Epidemiological study of visual functions--refractive errors, macular degeneration and glaucoma in children in the Karst area of Opatija.

Authors of earlier studies examined the epidemiological characteristics of certain eye diseases: age-related macular degeneration (AMD), refractive errors and glaucoma in the area of Primorsho-goranska County (the island of Rab, Novi Vinodolshi and Delnice). It was found that the occurrence of AMD is most common on the island of Rab, followed by Novi Vinodolski and it is least common in Gorshi Kotar. This fact is associated with the intensity of solar radiation in the UV-A and UV-B fields. The highest percentage of the occurrence of glaucoma was also identified on the island of Rab. In comparison to this study, it was found that in the karst area of Opatija (Mune, Brgud, Zejane, Bresca, Zvonece, Pasjak, Sapjane and Zaluki) there is a very high incidence of glaucoma (27% suspected and 7% diagnosed glaucoma) within the indigenous population. Glaucoma does not appear among children whose parents migrated to the karst area of Opatija. Refractive errors are far less common among children of indigenous population than among the children whose parents migrated to this area. The occurrence ofAMD was not found in any child that was born and lives in this area, regardless of whether their parents are indigenous or not. This statement is very important because it confirms author's earlier statement which claims that at low exposure to solar UV-A and UV-B there is no occurrence of AMD.

The importance of anatomical topography in nasolacrimal duct stenosis.

In our previous study the inclination of nasolacrimal canal in relation to Frankfurt horizontal plane has been analysed on 71 anatomically preparated human skulls by introducing the probe through canal. The results of that study showed that the alpha angle in the frontalplane was greater than 91 degrees in 27% of cases, i.e., nasolacrimal canals descend diverging in relation to the median plane and both probes are intersected on glabella. In 55% of cases, the alpha angle was less than 89 degrees and probes diverge on glabella, and in 18% of cases the canals were parallel to the median plane. In this study nasolacrimal ducts in patients were visualised with Omnipaque contrast that was injected with probe through the superior lacrimal punctum. Thereafter radiography was performed. These in vivo results confirm our previous results obtained on the skulls. Minimal individual variations of values of the angle were observed. These findings are very important inprobing of stenosis of nasolacrimal duct in infants, as the operator would not have to forcefully probe with rigid instrument through gentle infant nasolacrimal duct. Difficult and serious consequences for infants arise when directing the probe "via falsa" and that often happened in practice. The authors therefore suggest when using this old method ofprobing, that this "surgical" act should be performed with "soft" probe made of nylon or silver that is very pliable and does not lead to nasal or temporal rupture of the canal.

Horopters--definition and construction.

The feature of Horopter was studied allready since the arabic and persian school, where Aguilonius defined it in 1613 for the first time. From those times til now, horopter was investigated as a geometrical feature, but also as a physiological feature of single vision. In general, there is the geometrical or theoretical horopter (Vieth, G. 1818, Muller, J. 1823) and the empirical horopter (Wheatstone, C. 1838, Panum, P L. 1858). Helmholtz includes cyclo-rotation of the eye and though geometrically defines the horopter as a "twisted cubic" fenomena, which accept also Schreiber, K.M. (2006). Our approach is geometrically and includes trigonometrical analysis of the visual lines and fixation points in space, but including the eye accommodation because the horopter plane in space is determined with the convergence angle of the bulbus and the accommodation sharpness of the eye near the fixation point and the whole presenting retina in the horopter space. We get the horopter with the presentation of both retinas in space, shaped as two spherical planes (calots), two semi-spheres with a common center of fixation. The width of their spacing which is the Panum's fusional area known as confusion of accommodation corresponds to the convergence angle of both bulbuae. If the fixation point is nearer, the Panum's fusional area is wider and hence the larger the disparation of imagies on the retina. The authors have mathematically estimated the radius of the horopter planes as: R = PD/2cosa.

Influence of aeroallergens on the incidence of conjunctivitis in Zagreb and Zagreb County.

The aim of this study was to determine the temporal and spatial variations of pollen spectra in the City of Zagreb and Zagreb County according to frequency of inhalation allergy and rhino-conjunctivitis in the adult population by setting allergen/patient relationship. The study was carried out at three inland sites in Croatia during four years (2003-2006). A number of 2,192 patients have been tested for allergy skin prick tests over the same period. The majority of patients allergic to pollen allergens were sensitized to allergens from the plant pollen which belong to the botanical family of grass 46.91%, ambrosia 42.07%, birch 25.66%, hazel 15.19% (with symptoms of rhinoconjunctivitis (42.5%), conjunctivitis (28.3%) and rhinitis (23.9%). Increased symptoms in patients allergic to pollen allergens in the entire study period coincided with the presence of pollen in the air. Patients sensitized to dust mites have symptoms throughout the year with a slightly increased number of cases in April and June. In patients sensitized to fungi and mold spores and animal hairs, the number of cases with worsening of symptoms is equal during the same year.

Dermatological aspects of contact dermatitis from eyeglass frames and optical materials.

Although contact dermatitis (CD) from eyeglass frames is uncommon, occasionally it may be encountered. Various substances may cause allergic CD, including metals, cosmetics, plastics, rubber, solvents, antioxidants, dyes, and waxes, some of which can be found in the average eyeglass frame. Recently, it has been determined that plasticizers, UV stabilizers and nickel are the most common allergens. Thus CD from eyeglass frames should be suspected in patients with retroauricular dermatitis or with lesions on the point of contact with the skin. Sometimes, the question is raised whether skin lesions result from allergy or just irritation. It has also been found that the varnish applied to eyeglass frames could be a source of nickel. Sometimes, although the frame looks silver or gold, it may contain nickel. Additionally, palladium or titanium eyeglass frames have also been reported to result in allergic CD. Some titanium frames contain palladium, which may cause CD. Plastic frames occasionally present the problem as they contain a combination of materials, making it difficult to determine the exact composition. Most plastic glasses are made of zyl or propionate, and may contain other materials, such as nylon, carbon, polycarbonate, optyl and polyamid. Patch (epicutaneous) test on contact allergens with analysis of softened scrapings from frames is a valuable diagnostic method for these patients. Although topical corticosteroid therapy results in transient clinical resolution, they do not preclude recurrences and changing frame material is often the only solution for these patients. Additionally, hypoallergenic eyeglass frames are also available on the market.

Refractive errors in children of Primorsko-Goranska County--epidemiological study.

Three institutions: Teaching Institute of Public Health of Primorsko-Goranska County, Croatian Association "Albert Einstein" and Eye Clinic "Dr B.Vojnikovid" Rijeka agreed a five-year project to study children's health status of vision at Primorsko-Goranska County. Main task was the study of damage of vision in children due to prolonged sun exposure. Examination were conducted on a three locations, with the assumption of varying insolation: Island of Rab, Novi Vinodolski and Delnice. The study included children aged between 9 to 14 years. The study included 189 children. Except routine ophthalmologic examinations in addition were preformed biomicroscopic examination of the anterior segment of the eye, intraocular pressure and eye fundus. In a certain number of children with suspect of a specific disease (macular degeneration, glaucoma and refractive error), additional tests were performed: glaucoma treatment, field of vision, optical coherence tomography (OCT) of the eye and detailed eye refraction. This study specifically addressed of refractive error at that three different regions. It was found that the most difficult situation was at the Novi Vinodolski where as many as 40% of children have a refractive error, followed by Island of Rab with 17% and Delnice with 9%. Especially like to mention that on the island of Rab, 50-60 years ago, it was a very rare occurrence of some refractive errors in children.

Gullstrand's optical schematic system of the eye--modified by Vojnikovic & Tamajo.

According to early examination (Vojnikovic, 1978) estimated, that the index of refraction for aqueous and vitreous is not the sum (1.33 or 1.66), than is for aqueous n = 1.334, and for vitreous N = 1.336. This measurements are made with Abbe's refractometer, by temperature of 33 degrees C for aqueous, and 36 degrees C for vitreous, as it's in human eye. In the principle of these results, the authors calculated the new values of cardinal points for the eye, and compared with Gullstrand's optical schematic eye. So, the refractive power for the eye F = 59.98 D, first focal length f1 = -16.67 mm and second focal length f2 = +22.27 mm

The importance of the relationship between the position of the correcting lens principal planes (H'1-H'2) and principal planes (H1-H2) of the optical eye system--aphakic correction.

In the clinical refraction of the eye, aniseikonia and anisometropia are inevitably used terms. Image formation and its retinal size is the function of the power of the dioptric eye system. However, the correcting lens in front of the eye and the eye optical system represent a unique optical afocal system, in which the distance between correcting lens and corneal vertex is of utmost importance, since it determines the size (together with appropriate correcting lens) of the retinal image. In the case of a monoculus, the size of the retinal image is not important. But, when correcting one eye while the other is emmetropic, it is important to correct it in the way that the image of the corrected eye does not produce considerable aniseikonia as a consequence of anisometropia. The authors hereby present mathematical calculation proving that if the principal point of the correcting lens P'2 is in the F1 of the emmetropic eye, meaning that? is equal to the front focal length of the emmetropic eye, there is no change in the refractive eye system, i.e. it becomes emmetropic and there is no change in the size of the retinal image. It means that an ideal position of the correcting lens in front of the eye guarantees no aniseikonia even in the extreme case of monocular aphakic spectacle correction.

How to convert the obliquely crossed to non-crossed astigmatism? A simple method using vector analysis.

The authors discussed about the problem of special form in astigmatism classification. This special type of astigmatism is the form of obliquely crossed astigmatism. In which the meridians, major and minor, are not right angles. In this astigmatism is not possible to prescribing for cylindrical (toric) spectacle lens. Authors describe the Thompson formula for oblique crossed cylinder and observe that this formula is to complicate for calculation new cylinder power. In this reason, the authors create the new formula and simple procedure for this calculation. This simple formula based on vector analysis and read: DM3 = DM2 x cos2 beta.

Arteficially induced "monovision" is vitium artis and in reality corresponds with the "Monofixation Syndrome".

Monovision is a method, most frequently used, in correction of presbyopia, especially by begining presbyops. These persons want to see well at distance and also for near without the usual changes of eyeglasses correction. Sometimes this method is also applied by myopia and psedophakic eyes (pseudophakic monovision). In myopia and hyperopia the dominant eye is corrected for distance and non-domimnant for near less correction. By monovision, especially induced by Lasik, conductive keratoplasty and contact lenses, we can decrease the important visual function, such as contrast sensitivity, stereopsis, confusion in the field of Panum's area and visual field, and for this reason we conclude that this method of arteficially induced monovision is professionally incorrect and presents a vitium artis in optometric's practice and corresponds with the "Monofixation Syndrome".

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.

Seasonal, daily and intradiurnal variation of PM10, NO2, NO and O3 in residential part of Zagreb, Croatia.

Pollutants such as particulate matter, nitrogen oxides, carbon oxides, ground-level ozone, etc. are harmful to human health. Study of pollutant variation and its relationship with both dynamic and thermodynamic atmospheric boundary layer (ABL) structures is of importance not only for environmental protection but also for the public at large. The aim of this study was to analyze seasonal, daily and intradiurnal variation of PM10, NO2, NO and O3 in a residential part of an urban area, and the effect of some meteorological parameters. The study was conducted from January 1 till December 31, 2004 in the City of Zagreb using following methods: beta radiation absorption, chemiluminescence and UV photometry. The results presented in this article, show the dependence of air pollution levels upon traffic density, seasons and meteorological conditions. Considering the level of air pollution relative to the regulated limit and tolerated values, the measured 24-hour concentrations of all study pollutants exceeded the borderline values and/or tolerated values, however, the number of days with such pollutant concentrations did not exceed the allowed frequency. This is a preliminary study with the main objectives to point to the possible identification of the source of pollution and to assess the level of air contamination according to the new national legislation coordinated with European regulations. Future measurements and studies should evaluate in detail the causes of the concentration levels detected.

Micro-regional hypersensitivity variations to inhalant allergens in the city of Zagreb and Zagreb County.

Depending on the geographic and climatic region and vegetation, allergenic plants are characteristic for certain areas and the pollen concentrations of various plant species depend on the fenophase of each single species and most of all on the climatic and meteorological conditions of a certain area. It is precisely because of these specific characteristics that the hypersensitivity of patients to various types of pollen allergens differs according to the geographic regions. The aim of this paper is to determine the frequency of inhalation allergies in adult population (> 19 years of age) caused by single types of allergens according to the defined space units (micro-regions) with special emphasis on the rural and urban areas. A number of 2,192 patients have been tested for allergy skin prick tests over a period of four years. Every patient was asked to fill in the questionnaire which contained 29 questions. The results of skin prick testing show that out of a total of 2,192 patients 86.72% were sensitized to pollen, 36.45% to mites, 2.46% to spores of fungi and mould and 5.1% of patients to other allergens which include the allergens of cockroaches, feathers and animal hair (p < 0.001). The largest number of poly-sensitized persons allergic to pollen allergens was sensitized to allergens from the pollen of plants that belong to the botanical family of grass. There were 25.36% patients mono-sensitized to individual allergens. In the northern and western parts of the city and the county, the majority of persons were sensitized to the birch pollen allergens, and this is statistically much more than the share of patients with the place of residence in the southern and eastern parts of the city and the county. In the southern and eastern locations prevails the share of sensitized persons to ambrosia which is statistically much more than the share of patients with the place of residence in the northern and western part of the city and the county.

Diurnal variation in airborne pollen concentrations of the selected taxa in Zagreb, Croatia.

The number of individuals allergic to plant pollen has recently been on a constant increase. The knowledge of diurnal distribution and abundance of allergenic pollen types, their patterns and response to source position and weather is useful to correlate hay fever symptoms with the presence of allergenic pollen in the atmosphere. The aim of this study was to determine diurnal distribution of total airborne pollen, pollen of particular allergenic taxa, possible variation in diurnal pollen distribution at measuring sites placed at different heights, and effect of some meteorological parameters on airborne pollen concentrations. A 7-day Hirst-type volumetric pollen trap was used for pollen sampling. Qualitative and quantitative pollen analysis was performed under a light microscope (magnification x400). Total pollen of all plant taxa (Ambrosia sp., Betula sp., Cupressaceae, Urticaceae, Poaceae, Quercus sp., Fraxinus sp., Alnus sp., Corylus sp., Populus sp., Pinus sp., Picea sp.) observed showed a regular diurnal distribution at both sampling sites in both study years, with a rise in the pollen concentration recorded after 4.00 a.m. and 6.00 a.m., respectively. The peak pollen concentration occurred between 12.00 a.m. and 4.00 p.m., and the lowest diurnal pollen concentrations were recorded overnight. About 50% of the 24-h pollen concentration were released to the atmosphere between 10.00 a.m. and 4.00 p.m. The timing and size of diurnal peaks were closely related to high temperature, low humidity and south-west maximum wind direction.

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.