Light-scattering characteristics of explanted opacified Aquasense intraocular lenses.

AIM: To study forward light-scattering characteristics of calcified explanted intraocular lenses (IOLs) (Aquasense, Ophthalmic Innovation International Ontario). METHODS: The amount of light scattered by the opacified IOLs was measured using a validated in vitro set-up for angles from 1.7 degrees to 22 degrees . This set-up gives results directly comparable with straylight values as valid for the in vivo situation. RESULTS: Straylight is highest at large angles and declines steeply approaching 0 degrees angle. This corresponds to the in vivo findings that opacified IOLs cause important visual complaints but have little effect on visual acuity. At 7.5 degrees , log (s) is around 1.8 and 2.9 for the two lenses respectively. This corresponds to 8 x and 100 x increases in straylight values compared with values in young, normal eyes. CONCLUSION: High straylight values caused by opacified IOLs can explain subjective complaints of reduced quality of vision in patients with opacified implants, despite good visual acuity.

Visual information processing in high-functioning individuals with autism spectrum disorders and their parents.

The authors assessed visual information processing in high-functioning individuals with pervasive developmental disorders (PDD) and their parents. The authors used tasks for contrast sensitivity, motion, and form perception to test visual processing occurring relatively early and late in the magnocellular-dorsal and parvocellular-ventral pathways. No deficits were found in contrast sensitivity for low or high spatial frequencies or for motion or form perception between individuals with PDD in comparison with a matched control group. Individuals with PDD performed equally with or better than controls on motion detection tasks. In addition, the authors did not find differences on any of the tasks between parents of the PDD group and matched control parents. These results indicate that high-functioning individuals with PDD and their parents are able to process visual stimuli that rely on early or late processing in the magnocellular-dorsal and parvocellular-ventral pathways as well as controls.

Measurement of stray light and glare: comparison of Nyktotest, Mesotest, stray light meter, and computer implemented stray light meter.

AIM: To evaluate the properties of devices for measuring stray light and glare: the Nyktotest, Mesotest, "conventional" stray light meter and a new, computer implemented version of the stray light meter. METHODS: 112 subjects, divided in three groups: (1) young subjects without any eye disease; (2) elderly subjects without any eye disease, and (3) subjects with (early) cataract in at least one eye. All subjects underwent a battery of glare and stray light tests, measurement of visual acuity, contrast sensitivity, refraction, and LOCS III cataract classification. Subjects answered a questionnaire on perceived disability during driving. RESULTS: Repeatability values were similar for all glare/stray light tests. Validity (correlation with LOCS III and questionnaire scores), discriminative ability (ability to discriminate between the three groups), and added value (to measurement of visual acuity and contrast sensitivity) were all superior for both stray light meters. Results of successive measurements are interrelated for the conventional but not the new stray light meter. This indicates a better resistance to fraud for the latter device. CONCLUSIONS: The new computer implemented stray light meter is the most promising device for future stray light measurements.

Transscleral laser thermotherapy of hamster Greene melanoma: inducing tumour necrosis without scleral damage.

The feasibility of using transscleral thermotherapy (TSTT) to induce necrosis of choroidal melanoma without causing damage to the sclera was investigated. Fifty-two subcutaneously implanted hamster melanomas covered by human donor sclera were irradiated for 1 min with an 810 nm laser using a 3 mm spot diameter, with and without cooling of the scleral surface. Immediately after irradiation the temperature of the scleral surface was measured with an infrared camera. Irradiation at 2000 mW, without cooling of the sclera, resulted in tumour necrosis to a mean depth of 4.4 mm and a mean diameter of 5.5 mm, without causing damage to the scleral collagen; the surface temperature of the sclera was 44.5 degrees C, and the estimated temperature at the sclera-tumour interface was 60.1 degrees C. There was a sharp demarcation between the viable and the necrotic part of the tumour. TSTT at 2500 mW, without cooling of the sclera, caused maximal tumour necrosis to a mean depth of 5.2 mm and a mean diameter of 5.9 mm; the scleral layers adjacent to the tumour had an estimated temperature of 67.6 degrees C and showed signs of damage in 14% of the experiments. Cooling of the sclera resulted in less thermal damage to the sclera but also less tumour necrosis. Results indicate that TSTT has potential in the treatment of choroidal melanoma.

Temperature dependence of thermal damage to the sclera: exploring the heat tolerance of the sclera for transscleral thermotherapy.

Thermal damage to the human sclera in relation to temperature and duration of exposure was studied in order to determine the heat tolerance of the sclera with respect to transscleral thermotherapy of choroidal melanoma. Samples of human sclera were submerged in saline for 10 sec to 10 min at temperatures of 37-100 degrees C. The effects of heat on the shape, weight and size of the samples were studied. Thermal damage of scleral collagen was examined by polarized light microscopy (LM) and electron microscopy (EM). The sclera was embedded in epoxy resin and stained with toluidine blue for LM and with uranyl acetate and lead citrate for EM. Thermal damage of scleral collagen on polarized LM was graded on a five point scale. Scleral damage was visible on macroscopic examination and on LM and EM in sclera heated at 65 degrees C for 20 sec or longer, at 70 degrees C for 10 sec or longer, and at higher temperatures. A sigmoidal function was used to define the relation between temperature and changes in diameter, thickness, and weight of scleral samples. Using fitted functions, the threshold temperature for thermal damage was estimated to be 59-61 degrees C when samples were heated for 10 min, 62-63 degrees C when heated for 1 min, and 66-67 degrees C when heated for 10 sec; the threshold exposure time at 60 degrees C was estimated to be 7-12 min. These results indicate a temperature of 60 degrees C for 1 min is well tolerated by human donor sclera; information of in vivo studies is required to validate whether this setting can be used in transscleral thermotherapy (TSTT) for choroidal melanoma.

Autofluorescence distribution along the corneal axis in diabetic and healthy humans.

Corneal autofluorescence, as measured with a commercial scanning fluorophotometer (lambda(exc): 415-491 nm; lambda(em): 515-630 nm), is increased in patients with diabetes mellitus. However, such fluorophotometers register an average fluorescence signal over all corneal layers as a consequence of their limited axial resolution of 0.5 mm. In order to determine the location of the fluorophores responsible for the increased corneal autofluorescence measured in diabetics, an attempt was made to measure in vivo the distribution of autofluorescence along the optical axis of the cornea with a modified slitlamp. Fluorescence excitation and emission filters identical to those of the scanning fluorophotometer were fitted to a slitlamp equipped with a slow scan CCD camera. Corneal autofluorescence intensity profiles were obtained with the slitlamp in five patients with severe diabetic retinopathy and compared to those of age-matched healthy controls. Corneal autofluorescence was also measured with the scanning fluorophotometer for comparison. The resolution of the CCD camera for measurement of fluorescence along the corneal axis was 0.1 mm. The corneal autofluorescence intensity of the patients and the healthy controls gradually decreased by about the same amount from the endothelium to the epithelium (57% mm(-1)+/-6 s.d. and 52% mm(-1)+/-5 s.d., respectively). The area under the fluorescence intensity curve was significantly greater for the patients than for the healthy controls (factor 2.4+/-1.0 s.d., P<0.001) and was proportional to the corneal fluorescence measured with the scanning fluorophotometer (r=0.92, P<0.001). The results show that (1) the distribution of autofluorescence along the corneal axis can be measured in vivo in humans, (2) the fluorophores involved are distributed throughout the cornea, and (3) the relative distribution of fluorescence is similar in diabetic patients and healthy controls.

Conversion of lens slit lamp photographs into physical light-scattering units.

PURPOSE: To derive from lens slit lamp photographs by means of densitometry the physically defined quantity for light scattering (the Rayleigh ratio) and to expand the use of the Lens Opacity Classification System (LOCS III) to include clear lenses and also to calibrate the LOCS III Nuclear Opacity (NO) score in physical terms. METHODS: Series of slit lamp photographs were taken from 38 eyes from 29 subjects (age range 18 to 84 years old) including cataracts, for 0.1- and 0.2-mm slit width, using 200 ASA and 1600 ASA film speed (Kodak professional; Eastman Kodak, Rochester, NY) and different flash settings with a Topcon SL-6E (12 slit/speed/flash combinations; Paramus, NJ). Additionally 19 eyes were photographed with a Zeiss 40 SL/P (8 slit/speed/flash combinations; Carl Zeiss, Thornwood, NY). A calibrated suspension of latex spheres also was photographed at the same 20 conditions. Densitometry was performed on the nuclear area of all photographs including the LOCS III standards, using a photometrically corrected photocell. Slit width and flash intensity settings were photometrically calibrated. All eyes and the suspension were digitally "photographed" with the EAS-1000 (Nidek, Gamagori, Japan) Scheimpflug system. RESULTS: For each eye and the suspension, the series of 20 or 12 densities, corresponding to a range of about 1 log unit in the amount of light used, proved to follow closely a course common to all eyes (the two film characteristics), apart from a shift in the amount of light (because of the differences in light back scattering). CONCLUSIONS: From normal slit lamp photographs, the physical quantity for light (back) scattering can be derived using transformation graphs derived in this study. The LOCS III NO score also can be used for clear lenses and translated into physical units. In this way, slit lamp photography can be used better for more precise studies, provided some minimal calibration of the photograph slit lamp.

Light scattering model for donor lenses as a function of depth.

The amount of light scattered by normal donor lenses (n = 15, ages 43-82 years) from a 1 x 0.1 mm white slit beam was measured as a function of depth in the lens for seven angles from 10 to 165 degrees, and for four wavelengths from 400 to 700 nm. Apart from the most superficial layers, the data could be described with a model that consisted of three components. (1) small sized protein particles (alpha-crystallin), (2) large sized protein particles and (3) spectrally neutral rough surface reflectance ('zones of discontinuity'). Component (1) and (3) dominate backward scattering. Component (2) dominates forward scattering, but occupies only around 0.000006 of the lens volume, with the lowest values in the nucleus. Component (3) is important for a small range of backward directions only, being much stronger in extranuclear areas than in the nucleus.

Evaluation of a reference set based grading system for retinal nerve fiber layer photographs in 1941 eyes.

PURPOSE: To evaluate a reference set based grading system for retinal nerve fiber layer photographs. METHODS: A total of 1,941 retinal nerve fiber layer photographs (Canon non-mydriatic camera) were evaluated using a reference grading system. The reference system consists of 25 photographs of the retinal nerve fiber layer (Canon CF60U camera) of normals and patients with glaucoma. Each reference photograph represents a score for the visibility of the nerve fibers. Superior and inferior regions of the 1,941 photographs of the sample of the normal population were matched separately to the references. RESULTS: The standard deviation of between eyes differences was 2.76. This standard deviation compared reasonably to the standard deviation of 1.0 to 1.9 for real repeated measurements in an earlier study and indicates that the grading system has good accuracy in relation to the total range of 1 to 25. A clear relationship between photograph score and age was established. CONCLUSION: The photographic grading system demonstrated that it is viable in a different setting. Therefore, evaluation of retinal nerve fiber layer photographs with a photographic reference set might help ophthalmologists and technicians to integrate retinal nerve fiber layer photography in their clinical practice.

Light scattering by donor lenses as a function of depth and wavelength.

PURPOSE: To determine quantitatively dependence on the wavelength and angle, as a function of depth, of light scattering in the human lens. To compare the result for forward directions with psychophysical data. To derive candidate particle distributions that might be responsible for nuclear light scattering as significant in the psychophysical situation. METHODS: The amount of light scattered by donor lenses (n = 15, ages 48 to 82 years) from a 1-mm x 0.1-mm white slit beam was measured as a function of depth in the lens for seven angles from 10 degrees to 165 degrees, and for four wavelengths from 400 to 700 nm. Absolute values for light scattering (Rayleigh ratios) were derived. RESULTS: The light-scattering data are confounded by the short wavelength-absorbing pigments in the lens. After correction, backward light scattering in the nucleus followed wavelength to a power of -4. In the superior layers and for forward directions in the nucleus, light scattering was less dependent on wavelength. The nuclear data could be explained on the basis of a bimodal protein particle distribution: particles much smaller than wavelength, in quantitative accordance with the literature, and particles larger than wavelength, which control forward light scattering. CONCLUSIONS: The particles of significance for forward light scattering have, on average, a mean radius of 692 nm and constitute only 0.000003 of the volume. The wavelength dependence of retinal stray light is lessened by: the large sizes, the contribution of superficial lenticular layers, the lenticular pigments, and the contribution of other components of the eye.

A comparison of retinal and choroidal hemodynamics in patients with primary open-angle glaucoma and normal-pressure glaucoma.

PURPOSE: To quantify, compare, and assess differences between retinal and choroidal hemodynamics in normal control subjects and patients with ocular hypertension, primary open-angle glaucoma, and normal-pressure glaucoma. METHODS: Video fluorescein angiograms were made in 20 normal subjects, 11 patients with ocular hypertension, 45 patients with primary open-angle glaucoma, and 43 patients with normal-pressure glaucoma. Choroidal dye build-up curves were analyzed using an exponential model. The model time constant tau reflected the local blood refreshment time, the time needed to replace the blood volume in a tissue volume. Retinal arteriovenous passage time was estimated from the time lapse between retinal arterial and venous dye curves. RESULTS: The retinal arteriovenous passage time was longer in patients with primary open-angle glaucoma compared with normal subjects and patients with normal-pressure glaucoma; the average arteriovenous passage times (+/-SEM) in normal subjects and in patients with ocular hypertension, primary open-angle glaucoma, and normal-pressure glaucoma were, respectively, 2.44 +/- 0.19, 2.90 +/- 0.37, 3.02 +/- 0.17, and 2.55 +/- 0.15 seconds. Choroidal tau was longest in the normal-pressure glaucoma group but not as long in the primary open-angle glaucoma group; tau values in normal subjects and patients with ocular hypertension, primary open-angle glaucoma, and normal-pressure glaucoma were, respectively, 4.6 +/- 0.29, 5.6 +/- 0.69, 6.2 +/- 0.39, and 7.1 +/- 0.33 seconds. CONCLUSIONS: Whereas choroidal circulation is especially slower in patients with normal-pressure glaucoma, retinal circulation is delayed in patients with primary open-angle glaucoma. The choroidal and retinal vascular systems behave differently in primary open-angle and normal-pressure glaucoma, which may be important in the management of glaucoma.

Analysis of variance of microspheres blood flow measurements in rabbits.

As part of a larger study on the interpretation of angiographically derived hemodynamic parameters, blood flow in several ocular tissues was measured using the radioactively labelled microspheres technique. As an unexpected secondary results, it was found that the microspheres data gave quantitative information on hyperaemic effects in the eye. This is the subject of the present paper. The measurements were made in 13 anaesthetized pigmented rabbits. In each animal, three blood flow measurements were performed at three different ocular perfusion pressures (60-15 mmHg). The perfusion pressures of the experimental eye were varied by changing the intra-ocular pressure. The contra-lateral eye served as a control. Labelled microspheres were used as a non-recirculating blood flow indicator, enabling the estimation of regional blood flows, in this case for the iris, ciliary body, peripheral choroid and peripapillary choroid separately. Using analysis of variance with perfusion pressure as covariate and taking into account the blood flow of the control eye, hyperaemia could be quantified in the experimental eye. Apart from a difference amongst animals, hyperaemia depended on tissue type. The amount of hyperaemia proved to be more pronounced in the anterior part of the eye, iris and ciliary body, and to decrease towards the posterior pole. With regard to the causes of this hyperaemia one could speculate about the invasive handling (anterior eye needles) topical administration of tropicamide, in combination with the general anaesthesia.

Near infrared light absorption in the human eye media.

Available literature on the spectral transmittance of the eye media in the infrared (IR) is insufficiently accurate to estimate the deposited doses, e.g. in view of light damage risks. Analysis of the data of Boettner and Wolter [Investigative Ophthalmology and Visual Science, 1, 776-783 (1962)] for cornea, anterior chamber, lens and vitreous separately, shows that they can be explained on the basis of the pure water content. The transmittance spectrum of Geeraets et al. [Archives of Ophthalmology, 64, 606-615 (1960)] for all eye media combined is found to be impossible. It is concluded that in the near-IR, light losses in the eye media are best estimated with the absorption coefficient for pure water. A table is given from 700-2500 nm in steps of 10 nm.

Choroidal haemodynamics in glaucoma.

AIM: Quantification of haemodynamics of the peripapillary choroid in and the assessment of possible differences between normal subjects (N), ocular hypertensive (OHT), primary open angle (POAG), and normal pressure glaucoma (NPG) patients. METHODS: Video fluorescein angiograms (Rodenstock SLO 101) were made in 22 N subjects, 12 OHT, 48 POAG, and 46 NPG patients. The angiographically derived dye build up curves were described by means of an exponential model. One of the model parameters is the time constant tau theoretically reflecting local blood refreshment time; the blood refreshment time tau is the time needed to replace the blood volume in the choriocapillaris, inversely proportional to the local choroidal blood flow. Other variables are maximal fluorescence (Fdt) and time of first fluorescence (t0). Mean variable values were calculated for disc area and circular areas around the disc. RESULTS: Fdt of the disc was significantly lower in the POAG and NPG patients. There was no statistical difference in t0 between the study groups. The choroidal blood refreshment time was significantly longer in NPG patients and to a lesser extent in the POAG patients compared with the normal controls. The slowest choroidal blood refreshment can be found in the NPG group. The median choroidal blood refreshment times (25th-75th percentile) in the controls, OHT, POAG, and NPG patients were 4.1 (3.7-4.5), 4.4 (3.7-6.4), 5.8 (4.3-6.8), and 7.1 (5.5-9.3) seconds respectively. CONCLUSIONS: With the help of parametrisation of dye curves, using a one compartmental model, choroidal haemodynamics can be quantified. The blood refreshment time of the peripapillary choriocapillaris was found to be significantly prolonged especially in NPG patients; this may indicate slower choroidal haemodynamics in NPG patients.

Study of choroidal blood flow by comparison of SLO fluorescein angiography and microspheres.

Choroidal hemodynamics estimated with parameters describing the dye build-up curves obtained with video fluorescein angiography, were compared with a classical regional blood flow measurement: radioactively labelled microspheres. Video fluorescein angiograms (Rodenstock's SLO 101) and microspheres blood flow measurements were made in 13 anaesthetized pigmented rabbits. Ocular perfusion pressures were varied from 60 to 15 mmHg by changing the intraocular pressure. The angiographically derived dye build-up curves were described by means of an exponential model. One of the model parameters is the time constant tau theoretically reflecting local blood refreshment time. Labelled microspheres act as a non-recirculating blood flow indicator, enabling the estimation of regional blood flows. The relation between choroidal blood flow and perfusion pressure is nearly linear, suggesting the passive nature of choroidal vasculature. There is a significant correlation between tau and microspheres flow (R = 0.67, P < 0.01). According to the rheological model the product of blood flow and tau corresponds to the relevant blood volume. Hence, a function for the volume of the choriocapillaris as a function of perfusion pressure was established. The model parameter tau can be interpreted as the local blood refreshment time. Since the parameter tau, unlike microspheres, can be used clinically, tau may be used to retrieve information on choroidal hemodynamics in clinical practice. Information on the spatial distribution of choroidal hemodynamics is also obtained.

Retinal nerve fiber layer assessment by scanning laser polarimetry and standardized photography.

PURPOSE: To determine whether, in a clinical setting, scanning laser polarimetry and retinal nerve fiber layer photography provide equivalent information on the retinal nerve fiber layer. METHODS: We prospectively studied 60 patients with glaucoma or ocular hypertension and 24 healthy subjects. With scanning laser polarimetry, an estimate of the cross section of the retinal nerve fiber layer was obtained. By using a photographic reference set, we quantified photographs of the retinal nerve fiber layer. Visual fields were used to relate the results of both methods to functional damage. RESULTS: The scanning laser polarimetry measurements yielded reproducible cross-section values (coefficient of variation, 6.6%). Comparison of cross-section values and photograph scores gave Pearson correlation coefficients smaller than r = .4 (P < .01), improving to a maximum of r = .53 after compensation for offset. When cross-section values were compared to the mean deviation of the visual field, the Spearman correlation coefficients varied from an r of -.34 to -.53 (P < .01). Correction for offset resulted in an r of -.54 to -.65. When photograph scores and mean deviation of the visual field were compared, the Spearman correlation coefficients varied from an r of -.65 to -.71 (P < .01). CONCLUSIONS: Because r was maximal at .53, the information on the retinal nerve fiber layer obtained with scanning laser polarimetry and photography seems not equivalent. This result could not have been because of lack of reproducibility. Although the results suggested possible offset in scanning laser polarimetry, other methodologic differences must be considered to explain the differences between the two techniques.

Depth-dependent forward light scattering by donor lenses.

PURPOSE: To determine quantitatively forward light scattering in the human lens as a function of depth. To use this to explain the psychophysical result, verified earlier in vitro, showing total light scattering in the human lens to decrease with scattering angle according to an approximate power law (power -2). METHODS: The amount of light scattered by donor lenses (n = 15; age range, 43 to 82 years) from a 1 mm x 0.1 mm white slit beam was measured as a function of depth in the lens for seven angles from 10 degrees to 165 degrees and for four wavelengths from 400 to 700 nm. Absolute values for light scattering (Rayleigh ratios) were derived. RESULTS: Light scattering of the total lens corresponded quantitatively to psychophysically determined in vivo stray light data. Powers were approximately -2.2. An important source of forward scattered light is located superficially at the anterior and the posterior poles. Nuclear forward light scattering varied over 2 log units, more or less in line with clinical assessment of nuclear opacity (LOCS III NO score). Nuclear powers were approximately -1.4. CONCLUSIONS: In vitro forward light scattering of donor lenses as a whole corresponded with in vivo data, but different depths in the lens contributed differently. Studies on functionally relevant light scattering by the human lens proteins should be conducted to explain true (in vivo) lenticular light scattering.

Evaluation of the peripapillary circulation in healthy and glaucoma eyes with scanning laser Doppler flowmetry.

In order to study peripapillary perfusion, one randomly selected eye of 34 of healthy volunteers and 40 glaucoma patients (27 suffering from primary open-angle glaucoma (POAG) 10 from normal pressure glaucoma (NPG) nd three from other types of glaucoma) was studied with a Heidelberg Retina Flowmeter. Temporal flow adjacent to the disc edge was significantly higher than the nasal flow (p < 0.01). It was reduced significantly in myopia both in controls (p < 0.05) and in glaucoma patients (p < 0.001). However, there was no difference between either controls and glaucoma patients or between POAG and NPG patients. It was independent of treatment type in glaucoma. Within the temporal peripapillary area extremely high flow values (values higher than the mean + 2 SD of the corresponding individual retinal flow) seemed to represent deep peripapillary vascular rings. They were significantly more frequent in glaucoma (72%) than in healthy volunteers (44%, p < 0.05). Their frequency was 83% in myopic and 23% in non-myopic eyes in the control group (p < 0.001). However, in glaucoma patients they were common both in myopic eyes (71%) and in non-myopic ones (75%). The results suggest that capillary perfusion adjacent to the temporal edge of the disc is significantly reduced in myopia. Deep peripapillary vascular structures can be measured on images focused on the surface of the retina, especially if the retina is thinner than normal (healthy myopic eyes and glaucomatous eyes independently of the refraction). This may mask a deficient function of the retinal capillary bed.

Scanning laser Doppler flowmetry in glaucoma.

Scanning laser Doppler flowmetry is a new means for the measurement of capillary perfusion. We studied the retinal and neuroretinal rim capillary perfusion with the Heidelberg Retina Flowmeter in one randomly selected eye of 31 healthy volunteers, 42 primary open angle glaucoma (POAG) patients and 17 normal pressure glaucoma (NPG) patients. The reproducibility of the measurements on the temporal and nasal retina and on the disc rim was 19%, 26% and 28% in the unselected control group, 12% in the POAG and 12%, 13% and 10% in the NPG group, respectively. Optic disc flow was significantly higher than retinal flow (p < 0.000001). Differences in corresponding flow values between healthy volunteers and glaucoma patients as well as between POAG and NPG patients were not statistically significant. There was no correlation between the temporal and nasal flow values of the same eyes. The average variation in flow between adjacent frame positions was 18.5%. Actual intraocular pressure and the type of treatment had no influence on the retinal flow. The results suggest that the position of the test-frame is very important for the final result. We could not find any significant difference in the perfusion between glaucomatous and control eyes with the Heidelberg Retina Flowmeter.