Increased molar ratio of free fatty acids to albumin in blood as cause and early biomarker for the development of cataracts and Alzheimer's disease.

Cataracts and Alzheimer's disease (AD) are closely linked and are associated with aging and with systemic diseases that increase the molar ratio of free fatty acids to albumin (mFAR) in the blood. From the results of our earlier studies on the development of senile cataracts and from results recently published in the literature on the pathogenesis of Alzheimer's disease, we suggest that there is a common lipotoxic cascade for both diseases, explaining the strong connection between aging, an elevated mFAR in the blood, cataract formation, and AD. Long-chain free fatty acids (FFA) are transported in the blood as FFA/albumin complexes. In young people, vascular albumin barriers in the eyes and brain, very similar in their structure and effect, reduce the FFA/albumin complex concentration from around 650 µmol/l in the blood to 1-3 µmol/l in the aqueous humour of the eyes as well as in the cerebrospinal fluid of the brain. At such low concentrations the fatty acid uptake of the target cells - lens epithelial and brain cells - rises with increasing FFA/albumin complex concentrations, especially when the fatty acid load of albumin molecules is mFAR>1. At higher albumin concentrations, for instance in blood plasma or the interstitial tissue spaces, the fatty acid uptake of the target cells becomes increasingly independent of the FFA/albumin complex concentration and is mainly a function of the mFAR (Richieri et al., 1993). In the blood plasma of young people, the mFAR is normally below 1.0. In people over 40 years old, aging increases the mFAR by decreasing the plasma concentration of albumin and enhancing the plasma concentrations of FFA. The increase in the mFAR in association with C6-unsaturated FFA are risk factors for the vascular albumin barriers (Hennig et al., 1984). Damage to the vascular albumin barrier in the eyes and brain increases the concentration of FFA/albumin complex in the aqueous humour as well as in the cerebrospinal fluid, leading to mitochondrial dysfunction and the death of lens epithelial and brain cells, the development of cataracts, and AD. An age-dependent increase in the concentration of FFA/albumin complex has been found in the aqueous humour of 177 cataract patients, correlating with the mitochondria-mediated apoptotic death of lens epithelial cells, lens opacification and cataracts (Iwig et al., 2004). Mitochondrial dysfunction is also an early crucial event in Alzheimer's pathology, closely connected with the generation of amyloid beta peptides (Leuner et al., 2012). Very recently, amyloid beta production has also been confirmed in the lenses of Alzheimer's patients, causing cataracts (Moncaster et al., 2022). In view of this, we propose that there is a common lipotoxic cascade for senile cataract formation and senile AD, initiated by aging and/or systemic diseases, leading to an mFAR>1 in the blood.

Case report of fetus with Lowe syndrome: Expanding the prenatal phenotype.

Oculocerebrorenal syndrome (Lowe syndrome) is a rare X-linked disorder affecting 1/500,000 males that most frequently affects the eyes, central nervous system, and kidneys. Phenotypic presentation includes congenital cataracts, developmental delay, intellectual disability, and Fanconi-type renal dysfunction. Lowe Syndrome is caused by hemizygous loss of function variants in the OCRL gene. While individuals may live into the third and fourth decade of life, some will die in the first few years of either renal failure or infection. While early diagnosis is important, few cases have documented the prenatal phenotype of this condition, which has included bilateral cataracts and variable neurological abnormalities. We report a case of a family with an extensive history of congenital cataracts, immune compromise, and neonatal death in male members. The fetus was found to have a unilateral cataract, mild ventriculomegaly, vertebral anomalies, and an underlying diagnosis of Lowe Syndrome with a mutation in OCRL at c.2582-1G>C (IVS23-1G>C).

The effect of optical degradation from cataract using a new Deep Learning optical coherence tomography segmentation algorithm.

PURPOSE: To assess the validity of the results of a freely available online Deep Learning segmentation tool and its sensitivity to noise introduced by cataract. METHODS: The OCT images were collected with a Spectralis SD-OCT (Heidelberg Engineering, Heidelberg, Germany) as part of normal clinical practice. Data were segmented using a freely available online tool called Relayer ( https://www.relayer.online/ ), based on a cross-platform Deep Learning segmentation architecture specifically adapted for retinal OCT images. The segmentations were read into MATLAB (The MathWorks, Natick, MA, USA) and analyzed. RESULTS: There was an excellent agreement between the ETDRS measurements obtained from the two algorithms. Upon visual inspection, the segmentation based on Deep Learning obtained with Relayer appeared more accurate except in one case of apparent good quality image showing interrupted segmentations in some of the B-scans. CONCLUSION: A freely available online Deep Learning segmentation tool showed good and promising performance in healthy retinas before and after cataract surgery, proving robust to optical degradation of the image from media opacities.

Comparison of corneal tomographic parameters between Hispanic and non-Hispanic patients.

PURPOSE: To compare corneal tomographic parameters between Hispanic White and non-Hispanic White patients using Pentacam data. METHODS: This retrospective study evaluated preoperative Pentacam data from 641 patients 50 years or older who underwent surgery for senile cataract and self-identified as Hispanic or non-Hispanic White. Patients of non-White race or multiethnic groups, or a history of surgery, trauma, or any abnormality of the cornea or anterior segment were excluded. Cornea and anterior segment parameters, as measured with Pentacam, were then compared between Hispanics and non-Hispanics. RESULTS: There were 352 Hispanic White and 289 non-Hispanic White patients. These included 231 men and 410 women, with a mean age of 69.5 ± 8.2 years. There were no significant differences between Hispanics and non-Hispanics in front or back keratometry or amount of front astigmatism. However, Hispanics had a greater amount of back astigmatism (0.36 ± 0.19 vs 0.32 ± 0.17 diopter, P = 0.04). Moreover, there was a statistically significant difference in front steep axis of the left eyes between Hispanics and non-Hispanics (97.8 ± 47.9 vs 108.2 ± 48.9 deg, P = 0.01), and a marginally significant difference in front steep axis of the right eyes (81.0 ± 48.2 vs 73.5 ± 49.9 deg, P = 0.06). Hispanics also had a lower vertex pachymetry (548.1 ± 34.5 vs 553.4 ± 37.4 µm, P = 0.04) and a smaller anterior chamber volume (134.7 ± 39.0 vs 146.1 ± 39.9 mm3, P < 0.001). CONCLUSIONS: There are some differences in cornea and anterior segment parameters between Hispanics and non-Hispanics 50 years or older who underwent surgery for senile cataract. However, such differences may not be clinically significant.

Comparison of two swept-source optical coherence tomography devices, a Scheimpflug camera system and a ray-tracing aberrometer in the measurement of corneal power in patients with cataract.

PURPOSE: To assess the differences and similarities in the corneal curvature obtained by two swept-source optical coherence tomography (SS-OCT) devices, Scheimpflug imaging system and one ray tracing aberrometer in patients with cataracts. Moreover, this study aimed to compare the differences in posterior corneal (PK), total corneal (TK) and true net power (TNP) measurements among the IOLMaster 700, CASIA2, and Pentacam. METHODS: A total of 200 eyes of 200 patients (116 female, 58%) were enrolled in this study, with a mean age of 65.9 ± 9.5 years. The flattest (Kf), steepest (Ks), and mean cornal powers (Km), J0, and J45 were obtained using two SS-OCT-based biometric devices, one rotating camera system and one ray-tracing aberrometer. The PK, TK and TNP values were also measured using these devices. To evaluate the differences and similarities between the devicves, the Friedman test, Pearson correlation coefficient (r), intraclass coefficient correlation (ICC) and Bland‒Altman plots with 95% limits of agreement (LoA) were used, and boxplots and stacked histograms were generated to describe the distributions of the data. RESULTS: There were no significant differences between the IOLMaster 700 and Pentacam for any of the keratometry values. Additionally, there were no significant differences between the IOLMaster 700 and iTrace in evaluating J0 and J45. Bland‒Altman plots revealed relatively wide LoA widths, almost larger than 1 diopter for the keratometry values and almost larger than 0.5 diopter for J0 and J45 values among the four devices. In terms of PK and TK values, significant differences and low ICCs were found among the three devices. CONCLUSIONS: Although strong correlations and good agreement were found among the IOLMaster700, CASIA2, Pentacam and iTrace for Kf, Ks, Km and J0, J45, it seems that the measurements should not be used interchangeably because of the wide LoA widths and the presence of significant differences among the devices. Similarly, due to significant differences and low ICCs, the PK, TK and TNP values obtained by IOLMaster 700, CASIA2, and Pentacam should not be used interchangeably.

The effect of uneventful cataract surgery on Schlemm's canal and the trabecular meshwork in cases with pseudoexfoliation.

PURPOSE: To evaluate the effect of uneventful cataract surgery on Schlemm's canal (SC) and the trabecular meshwork (TM) in cases with pseudoexfoliation (PX). METHODS: In this prospective study, 37 PX and 37 normal eyes, who underwent cataract surgery, were included. The PX group was further divided into two subgroups: PX syndrome (PXS) and PX glaucoma (PXG). Preoperative complete ophthalmologic examination, anterior segment (AS) imaging using a Scheimpflug camera, and measurements of SC length and area and TM thickness and length using AS optical coherence tomography (AS-OCT) were performed in all cases. All measurements were repeated at the first and third months after surgery. RESULTS: Preoperative intraocular pressure (IOP), AS parameters, SC, and TM values showed no significant differences between the groups (p > 0.05). After surgery, there was a significant increase in AS parameter values and a significant decrease in IOP values in both the PX and control groups (p < 0.05). The nasal and temporal SC area showed a significant increase in the PX group after surgery (p = 0.007, p = 0.003, respectively). In the subgroup analysis, the only significant change in the nasal and temporal SC area was in the PXS group (p = 0.006, p = 0.003, respectively). CONCLUSION: Cataract surgery resulted in an increase in the SC area in patients with PXS. This increase may be due to multiple mechanisms including the IOP-lowering effect of cataract removal, change in AS, and removal of intraocular PX material after surgery.

Trichromatic critical flicker frequency as potential visual test in cataract and macula disease patients.

PURPOSE: To investigate the capacity of critical flicker frequency (CFF) in discriminating cataract eyes with or without macula disease using trichromatic flickers, and to develop a model to predict postoperative best corrected visual acuity (BCVA). METHODS: Patients were divided into two groups based on the presence or absence of macular disease. CFF threshold measurements of red (R-CFF), green (G-CFF), and yellow (Y-CFF) flickers were conducted both preoperatively and postoperatively. A generalized estimating equations model (GEE) was employed to examine the relationship between CFF threshold and 3-month postoperative BCVA. RESULTS: A total of 115 eyes were enrolled, with 59 eyes in the cataract alone group and 56 eyes in the cataract with macular disease group completing the follow-up. R-CFF was found to be consistent before and after cataract removal (P = 0.06), even in cases where OCT was not performed successfully (P > 0.05). Y-CFF showed the highest AUC (0.798) for differentiating ocular comorbidities. According to the GEE model, in patients with a CFF threshold below 26 Hz, the odds ratios for achieving a postoperative VA of 20/40 or better were 34.8% for R-CFF, 26.0% for G-CFF, and 24.5% for Y-CFF. CONCLUSION: CFF emerges as a promising tool for predicting postoperative BCVA, providing valuable supplementary insights when fundus examination is obstructed. R-CFF demonstrates the best resistance to cataracts, while Y-CFF exhibits the highest sensitivity both in identifying macular diseases and predicting postoperative BCVA of 20/40 or better.

Utilizing visual symptoms to distinguish dry eye from glaucoma, cataract, and suspect glaucoma patients: a cross-sectional study.

BACKGROUND: The diagnosis of dry eye and other common ophthalmological conditions can be supported using patient reported symptoms, which is increasingly useful in contexts such as telemedicine. We aim to ascertain visual symptoms that differentiate dry eye from cataract, glaucoma, or glaucoma suspects. METHODS: Adults with dry eye, glaucoma, cataract, and suspected glaucoma (controls) completed a questionnaire to rate the frequency and severity of 28 visual symptoms. Univariate, followed by multivariable logistic regression with backward stepwise selection (p < 0.05), determined the individual symptoms and set of symptoms best distinguishing dry eye from each of the other conditions. RESULTS: Mean age of 353 patients (94 glaucoma suspect controls, 79 glaucoma, 84 cataract, and 96 dry eye) was 64.1 years (SD = 14.1); 67% were female and 68% White. Dry eye patients reported more frequent light sensitivity (OR = 15.0, 95% CI = 6.3-35.7) and spots in vision (OR = 2.8, 95% CI = 1.2-6.3) compared to glaucoma suspect controls. Compared to glaucoma patients, dry eye patients experienced more frequent light sensitivity (OR = 9.2, 95% CI = 2.0-41.7), but less frequent poor peripheral vision (OR = 0.2, 95% CI = 0.06-0.7), difference in vision between eyes (OR = 0.09, 95% CI = 0.01-0.7), and missing patches of vision (OR = 0.06, 95% CI = 0.009-0.3). Compared to cataract patients, dry eye patients reported more frequent spots in vision (OR = 4.5, 95% CI = 1.5-13.4) and vision variability across the week (OR = 4.7, 95% CI = 1.2-17.7) and were less likely to report worsening vision (OR = 0.1, 95% CI = 0.03-0.4) and blindness (OR = 0.1, 95% CI = 0.02-0.8). CONCLUSION: Visual symptoms may serve as a complementary tool to distinguish dry eye from various ocular conditions, though the symptoms that best distinguish dry eye differ across comparisons. Differentiating how patients visually perceive common eye diseases may be used in a variety of clinical settings to rule out specific conditions.

Intraoperative quantitative crystalline lens nuclear opacities analysis based on crystalline lenSx platform.

PURPOSE: The main objective is to quantify the lens nuclear opacity using spectral-domain optical coherence tomography (SD-OCT) and to evaluate its association with Lens Opacities Classification System III (LOCS-III) system, lens thickness (LT), and surgical parameters. The secondary objective is to assess the diagnostic model performance for hard nuclear cataract. METHODS: This study included 70 eyes of 57 adults with cataract, with 49 (70%) and 21 (30%) in training and validation cohort, respectively. Correlations of the average nuclear density (AND) /maximum nuclear density (MND) with LOCS-III scores, LT, and surgical parameters were analyzed. Univariate and multivariate logistic regression analysis, receiver operating characteristic curves and calibration curves were performed for the diagnostic of hard nuclear cataract. RESULTS: The pre-operative uncorrected distance visual acuity (UDVA), intraocular pressure (IOP), mean axial length (AL), and LT were 1.20 ± 0.47 log MAR, 15.50 ± 2.87 mmHg, 27.34 ± 3.77 mm and 4.32 ± 0.45 mm, respectively. The average nuclear opalescence (NO) and nuclear colour (NC) scores were 3.61 ± 0.94 and 3.50 ± 0.91 (ranging from 1.00 to 6.90), respectively. The average AND and MND were 137.94 ± 17.01 and 230.01 ± 8.91, respectively. NC and NO scores both significantly correlated with the AND (rNC = 0.733, p = 0.000; rNO = 0.755, p = 0.000) and MND (rNC = 0.643, p = 0.000; rNO = 0.634, p = 0.000). In the training cohort, the area under the curve (AUC) of the model was 0.769 (P < 0.001, 95%CI 0.620-0.919), which had a good degree of differentiation (Fig. 2a). The calibration curve showed good agreement between predicted and actual probability. CONCLUSION: The nuclear density measurement on SD-OCT images can serve as an objective and reliable indicator for quantifying nuclear density.

Spiroplasma infection as a cause of severe congenital keratouveitis, cataract and glaucoma.

BACKGROUND: Only seven cases of ocular Spiroplasma infection have been reported to date, all presenting as congenital cataracts with concomitant intraocular inflammation. We describe the first case of Spiroplasma infection initially presenting as a corneal infiltrate. CASE PRESENTATION: A 1-month-old girl was referred for a corneal infiltrate in the left eye. She presented in our hospital with unilateral keratouveitis. Examination showed a stromal corneal infiltrate and dense white keratic precipitates in the left eye. Herpetic keratouveitis was suspected and intravenous acyclovir therapy was initiated. Two weeks later, the inflammation in the left eye persisted and was also noticed in the right eye. Acute angle-closure glaucoma and a cataract with dilated iris vessels extending onto the anterior lens capsule developed in the left eye. The inflammation resolved after treatment with azithromycin. Iridectomy, synechiolysis and lensectomy were performed. Bacterial metagenomic sequencing (16 S rRNA) and transmission electron microscopy revealed Spiroplasma ixodetis species in lens aspirates and biopsy. Consequently, a diagnosis of bilateral Spiroplasma uveitis was made. CONCLUSIONS: In cases of congenital cataract with concomitant intraocular inflammation, Spiroplasma infection should be considered. The purpose of this case report is to raise awareness of congenital Spiroplasma infection as a cause of severe keratouveitis, cataract and angle-closure glaucoma in newborns. Performing molecular testing on lens aspirates is essential to confirm diagnosis. Systemic macrolides are suggested as the mainstay of treatment.

Susceptibility to eye diseases in relation to age and kidney failure among Taiwanese adults.

BACKGROUND: The kidney and eyes share common pathways and are thought to be closely connected. Chronic kidney disease and major eye diseases, such as cataract and glaucoma, are strongly associated with age. However, further investigation is needed to understand the joint impact of age and kidney diseases on eye diseases. In this study, we assessed the risk of eye diseases in relation to age and kidney failure in Taiwanese adults. METHODS: Our study included 127,561 cancer-free volunteers aged 30 to 70 years who participated in the Taiwan Biobank (TWB) project from 2008 to 2020. Information on the main exposures (kidney failure and age) and the outcome (eye diseases, including glaucoma, cataract, xerophthalmia, and retinal detachment) was collected through questionnaires. RESULTS: In general, kidney failure and older age were independently associated with a higher risk of eye, particularly cataract and retinal detachment: prevalence odds ratio (POR); 95% confidence interval (CI) = 2.480; 1.635-3.761 for cataract and 3.885; 1.968-7.666 for retinal detachment. A significant interaction between kidney failure and age on cataract was observed (p-value = 0.0002). Age-stratified analysis revealed a higher risk of cataract among patients with kidney failure aged below 50 (POR = 6.534; 95% CI = 2.493-17.124) and between 50 and 60 years (POR = 3.957; 95%CI = 1.986-7.881). Combining kidney failure and age (reference: no kidney failure and age < 50 years), kidney failure in all age groups was associated with a higher risk of cataract. The PORs; 95% CIs were 10.725; 4.227-27.211 for patients below 50 years, 28.487; 14.270-56.866 for those aged 50-60 years, and 43.183; 24.434-72.824 for those > 60 years. Combining cataract and age (reference: no cataract and age < 50 years), patients below 50 years had the highest risk of kidney failure (POR; 95% CI = 9.510; 3.722-24.297). CONCLUSIONS: Our study suggests that age and kidney failure may jointly contribute to eye diseases, particularly cataract. The association between cataract and kidney failure could be bidirectional, especially in individuals below 50 years. This significant bidirectional relationship underscores the need for screening patients with cataract for kidney failure and vice versa, particularly in younger adults.

Ultrasound biomicroscopy in the management of complex cataract and intraocular lens: A review.

Ultrasound biomicroscopy (UBM) is an invaluable investigation for imaging anterior segment structures. Although it is operator-dependent and time consuming, unlike optical-based imaging techniques, it is able to image structures posterior to the iris, such as the zonules, ciliary body and part of the pars plana. It is especially useful in advanced cataracts, traumatic cataracts, subluxed lenses, posterior polar cataracts, and congenital and developmental anomalies affecting the anterior segment. It provides diagnostic information in eyes with complex cataracts or intraocular lens (IOL)-related pathology, and aids in surgical planning in order to minimise complications. In this review, we describe the UBM features of various lenticular pathologies and demonstrate its application in the diagnosis and surgical management of lens and IOL-related pathologies.

Ocular examination findings and selected ophthalmic diagnostic tests in African green monkeys (Chlorocebus aethiops sabaeus).

OBJECTIVE: To document ocular lesions and establish ophthalmic diagnostic test reference values in a colony of African green monkeys (Chlorocebus aethiops sabaeus). ANIMALS STUDIED: Fifty one geriatric (GAGM, 19-30 years old), 10 adult (AAGM, 5-9 years old) and 10 juvenile (JAGM, <2 years old) African green monkeys housed in a single Caribbean research colony. PROCEDURES: Ocular biomicroscopy, indirect fundoscopy, Schirmer tear test (STT), rebound tonometry (TonoVet®) and corneal fluorescein staining were performed. Mixed ANCOVA tests were performed to compare STT and IOP between groups. RESULTS: Common ocular lesions in GAGM included vitreal degeneration (27/51, 51/102 eyes) and cataracts (21/51, 32/102 eyes). Vitreal degeneration was also common in AAGM (8/10, 16/20 eyes) and infrequent in JAGM (3/10, 6/20 eyes). Cataracts were not present in any JAGM or AAGM. All eyes in all three groups had perilimbal corneal pigmentation and faint lace-like anterior corneal stromal opacification. Median (range) STT values were 16.0 (18) mm/min in GAGM. Mean (SD) STT values were 14.2 (4.6) mm/min in AAGM, and 8.9 (3.4) mm/min in JAGM. Median (range) IOP values were 16.5 (27) mmHg in GAGM. Mean (SD) IOP values were 18.0 (2.8) mmHg in AAGM, and 14.1 (2.2) mmHg in JAGM. JAGM had significantly lower STT and IOP values compared to AAGM (p = .0449, .0057, respectively) and GAGM (p = .0002, .0130, respectively). CONCLUSIONS: Spontaneous ocular lesions were common in geriatric monkeys in this research colony. IOP and STT values were lower in juvenile African green monkeys relative to adult or geriatric animals.

[Economic index - predictor of premature aging.]

It is widely known that in economically developed countries there is an increase in the proportion of older people. However, the problem of the influence of territorial features of economic development on the rate of population aging is not sufficiently covered. The goal was to study the impact of economic development indicators (EDI) on the processes of premature aging of the population. The materials were statistical collections of the Ministry of Health of Russia and Russian Statistics Service for 2011-2019. The highest incidence was characteristic of cataracts and glaucoma. A direct correlation has been established between the EDI and the age-specific incidence index (ASII) of cataracts (r=0,31; p=0,00436). A group of regions with a high level of economic development was characterized by a higher value of ASII, which, as a rule, corresponds to the later development of the disease.

Cataract Classification Systems: A Review.

Cataract is among the leading causes of visual impairment worldwide. Innovations in treatment have drastically improved patient outcomes, but to be properly implemented, it is necessary to have the right diagnostic tools. This review explores the cataract grading systems developed by researchers in recent decades and provides insight into both merits and limitations. To this day, the gold standard for cataract classification is the Lens Opacity Classification System III. Different cataract features are graded according to standard photographs during slit lamp examination. Although widely used in research, its clinical application is rare, and it is limited by its subjective nature. Meanwhile, recent advancements in imaging technology, notably Scheimpflug imaging and optical coherence tomography, have opened the possibility of objective assessment of lens structure. With the use of automatic lens anatomy detection software, researchers demonstrated a good correlation to functional and surgical metrics such as visual acuity, phacoemulsification energy, and surgical time. The development of deep learning networks has further increased the capability of these grading systems by improving interpretability and increasing robustness when applied to norm-deviating cases. These classification systems, which can be used for both screening and preoperative diagnostics, are of value for targeted prospective studies, but still require implementation and validation in everyday clinical practice.

Comparison of Capsular Tension Ring Implantation before vs. after Toric Intraocular Lens for Rotational Stability.

PURPOSE: To compare the effect of implanting the capsular tension ring (CTR) before or after a toric intraocular lens (IOL) on rotational stability in patients with cataract and astigmatism. METHODS: This is a randomized retrospective study. Patients who underwent phacoemulsification combined with toric IOL implantation due to cataract and astigmatism between February 2018 and October 2019 were enrolled in the study. Group 1 consisted of 53 eyes of 53 patients in whom the CTR was placed into the capsular bag after the implantation of the toric IOL. On the other hand, group 2 consisted of 55 eyes of 55 patients in whom the CTR was placed into the capsular bag before implantation of the toric IOL. The two groups were compared in terms of preoperative and postoperative astigmatism, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and postoperative IOL rotation degree. RESULTS: There were no significant differences between the two groups related to age and sex (p > 0.05) or the mean preoperative spherical value, UCVA, BCVA, and corneal astigmatism (p > 0.05). Although the mean postoperative residual astigmatism of the first group (- 0.29 ± 0.26) was lower than that of the second (- 0.43 ± 0.31), the difference was not statistically significant (p = 0.16). The mean degree of rotation was 0.75 ± 2.66° in group 1 and 2.90 ± 6.57° in group 2, which was found to be statistically significant (p = 0.02). CONCLUSION: The implantation of CTR after a toric IOL provides further rotational stability and more effective astigmatic correction.

[Geriatric ophthalmologic co-management : A case report of interdisciplinary collaboration]. / Geriatrisch-ophthalmologisches Co-Management : Ein Fallbeispiel interdisziplinärer Zusammenarbeit.

This case report details the assessment and interdisciplinary collaboration in the management of an 81-year-old patient presenting with acute visual impairment, dizziness, general weakness, gait disturbances and fear of falling. A holistic geriatric evaluation revealed orthostatic dysregulation and an underlying multifactorial gait disorder exacerbated by visual impairment. Ophthalmological findings included left central retinal artery branch occlusion and cataracts. A comprehensive geriatric assessment showed frailty, impaired mobility and decreased functional abilities. Subsequent patient-centered interdisciplinary approaches included treatment for retinal ischemia, orthostatic testing, medication reconciliation, physiotherapy and occupational therapy. This case emphasizes how interdisciplinary collaboration between ophthalmology and geriatrics enables proactive assessment and intervention to reduce the risk of functional decline and loss of autonomy in visually impaired patients, which is of particular relevance considering the increasing prevalence of visual impairment in the ageing population.

Comparison of keratometric values and anterior segment parameters measured using Scheimpflug Sirius topography and Lenstar biometry.

PURPOSE: This study aimed to evaluate the consistency of preoperative keratometric values, anterior segment, and intraocular lens (IOL) power measurements in patients with cataract and no comorbidities using the Sirius topography device (CSO, Italy) and Lenstar LS 900 (Haag-Streit AG, Köeniz, Switzerland). METHODS: Patients with grade 2 and 3 cataracts who applied to Ophthalmology Clinic of Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences and planned for cataract surgery were included the study. Forty eyes with cataract from 40 patients were taken in the study. All patients underwent preoperative assessment using a combined Scheimpflug-Placido disc-based tomography device (Sirius) and Lenstar before cataract surgery. Keratometric measurements, such as flat keratometry (K1), steep keratometry (K2), and maximum keratometry (Kmax), and anterior segment parameters, white-to-white (WTW) distance, IOL power, astigmatism (AST), anterior chamber depth (ACD), aqueous depth (AD), and central cornea thickness (CCT), were recorded. RESULTS: There were significant differences between K1Lenstar and K1Sirius, K2Lenstar and K2Sirius, KmaxLenstar and KmaxSirius, WTWLenstar and WTWSirius, and IOL powerLenstar versus IOL powerSirius. However, there were insignificant differences between ASTLenstar and ASTSirius, ACDLenstar versus ACDSirius, ADLenstar and ADSirius, and CCTLenstar and CCTSirius variables. Furthermore, it was found that Sirius measured significantly higher than Lenstar, especially in terms of IOL power. CONCLUSION: Significant differences were observed between Lenstar and Sirius in terms of keratometric values, WTW distance, and IOL power. The IOL power value measured with Sirius was found to be higher than the IOL power value measured with Lenstar.

A case report of iridoschisis and cataract: a challenging diagnosis.

PURPOSE: To report the cataract surgery of a 79-year-old female patient with iridoschisis and senile nuclear cataracts. OBSERVATIONS: Ophthalmologic examination of the 79-year-old female patient who came to our clinic with complaints of decreased vision in the right eye was observed to have a grade-3 senile nuclear cataract and iridoschisis in quadrants 2-3, 4-7, and 10-11 of the iris in the right eye and a grade-2 senile nuclear cataract and iridoschisis in quadrants 5-7 in the left eye to a lesser extent compared to the right eye. The iris fibrils were not connected to the corneal endothelium. A safe surgical area was created by administering the viscoelastic material several times during cataract surgery. CONCLUSIONS AND IMPORTANCE: Although iridoschisis has a low incidence rate, it is important to also consider comorbid ocular pathologies when treating iridoschisis patients. Since cataract surgery for these patients is more specialized than for uncomplicated cases, the necessary surgical planning must be paid due diligence.

Association of refractive outcome with postoperative anterior chamber depth measured with 3 optical biometers.

PURPOSE: This study evaluated the relationship between refractive outcomes and postoperative anterior chamber depth (ACD, measured from corneal epithelium to lens) measured by swept-source optical coherence tomography (SS-OCT), optical low-coherence reflectometry (OLCR), and Scheimpflug devices under the undilated pupil. METHODS: Patients undergoing cataract phacoemulsification with intraocular lens (IOL) implantation in a hospital setting were enrolled. Postoperative ACD (postACD) was performed with an SS-OCT device, an OLCR device, and a Scheimpflug device at least 1 month after cataract surgery. After adjusting the mean predicted error to 0, differences in refractive outcomes were calculated with the Olsen formula using actual postACD measured from 3 devices and predicted value. RESULTS: Overall, this comparative case study included 69 eyes of 69 patients, and postACD measurements were successfully taken using all 3 devices. The postACD measured with the SS-OCT, OLCR, and Scheimpflug devices was 4.59 ± 0.30, 4.50 ± 0.30, and 4.54 ± 0.32 mm, respectively. Statistically significant differences in postACD were found among 3 devices (P < 0.001), with intraclass correlation coefficients (ICCs) and Bland-Altman showing good agreement. No significant difference in median absolute error was found with the Olsen formula using actual postACD obtained with 3 devices. Percentage prediction errors were within ± 0.50 D in 65% (OLCR), 70% (Scheimpflug), and 67% (SS-OCT) calculated by actual postACD versus 64% by predicted value. CONCLUSION: Substantial agreement was found in postACD measurements obtained from the SS-OCT, OLCR, and Scheimpflug devices, with a trend toward comparable refractive outcomes in the Olsen formula. Meanwhile, postACD measurements may be potentially superior for the additional enhancement of refractive outcomes.