Impact of accommodative insufficiency and accommodative/vergence therapy on ciliary muscle thickness in the eye.

PURPOSE: Recent evidence suggests that the ciliary muscle apical fibres are most responsive to accommodative load; however, the structure of the ciliary muscle in individuals with accommodative insufficiency is unknown. This study examined ciliary muscle structure in individuals with accommodative insufficiency (AI). We also determined the response of the ciliary muscle to accommodative/vergence therapy and increasing accommodative demands to investigate the muscle's responsiveness to workload. METHODS: Subjects with AI were enrolled and matched by age and refractive error with subjects enrolled in another ciliary muscle study as controls. Anterior segment optical coherence tomography was used to measure the ciliary muscle thickness (CMT) at rest (0D), maximum thickness (CMTMAX) and over the area from 0.75 mm (CMT0.75) to 3 mm (CMT3) posterior to the scleral spur of the right eye. For those with AI, the ciliary muscle was also measured at increasing levels of accommodative demand (2D, 4D and 6D), both before and after accommodative/vergence therapy. RESULTS: Sixteen subjects with AI (mean age = 17.4 years, SD = 8.0) were matched with 48 controls (mean age = 17.8 years, SD = 8.2). On average, the controls had 52-72 µm thicker ciliary muscles in the apical region at 0D than those with AI (p = 0.03 for both CMTMAX and CMT 0.75). Differences in thickness between the groups in other regions of the muscle were not statistically significant. After 8 weeks of accommodative/vergence therapy, the CMT increased by an average of 22-42 µm (p ≤ 0.04 for all), while AA increased by 7D (p < 0.001). CONCLUSIONS: This study demonstrated significantly thinner apical ciliary muscle thickness in those with AI and that the ciliary muscle can thicken in response to increased workload. This may explain the mechanism for improvement in signs and symptoms with accommodative/vergence therapy.

Ciliary muscle thickness in adults with Down syndrome.

PURPOSE: The relationship between ciliary muscle thickness (CMT), age and refractive error was investigated to determine if CMT, like other anterior ocular anatomy, differs in adults with Down syndrome (DS). METHODS: The CMT of 33 adults with DS was imaged using anterior segment optical coherence tomography. Images from the right eye obtained 45 minutes after cycloplegia (1% tropicamide, 2.5% phenylephrine) were analysed to calculate thickness at 1, 2 and 3 mm posterior to the scleral spur (CMT1, CMT2, CMT3), maximum thickness (CMTMAX) and apical thickness (AT = CMT1 - CMT2). Spherical equivalent refractive error was determined by clinical refraction using both non-dilated and dilated measures. Multivariate regression analysis evaluated the relationship between CMT and refractive error while controlling for subject age. RESULTS: Images were analysed from 26 subjects (mean age (SD) 29 years; mean refractive error (SD): -0.90 (5.03) D, range: -15.75 to +5.13D). Mean (SD) CMT decreased with posterior position (CMT1: 804 (83) µm; CMT2: 543 (131) µm; CMT3: 312 (100) µm). Mean (SD) CMTMAX and AT was 869 (57) µm and 260 (84) µm, respectively. There was a significant linear correlation indicating thinning CMT with increasing age for CMT1 and CMT2 (p ≤0.05). CMT2 and CMT3 had a significant negative correlation (thicker muscle with increasing myopic refractive error) (p ≤0.01). AT had a significant positive correlation (thicker muscle with increasing hyperopic refractive error) (p <0.01). CONCLUSIONS: Ciliary muscle thickness in participants with DS was found to be in a similar range with similar refractive error trends to previous reports of individuals without DS. However, it is important to note that the refractive error trends were driven by individuals with moderate to high levels of myopia.

A randomised clinical trial of multifocal contact lenses and contact lens discomfort.

PURPOSE: To determine how multifocal contact lenses affect contact lens discomfort. METHODS: This randomised, participant-masked, crossover clinical trial fitted 84 uncomfortable soft contact lens wearers (30-40 years old) with single vision and multifocal contact lenses. Contact lens discomfort was assessed using the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8). RESULTS: There was no difference between multifocal and single vision survey scores (p = 0.08). There was an interaction between lens type and age group (p = 0.05). CLDEQ-8 scores with the single vision lens were less symptomatic than multifocal scores in participants <35 years old (p = 0.01). Single vision and multifocal scores for the older age group were not different. Subjectively, those in the <35 year-old age group preferred the single vision lens for intermediate (p = 0.02), distance (p = 0.003), and overall vision (p = 0.002). In the ≥35 year-old age group, no lens was significantly preferred for vision. CONCLUSIONS: Participants in the younger age group had more favourable wearing experiences with the single vision lens compared to the multifocal lens. The older age group, however, had similar wearing experiences with both lens types. While younger contact lens wearers may prefer the wearing experience with single vision lenses, some uncomfortable contact lens wearers approaching 40 years old may benefit from wearing a multifocal contact lens sooner in life than is typically practised.

Relationship of Adverse Family Experiences to Resilience and School Engagement Among Vermont Youth.

INTRODUCTION: Adverse childhood experiences (ACEs) are associated with a range of health outcomes and risk behaviors. In 2011-2012, the National Survey of Children's Health (NSCH) included questions about adverse family experiences (AFEs). AFE survey questions are similar to ACE questions, except there are no questions about emotional/physical/sexual trauma, and questions are asked of parents rather than children. Although the relationship between ACEs and work/school absenteeism has been studied, the relationships between AFEs of school-aged children, school performance, and buffering behaviors have not been explored in depth. METHODS: We examined AFEs and measures of resilience and school engagement among 1330 Vermont children (6-17 years) included in the NSCH, using descriptive, bivariate, and multivariable analyses. RESULTS: The most prevalent AFEs were divorce/separation of parents; family income hardship; substance use problems; and mental illness, suicidality, or severe depression. Adjusting for sex, age, special health care needs, poverty level, and maternal physical/mental-emotional health status, children who had three or more AFEs had lower odds of completing all required homework [adjusted odds ratio (AOR) 3.3, 95% confidence interval (CI) 1.7-6.3] and higher odds of failing to exhibit resilience (AOR 2.1, 95% CI 1.2-3.8), compared to children having no AFEs. DISCUSSION: Children with three or more AFEs had difficulty engaging in school and completing homework, though poor outcomes were buffered when children showed resilience. Parents, school-based mental health professionals, and teachers could help identify children who may be less resilient and have difficulties completing homework assignments. Preventive approaches to children's emotional problems (e.g., promoting family health, using family-based approaches to treat emotional/behavioral problems) could be applied in schools and communities to foster resilience and improve school engagement of children.

A Survey of Presbyopic Contact Lens Wearers in a University Setting.

PURPOSE: To determine why presbyopic patients discontinue contact lens wear and describe their opinions of comfort and visual quality with contact lenses. METHODS: A survey assessing current age, gender, contact lens material/design, and opinions of contact lens comfort and visual quality was mailed to 2400 presbyopic patients (age 40 years and older) that have had eye exams in the Ohio State University College of Optometry's Contact Lens Services over the last 4 years. RESULTS: A total of 496 surveys were analyzed. The mean age of survey respondents was 57 ± 9 years, and 68% of the sample was female. Permanent discontinuation of contact lens wear was reported by 15%. No association was found between contact lens discontinuation and age (p = 0.7), gender (p = 0.2), age of beginning contact lens wear (p = 0.1), or contact lens material (p = 0.1). Poor vision (38%), discomfort (34%), convenience (20%), and cost (6%) were the primary reported reasons for discontinuation. There was no difference between the proportion of subjects reporting "poor vision" as their primary discontinuation reason and those reporting "discomfort" (p = 0.7). Discontinued wearers had a worse overall opinion of their distance (p = 0.03), intermediate (p = 0.01), and near vision (p = 0.002) compared to subjects who were still wearing their contact lenses. CONCLUSIONS: Discomfort has been reported as the primary reason for contact lens discontinuation. In this presbyopic population, dissatisfaction with vision and discomfort were reported equally as often as primary reasons for discontinuation. As well, subjects who ceased contact lens wear had worse overall opinions of their vision at all distances than current contact lens wearers. The results of this survey suggest that presbyopes have unique demands and opinions related to contact lens wear.

Can Binocular Vision Disorders Contribute to Contact Lens Discomfort?

PURPOSE: To determine the relationship between binocular vision (BV) disorder and dry eye symptoms and the frequency of BV disorders in subjects with contact lens-induced dry eye symptoms. METHODS: Subjects recruited for a larger dry eye study (n = 104) completed the Ocular Surface Disease Index (OSDI) and Convergence Insufficiency Symptom Survey (CISS) to determine if symptoms assessed on these two surveys were related. Also, myopic soft contact lens wearers (n = 29) with self-reported dry eye symptoms were recruited. Subjects completed the OSDI and CISS to assess severity of dry eye and BV disorder symptoms. Basic BV and dry eye testing was performed on each subject. RESULTS: Severity of symptoms assessed on the OSDI and CISS was found to be significantly correlated in the larger subject group (ρ = 0.68, p = 0.0001). This significant correlation warranted further investigation of both symptoms and clinical signs. In the group of myopic soft contact lens wearers, 48.3% had a BV disorder. This proportion appeared to be higher than previously reported prevalence estimates of BV disorders. Accommodative lag greater than or equal to 1.00 diopter was the most common BV disorder sign encountered (48.3%), and pseudo-convergence insufficiency was the most common BV disorder (31.0%). CONCLUSIONS: Symptoms related to dry eye and BV disorders overlap. Subjects with symptoms of discomfort while wearing soft contact lenses may be experiencing a concurrent or stand-alone BV disorder. Accommodative insufficiency and pseudo-convergence insufficiency were common in the sample of myopic soft contact lens wearers. Clinicians should screen symptomatic contact lens-induced dry eye patients for BV disorders. Dry eye studies should assess basic BV function.

Ciliary muscle thickness in anisometropia.

PURPOSE: The purpose of this study was to investigate the relationships between ciliary muscle thickness (CMT), refractive error, and axial length both across subjects and between the more and less myopic eyes of adults with anisometropia. METHODS: Both eyes of 29 adult subjects with at least 1.00 D of anisometropia were measured. Ciliary muscle thickness was measured at the maximum thickness (CMTMAX) and at 1.0 (CMT1), 2.0 (CMT2), and 3.0 mm (CMT3) posterior to the scleral spur, and also at the apical region (Apical CMTMAX = CMTMAX - CMT2, and Apical CMT1 = CMT1 - CMT2). Multilevel regression models were used to determine the relationship between the various CMT measures and cycloplegic refractive error or axial length, and to assess whether there are CMT differences between the more and less myopic eyes of an anisometropic adult. RESULTS: CMTMAX, CMT1, CMT2, and CMT3 were negatively associated with mean refractive error (all p ≤ 0.03), and the strongest association was in the posterior region (CMT2 and CMT3). Apical CMTMAX and Apical CMT1, however, were positively associated with mean refractive error (both p < 0.0001) across subjects. Within a subject, i.e., comparing the two anisometropic eyes, there was no statistically significant difference in CMT in any region. CONCLUSIONS: Similar to previous studies, across anisometropic subjects, a thicker posterior region of the ciliary muscle (CMT2 and CMT3) was associated with increased myopic refractive error. Conversely, shorter, more hyperopic eyes tended to have thicker anterior, apical fiber portions of their ciliary muscle (Apical CMTMAX and Apical CMT1). There was no difference between the two eyes for any CMT measurement, indicating that in anisometropia, an eye can grow longer and more myopic than its fellow eye without resulting in an increase in CMT.

Asymptomatic retinal emboli and current practice guidelines: a review.

Asymptomatic retinal emboli are found in 1-3% of patients on routine fundus examination. As the use of teleretinal imaging for diabetic patients and ocular photography continues to increase, the number of asymptomatic retinal emboli found will also increase. This article will discuss the different aetiologies of retinal emboli and will present an overview of the recommended referrals for further systemic testing and treatment. It is important to communicate well with the primary care physician when asymptomatic retinal emboli are detected to ensure the appropriate investigations are undertaken.

Exposure to green tea extract alters the incidence of specific cyclophosphamide-induced malformations.

BACKGROUND: Green tea extract (GTE) has been shown to have antioxidative properties due to its high content of polyphenols and catechin gallates. Previous studies indicated that catechin gallates scavenge free radicals and attenuate the effects of reactive oxygen species. Cyclophosphamide (CP) produces reactive oxidative species, which can have adverse effects on development, causing limb, digit, and cranial abnormalities. The current study was performed to determine if exposure to GTE can decrease teratogenic effects induced by CP in CD-1 mice. METHODS: From gestation days (GD) 6-13, mated CD-1 mice were dosed with 400 or 800 mg/kg/d GTE; 100, 200, 400, or 800 mg/kg/d GTE + CP; CP alone, or the vehicle. GTE was given by gavage. CP (20 mg/kg) was given by intraperitoneal injection on GD 10. Dams were sacrificed on GD 17, and their litters were examined for adverse effects. RESULTS: The highest GTE dose did not effectively attenuate, and in some cases exacerbated the negative effect of CP. GTE alone was also associated with an increased incidence of microblepharia. Conversely, moderate GTE doses (200 and/or 400 mg/kg/d) attenuated the effect of CP on fetal weight and (GTE 200 mg/kg/d) decreased the incidences of certain defects resulting from CP exposure. CONCLUSIONS: Exposure of a developing mammal to moderate doses of GTE can modulate the effects of exposure to CP during development, possibly by affecting biotransformation, while a higher GTE dose tended to exacerbate the developmental toxicity of CP. GTE alone appeared to cause an adverse effect on eyelid development.

The effect of phenylephrine on the ciliary muscle and accommodation.

PURPOSE: To objectively measure changes in the human ciliary muscle dimensions in vivo after instillation of topical phenylephrine, a mydriatic and vasodilating agent. METHODS: A cross-sectional study of 25 healthy young adults was conducted. Measurements of pupil size, accommodation, and ciliary muscle thickness were made both before and 30 min after instillation of 1% proparacaine and 2.5% phenylephrine. Accommodation was measured in three ways: subjectively using a push-up technique and Royal Air Force (RAF) rule, and objectively using both the Grand Seiko autorefractor and PowerRefractor. Images of the temporal ciliary muscle were acquired using the Visante Anterior Segment Optical Coherence Tomographer (OCT). Ciliary muscle images were objectively analyzed using a computer-based segmentation technique. RESULTS: Amplitude of accommodation using the push-up test was reduced by about 1 D with phenylephrine (p < 0.001). Phenylephrine did not change the accommodative response to a 4 D Badal target as measured by either autorefraction or photorefraction (p > 0.30). There was statistically significant thickening of the anterior region and thinning of the posterior region of the ciliary muscle with accommodation (p < 0.001, all locations). Phenylephrine did not affect either baseline ciliary muscle thickness or the accommodative contraction of the muscle (p > 0.09). CONCLUSIONS: Low-dose phenylephrine does not affect ciliary muscle dimensions, ciliary muscle contractility, or accommodative response to a 4 D near target.

Measuring changes in ciliary muscle thickness with accommodation in young adults.

PURPOSE: To develop a measurement protocol for changes in the shape and size of the ciliary muscle with accommodation using the Zeiss Visante™ anterior segment optical coherence tomography (AS-OCT) and to determine the test-retest repeatability of these measurements. METHODS: Subjects were 25 adults aged 23 to 28 years. The ciliary muscle was imaged at two visits with the Visante™ while accommodative response was monitored during imaging using the PowerRefractor. Ciliary muscle thickness (CMT) was measured at 1 mm (CMT1), 2 mm (CMT2), and 3 mm (CMT3) posterior to the scleral spur and at the point of maximal thickness (CMTMAX). Thickness was measured at these locations while subjects viewed a target at distance and at a 4.00 D accommodative stimulus. Outcome measures were the change in thickness between distance and the 4.00 D stimulus and the change in thickness per diopter of accommodative response (PowerRefractor). Finally, the repeatability measurements between visit 1 and visit 2 were determined with a Bland-Altman analysis. RESULTS: The statistically significant modeled changes in CMT were as follows: CMTMAX = 69.2 µm (4.00 D stimulus) and 18.1 µm (per diopter of accommodation); CMT1 = 45.2 µm (4.00 D stimulus) and 12.3 µm (per diopter of accommodation); and CMT3 = -45.9 µm (4.00 D stimulus) and -12.0 µm (per diopter of accommodation); p < 0.0001 for all. CONCLUSIONS: The combination of the Visante™ and the PowerRefractor is a feasible tool for measuring thickening of ciliary muscle at more anterior locations and thinning at more posterior locations during accommodation. We noted a wide range of accommodative responses during the time of image capture in this study indicating that the most accurate estimates of the change in ciliary muscle dimensions with accommodation may be obtained by using accommodative response rather than stimulus values and by using measurements taken simultaneously with image capture.

Changes in ciliary muscle thickness during accommodation in children.

PURPOSE: To investigate the morphology of the ciliary muscle during the act of accommodation in a population of children. METHODS: Thirty children aged 6 to 12 years were enrolled. Accommodative response was measured through habitual correction. Height was measured as a control variable. Central axial length was measured with the IOLMaster. Four images of the temporal ciliary muscle were taken with the Visante Optical Coherence Tomographer at three different stimulus levels (0, 4, and 6 D) while accommodative response was monitored concurrently with the PowerRefractor. Accommodative response monitoring was time-matched to ciliary muscle image capture, and the mean was calculated for 5 s surrounding this time point. Four cycloplegic images of the temporal ciliary muscle were also taken. Ciliary muscle thickness measurements were made at the point of maximum thickness (CMTMAX) and at 1 mm (CMT1), 2 mm (CMT2) and 3 mm (CMT3) posterior to the sclera spur. RESULTS: Increasing accommodative response was correlated with increases in the thickness of CMTMAX (p = <0.001) and CMT1 (p = <0.001) and decreases in the thickness of CMT3 (p = <0.001). Thicker values of CMTMAX under cycloplegic conditions were significantly correlated with values of CMTMAX (p = <0.001) and CMT1 (p = 0.001) while accommodating and approached significance in modeling CMT3 (p = 0.06). Mean axial length was correlated with the amount of thinning at CMT3 with accommodation (p = 0.002). Axial length was not significantly correlated with thickness values at CMTMAX (p = 0.7) or CMT1 (p = 0.6). CONCLUSIONS: In a manner similar to previous adult studies, ciliary muscle thickness at CMTMAX and CMT1 increased with accommodation and CMT3 thinned with accommodation. Further investigation is necessary to determine whether CMT2 is a "fulcrum" point along the length of the ciliary muscle where the net change with accommodation is always zero or whether that point varies across subjects or with varying levels of accommodative effort.

Intraoperative MRI electrical noise and monitor ECG filters affect arrhythmia detection and identification.

Most electrical equipment in the modern operating room (OR) radiates electrical noise (EN) that can interfere with patient monitors. We have described the EN that an intraoperative magnetic resonance imaging (iMRI) system emits and have shown that this high-energy EN diminishes the quality of the ECG waveform during iMRI scans in our neurosurgical OR. We have also shown that the ECG signal filters in our iMRI-compatible patient monitor reduce this interference but, in the process, disturb the true morphology of the displayed waveform. This simulation study evaluates how iMRI-generated EN affects the ability of the anesthetist to detect and identify ECG arrhythmias and whether the patient monitor's ECG signal filters can improve arrhythmia recognition. Using an ECG simulator, we generated Lead II and V5 ECG signal segments that contained either no arrhythmia or one of four common cardiac arrhythmias. We filtered the ECG segments with four filters available on our iMRI-compatible monitor (Veris MR, MEDRAD Inc., Indianola, PA USA). We then digitized the segments and mixed simulated iMRI EN into the resultant tracings. With institutional approval and written informed consent, board-certified anesthesiologists reviewed the tracings, determined if an arrhythmia was present and identified the arrhythmia. We conducted the study anonymously. We reported the data as percent correct arrhythmia detection and correct arrhythmia identification. Thirty-one anesthesiologists completed the study. Overall, the participants correctly detected 79.5% (95% CI: 77.2, 81.7%) of the arrhythmias and correctly identified 62.5% (95% CI: 59.8, 65.3%) of the arrhythmias, regardless of EN presence. Although the proportions among monitor noise filters studied were not significant, the manufacturer-designated MR5 Veris MR filter optimized arrhythmia detection and arrhythmia identification for our participants, regardless if EN was present in the ECG tracings. In the neurosurgical OR, the anesthetist must be able to effectively monitor a patient in the presence of iMRI-generated EN. Depending on the OR design, the patient may be out of the anesthetist's direct view during a scan procedure. The anesthetist must rely on monitored physiologic parameters to assess patient status during this time. He/she should be familiar with his/her monitor's filtering capabilities and routinely adjust the ECG filters to achieve the best compromise between minimized EN effects and maximized displayed ECG signal quality.

The effects of subacute exposure to a water-soluble cannabinol compound in male mice.

BACKGROUND: Cannabinol (CBN) is one of the many cannabinoids present in Cannabis sativa and has been explored as a potential treatment for sleeplessness. The purpose of this study was to determine the physiological and behavioral effects of subacute exposure to therapeutic and low pharmacological levels of a mechanically formed, stabilized water-soluble cannabinol nano-emulsion (CBNight™). METHODS: Sixty-two male mice were randomly assigned to one of six treatment groups given CBNight™ at dosages designed to deliver 0mg (control) to 4 mg/kg of CBN daily via oral gavage for 14 days. In-cage behavior was observed at 30 minutes and at 2, 4, 8, and 16 hours after each dose. After 14 days, the mice were sacrificed and necropsied. Organs were weighed and inspected for gross abnormalities, and blood was collected via cardiac puncture for clinical chemistry. RESULTS: No dosage-dependent adverse effects on behavior, body mass, or blood chemistry were observed, except that the highest doses of CBNight™ were associated with significantly lower eosinophil counts. CONCLUSIONS: The commercially available, water-soluble CBN compound employed in this study does not appear to cause adverse effects in mice; rather, it appears to be well tolerated at pharmacological levels. The findings of eosinopenia at higher doses of CBN and lack of hepatotoxicity at any dosage employed in this study have not been reported to date.

Semiautomatic extraction algorithm for images of the ciliary muscle.

PURPOSE: To develop and evaluate a semiautomatic algorithm for segmentation and morphological assessment of the dimensions of the ciliary muscle in Visante Anterior Segment Optical Coherence Tomography images. METHODS: Geometric distortions in Visante images analyzed as binary files were assessed by imaging an optical flat and human donor tissue. The appropriate pixel/mm conversion factor to use for air (n = 1) was estimated by imaging calibration spheres. A semiautomatic algorithm was developed to extract the dimensions of the ciliary muscle from Visante images. Measurements were also made manually using Visante software calipers. Interclass correlation coefficients and Bland-Altman analyses were used to compare the methods. A multilevel model was fitted to estimate the variance of algorithm measurements that was due to differences within- and between-examiners in scleral spur selection vs. biological variability. RESULTS: The optical flat and the human donor tissue were imaged and appeared without geometric distortions in binary file format. Bland-Altman analyses revealed that caliper measurements tended to underestimate ciliary muscle thickness at 3 mm posterior to the scleral spur in subjects with the thickest ciliary muscles (t = 3.6, p < 0.001). The percent variance due to within- or between-examiner differences in scleral spur selection was found to be small (6%) when compared with the variance because of biological difference across subjects (80%). Using the mean of measurements from three images, achieved an estimated interclass correlation coefficient of 0.85. CONCLUSIONS: The semiautomatic algorithm successfully segmented the ciliary muscle for further measurement. Using the algorithm to follow the scleral curvature to locate more posterior measurements is critical to avoid underestimating thickness measurements. This semiautomatic algorithm will allow for repeatable, efficient, and masked ciliary muscle measurements in large datasets.

A comparison of the effects of prenatal exposure of CD-1 mice to three imidazolium-based ionic liquids.

BACKGROUND: Ionic liquids (ILs; salts with melting points below 100 degrees C) exhibit wide liquid ranges, non-flammability, and thermal stability among other properties. These unique salts are best known as "green" alternatives to traditional volatile organic solvents, which are utilized in both academia and industry. Our current study compares the developmental toxicity potential of three representative ionic liquids, with various chain lengths: 1-ethyl-3-methylimidazolium chloride ([C(2)mim]Cl), 1-butyl-3-methylimidazolium chloride ([C(4)mim]Cl), and 1-decyl-3methylimidazolium chloride ([C(10)mim]Cl). METHODS: From gestation days (GD) 6-16, mated CD-1 mice were orally dosed with one of the following: 1,000, 2,000, or 3,000 mg/kg/day [C(2)mim]Cl; 113, 169, or 225 mg/kg/day [C(4)mim]Cl; 50, 75, or 100 mg/kg/day [C(10)mim]Cl; or the vehicle only. Dams were sacrificed on GD 17, and their litters were examined for adverse effects. RESULTS: Fetal weight was significantly decreased in the two highest dosage groups exposed to [C(4)mim]Cl and [C(10)mim]Cl in comparison with their controls, but the [C(2)mim]Cl treated groups were not affected. An apparent teratogenic effect was associated with both [C(4)mim]Cl and [C(10)mim]Cl, as the offspring exhibited certain uncommon morphological defects. However, the incidences of malformations were low and no correlation between incidence and dosage could be made. No morphological defects were observed in any of the [C(2)mim]Cl-treated groups, despite maternal morbidity at the highest dosage level. CONCLUSIONS: This study indicates that [C(4)mim]Cl and [C(10)mim]Cl may have adverse effects on development at high maternal exposures and strongly supports the supposition that the toxicity of imidazolium-based ILs is influenced by alkyl chain length.

A Culinary Medicine Elective for Clinically Experienced Medical Students: A Pilot Study.

Purpose: Culinary medicine, a combination of nutrition science and the culinary arts, is an emerging approach for teaching nutrition to medical students and improving their competence in counseling patients with diet-associated diseases. Data are, however, lacking on the impact of culinary medicine courses directed at clinically experienced students. This study reports initial outcomes of a pilot nutrition and culinary medicine course targeting 4th-year medical students. Methods: An elective course on culinary medicine was offered to 4th-year medical students at the Perelman School of Medicine, comprising seven disease-focused sessions, with a final capstone session. Students read primary literature for each session. Individual sessions consisted of culinary literacy, cooking, and a case discussion led by physicians and registered dietitians. In addition, students participated in a nutrition education initiative in a local high school. Students completed pre-and postcourse surveys that evaluated perceived nutrition knowledge and counseling skills and personal dietary choices, and included free-text options for qualitative comments. Results: Thirty-one 4th-year medical students participated in three offerings of the course in 2018 and 2019. There was strong student enthusiasm for the course as (1) all the available slots for each course offering were filled within 2 h of an e-mail announcement to the students; (2) student attendance was consistently very high; and (3) student feedback about the course was uniformly positive. Students reported significant increases in their confidence regarding (1) knowledge of pertinent nutrition information; (2) discussing nutrition with patients; and (3) ability to impact patient behavior through counseling (p < 0.001). Qualitative comments suggested that students were contemplating or implementing changes in their dietary habits and food choices. Conclusion: A culinary medicine course for clinically experienced medical students may improve perceived nutrition knowledge and increases confidence in counseling patients with diet-associated diseases.

Validation of optical coherence tomography-based crystalline lens thickness measurements in children.

PURPOSE: To evaluate the validity and repeatability of crystalline lens thickness measurements obtained by anterior segment optical coherence tomography (OCT). METHODS: Forty-seven normal children (mean age, 11.06 +/- 2.30 yr) had their crystalline lens thickness measured with the Visante anterior segment OCT (Carl Zeiss Meditec, Dublin, CA) and with conventional corneal touch A-scan ultransonography (ultrasound) (Humphrey 820). The subjects' right corneas were anesthetized, and their right eyes were cyclopleged. Five ultrasound measurements were recorded per eye, and three Visante OCT measurements were recorded per eye. Thirty-eight subjects had measurements at a second visit where three additional Visante OCT measurements were recorded. RESULTS: The mean of the differences between the Visante OCT and ultrasound was -0.045 mm (p = 0.017) with 95% limits of agreement from -0.29 to 0.20 mm, indicating that the measurement of crystalline lens thickness was slightly thinner with the Visante OCT. When validity was assessed using only Visante OCT images that contained the corneal reflex, the mean of the differences was 0.019 mm (p = 0.11) with 95% limits of agreement from -0.091 to 0.13 mm. For the repeatability of the Visante OCT, the mean of the differences between visit one and visit two was -0.008 mm (p = 0.25) with 95% limits of agreement from -0.088 to 0.072 mm. Repeatability improved when reassessed using only images that contain the corneal reflex; the mean of the differences was -0.0001 mm (p = 0.97) with 95% limits of agreement from -0.030 to 0.030 mm. CONCLUSION: The Visante OCT is a non-contact instrument that is simple to use, and it provides valid crystalline lens thickness measurements with excellent repeatability. Validity and repeatability are optimized when the Visante OCT images contain the corneal reflex and a consistent corneal index refraction is applied to the entire image.

Accommodative fluctuations, lens tension, and ciliary body thickness in children.

PURPOSE: To investigate the relationship among microfluctuations in accommodation, resting tension on the crystalline lens, ciliary body thickness, and refractive error in children. METHODS: Subjects were 49 children, aged 8 to 15 years. Subjects wore habitual correction over their left eye and an infrared filter over the right eye during accommodative measurements. Monocular accommodation was measured continuously for two, 30-second periods using a PowerRef I at a sampling rate of 25 Hz while subjects viewed a high-contrast target at 0.25 m. The high (1.0 to 2.3 Hz) and low- (0 to 0.6 Hz) frequency components of the power spectrum from a fast Fourier transform of the accommodative response were used in analysis. Resting tension on the crystalline lens was assessed by measuring the amplitude of the oscillations of the crystalline lens after a rightward 20 degrees saccadic eye movement. Ciliary body thickness was measured 2 mm posterior to the scleral spur from images obtained with a Zeiss Visante optical coherence tomography (OCT). Cycloplegic spherical equivalent refractive error was obtained with the Grand Seiko autorefractor. RESULTS: The mean +/- SD spherical equivalent refractive error was -1.00 D +/- 2.25 (range, -6.00 D to +3.44 D). Greater power in the log of the high-frequency component of accommodative microfluctuations was associated with thinner ciliary bodies (p = 0.03) and lower ages (p = 0.0004). More hyperopic refractive errors with greater power in the high-frequency component (p = 0.0005) and the low-frequency component (p = 0.02). No statistically significant relationship was found for the low-frequency component or root mean square of accommodative microfluctuations and refractive error. CONCLUSIONS: High-frequency microfluctuations of accommodation appear to be suppressed with thicker ciliary bodies. These variations in accommodation need to be observed in a longitudinal study to better assess the functional significance of their relationship to ciliary body size and refractive error.

A study of contact lens compliance in a non-clinical setting.

PURPOSE: To evaluate soft contact lens replacement, overnight (ON) wear, and contact lens case compliance in a non-clinical sample. METHODS: Subjects (n = 297) were recruited at the Center for Science and Industry (COSI) in Columbus, Ohio. Adult (≥ 18 years) soft contact lens wearers completed a survey about contact lens replacement, ON contact lens wear, and contact lens case replacement habits. RESULTS: Two-week replacement lenses (according to the manufacturer's replacement schedule [MRS]) were most common (45.5%), followed by monthly (34.3%) and daily replacement (20.2%). Non-compliance with replacement schedule was reported in 38.7% of subjects. Age (p = 0.02), years of lens wear (p = 0.02), and MRS (p <0.0001) affected replacement compliance. Post-hoc analysis showed daily replacement wearers were more compliant than two-week (p <0.0001) and monthly (p <0.0001) replacement wearers with prescribed lens replacement. Non-compliance with prescribed ON wear was reported in 23.9% of subjects. Subjects who were non-compliant with lens replacement were more likely to be non-compliant with ON wear (p = 0.02) and had worn contact lenses for less time (p = 0.02). Of the subjects who used contact lens cases, 74.6% were unsure when they should replace their case. Frequency of case replacement was not associated with age (p = 0.5), gender (p = 0.5), years of contact lens wear (p = 0.7), MRS (p = 0.4), replacement compliance (p = 0.3), or ON wear compliance (p = 0.7). CONCLUSIONS: Daily replacement wearers were most likely to be compliant with contact lens replacement, but all subjects, including daily replacement wearers, had similar ON wear non-compliance. Non-compliant lens replacement was associated with non-compliant ON wear, but contact lens case replacement was not related to either compliance category. The majority of subjects had no knowledge of proper contact lens case replacement, despite compliance in other categories.