardized coefficient, 0.63) and moderately associated with reading acuity (standardized coefficient, -0.30). REX test also mediated the effects of Pelli-Robson contrast sensitivity (standardized coefficient, 0.44), MP1 fixation eccentricity (standardized coefficient, -0.19), and the mean retinal sensitivity (standardized coefficient, 0.23) on reading performance. The MP1 fixation stability was associated with both MNREAD reading acuity (standardized coefficient, -0.24) and MNREAD reading speed (standardized coefficient, 0.23), while ETDRS visual acuity only affected reading acuity (standardized coefficient, 0.44). CONCLUSIONS: Fixation instability and contrast sensitivity loss are key factors limiting reading performance of patients with mild or moderate low vision. REX charts directly assess the impact of text contrast on letter recognition and text navigation and may be a useful aid in reading rehabilitation.

Relationship between fixation stability measured with MP-1 and reading performance.

BACKGROUND: People with visual impairment have reduced reading performance, which is thought to be related to unstable or eccentric fixation. New microperimeters such as the MP-1 offer straightforward analysis of fixation stability. The aim of this study was to investigate the relationship between fixation stability and reading speed in a large cohort of people with diverse causes of visual impairment and to verify the correlation between reading speed and different methods for the quantification of fixation. METHODS: The better eye of one hundred and twenty subjects was assessed. Fixation values were obtained from the MP-1 microperimeter. Reading speed was evaluated using newspaper text with magnifiers if required. RESULTS: The poorest fixation stability and reading performance was found in people with age-related macular degeneration while the best fixation was in retinitis pigmentosa subjects. A linear relationship was found between reading speed and the proportion of fixations within 2° (r² = 0.51, p < 0.001) and 4° (r² = 0.36, p < 0.001). A negative correlation was found between reading speed and all three bivariate contour ellipse areas (BCEA; for log transformation of 1-S.D., 2-S.D. and 3-S.D.: r² = 0.39, p < 0.001). In a multiple regression model, proportion of points falling within 2° and 4° circle was significantly related to reading speed (r² = 0.55, p < 0.01; r² = 0.43 p < 0.01); also BCEAs values were strongly related to reading ability only in patients with central vision loss (r² = 0.62, p < 0.01 for LogBCEA 68.2%; r² = 0.61, p < 0.01 for LogBCEA 95.4% and 99.6%) and peripheral defect (r² = 0.52, p < 0.01 for LogBCEA 68.2%; r² = 0.50, p < 0.01 for LogBCEA 95.4%; r² = 0.49, p < 0.01 for LogBCEA 99.6%) but not in combined defect subjects. CONCLUSIONS: The study confirms that in people with visual impairment the reduced reading performance is correlated with fixation instability. Moreover, there is a strong relationship between reading speed and both the proportion of fixations falling within 2° and 4° and bivariate contour ellipse area values.

Long-term results of intravitreal bevacizumab for choroidal neovascularisation in pathological myopia.

AIM: To evaluate the long-term results and prognostic factors of intravitreal bevacizumab (IVB) for myopic choroidal neovascularisation (mCNV). METHODS: Thirty-two eyes of 30 patients with mCNV were included in a prospective case series. Treatment consisted of three monthly 1.25 mg IVB injections. Best corrected visual acuity (BCVA) and CNV area were compared before and after treatment. Prognostic factors included in the regression analyses were age, axial length, baseline BCVA, pretreatment CNV area, CNV location and peripapillary atrophy area. RESULTS: Results were evaluated at 2 years for 32 eyes and at 3 years for 27 eyes. Mean (± SD) baseline BCVA had improved significantly from 30.1 (± 15.6) letters to 45.4 (± 13.0) letters at 3 years (p<0.0001), with a better outcome in eyes with juxtafoveal CNV (40.4 ± 13.5 vs. 54.0 ± 5.8, p=0.001). Baseline BCVA correlated positively with final BCVA (ß= 0.560, p=0.001), while age showed a negative correlation (ß= -0.399, p=0.01). CNV area decreased from 0.63 (± 0.71) mm(2) at baseline to 0.40 (± 0.57) mm(2) at 3 years (p<0.0001). Peripapillary atrophy area was the only significant contributing determinant for re-treatment (OR 1.20, 95% CI 1.01 to 1.42, p=0.04). CONCLUSIONS: A regimen of three monthly IVB injections yielded effective and sustained results in the treatment of mCNV at 3 years of follow-up. Initial BCVA and age were the factors that correlated independently with BCVA outcome.

Evaluation of five elements in lenses and aqueous humour of experimental rabbits after induced opacity.

We evaluated the presence of Ca, Na, K, Cu and Zn in the lenses and aqueous humour of rabbits treated with an Nd:YAG laser to induce opacity of the crystalline. The mean concentrations of the elements found in control lenses were: Ca: 15.8+/-5.2 mg/kg; Na: 1.2+/-0.6 g/kg; K: 10.3+/-3.3 g/kg; Cu: 0.19+/-0.06 mg/kg; Zn: 20.6+/-3.0 mg/kg. With the exception of K and Zn, the values found in the lenses of treated eyes (Ca: 135+/-24 mg/kg; Na: 4.3+/-1.5 g/kg; K: 10.1 +/- 3.2 g/kg; Cu: 0.47+/-0.17 mg/kg; Zn: 21.8+/-4.2 mg/kg) were significantly higher than in the controls. On the other hand, the concentrations found in the aqueous humour of treated eyes (Ca: 21.7+/-4.5 mg/l; Na: 0.66+/-0.21 g/l; K: 0.29+/-0.10 g/l; Cu: 0.035+/-0.009 mg/l; Zn: 0.079+/-0.01 mg/l) were significantly lower than those of the controls. The greatest difference was observed for Na (-68.6%) and Cu (-52.7%), followed by Ca and Zn (-35.0% and -35.2%, respectively). A positive correlation was found between Ca and Na in treated lenses (r2 = 0.9226, p < 0.0001) whereas inverse correlations were found for both Ca (r2 = 0.9788, p<0.0001) and Na (r2 = 0.9491, p<0.0001) between the concentrations found in the lenses and in the aqueous humour of treated eyes.