Macular Degeneration

A peculiar occasional observation prompted our attention some years ago on the relationship between age-related macular degeneration (AMD) and amblyopia. A 75-year old gentleman, family friend of one of us (ECC) for decades, developed an hemorragic type of AMD in his sound eye. The other eye had a severe strabismic amblyopia, with excentric fixation and a visual acuity not better than 6/30. Initial fluorangiographic retinal changes were present in this eye as well. Over an eight year period no functional deterioration took place in the amblyopic eye, with only light perception present in the sound eye. Based on this clinical observation, we undertook a prospective study for evaluating the time course of a possible symmetrization of AMD in patients with strabismic amblyopia in which AMD started in the non-amblyopic eye. Ten patients initially presenting with clinically relevant AMD in one eye have been followed over a six year period. Five had esotropia with deep amblyopia of the deviated eye and five had normal binocular vision. The amblyopic patients were selected on the basis of the presence of an AMD in the sound eye. Visual acuity measurements and retinal fluorescein angiography (RFA) were repeated annually, in order to detect the time course of involvement of the second eye. Visual acuity of the eye with AMD in the patients with strabismic amblyopia of the other eye deteriorated rapidly to levels lower than that of the amblyopic eye (between 2 and 8 months from the initial observation). In the amblyopic eye, there was no change in the visual acuity over the six year period. In the strabismic patients the macular lesions of the eyes with AMD deteriorated from an hemorragic to a cicatricial stage in all five patients after 2 to 12 months. The RFA of the amblyopic eye showed initial changes, i.e., 'typical' or 'exudat-ive' drusen, after 6 to 48 months from the beginning of the study. Visual acuity testing in both eyes of the five patients without strabismus showed a progressive although slow deterioration in both the originally affected eye and the second eye. An initial deterioration of visual acuity in the second eye could be observed after 12 to 38 months from the beginning of the study. Visual acuity in the two eyes tended to be equal at the end of the observation period of six years. The earliest signs of the disease in the originally non-affected eye were revealed by RFA after 8 to 24 months from the beginning of the study.

Masson SAS. Tous droits réservés.-Document téléchargé le 24/11/2021 Il est interdit et illégal de diffuser ce document. 30 L. El Matri et al. Conclusion.-Nos résultats fonctionnels et anatomiques ont montré la supériorité de bevacizumab versus la photothérapie dynamique dans le traitement des NVC du myope fort à long terme.

Refractory neovascular age-related macular degeneration (nAMD) is defined when intravitreal anti-vascular endothelial growth factor injection therapy results in poor response. Treatment of refractory patients determines the success or failure of treatment for nAMD. In this article, we present the definition and mechanism of refractory nAMD, and address various possible therapeutic approaches that can overcome refractoriness, such as switching drugs, increasing injection dosage or frequency, and combination therapy with photodynamic therapy or intravitreal steroid injection.

Age-related macular degeneration (AMD) is a degenerative disease of the human retina affecting individuals over the age of 55 years. This heterogeneous condition arises from a complex interplay between age, genetics, and environmental factors including smoking and diet. It is the leading cause of blindness in industrialized countries. Worldwide, the number of people with AMD is predicted to increase from 196 million in 2020 to 288 million by 2040. By this time, Asia is predicted to have the largest number of people with the disease. Distinct patterns of AMD prevalence and phenotype are seen between geographical areas that are not explained fully by disparities in population structures. AMD is classified into early, intermediate, and late stages. The early and intermediate stages, when visual symptoms are typically absent or mild, are characterized by macular deposits (drusen) and pigmentary abnormalities. Through risk prediction calculators, grading these features helps predict the ...

PurposeMelanolipofuscin (MLF) is a complex granule, exhibiting properties of both melanosomes and lipofuscin (LF) granules, which accumulates in retinal pigment epithelial (RPE) cells and may contribute to the etiology of age-related macular degeneration (AMD). MLF accumulation has been reported by Feeney-Burns to more closely reflect the onset of AMD than the accumulation of lipofuscin. In an effort to assess the possible contribution MLF may have to the onset of AMD, we analyzed the phototoxicity and protein composition of MLF and compared those results to that of LF.MethodsSpecifically, we observed the accumulation of MLF in human RPE from different decades of life, and assessed the phototoxicity of these granules. We also employed fluorescence spectroscopy, atomic force microscopy, transmission and scanning electron microscopy and proteomic analysis to examine the composition of MLF granules in an effort to ascertain their origin.ResultsOur results show that MLF granules are phototoxic and their accumulation more closely reflects the onset of AMD than does LF accumulation. Our compositional analysis of MLF has shown that while these granules contain some similarities to LF granules, MLF is substantially different. Of significant interest is the finding that MLF, in contrast to LF, does not contain photoreceptor-specific proteins, suggesting that MLF may not originate from the phagocytosis of photoreceptor outer segments. Instead the presence of RPE- and melanosome-specific proteins would suggest that MLF accumulates as a result of the melanosomal autophagocytosis of RPE cells.ConclusionsOur results provide significant insight into understanding the formation and toxicity of MLF and suggest a possible contribution to the etiology of retinal diseases.

The Virtual Retinal Display (VRD) is a new technology for creating visual images. It was developed at the Human Interface Technology Laboratory (HIT Lab) by Dr. Thomas A. Furness III. The VRD creates images by scanning low power laser light directly onto the retina. This special method results in images that are bright, high contrast and high resolution. In this paper, we describe how the VRD functions, the special consequences of its mechanism of action and potential medical applications of the VRD, including surgical displays and displays for people with low vision. A description of its safety analysis will also be included. In one set of tests we had a number of patients with partial loss of vision view images with the VRD. There were two groups of subjects: patients with macular degeneration, a degenerative disease of the retina and patients with keratoconus. Typical VRD images are on the order of 300 nanowatts. VRD images are also readily viewed superimposed on ambient room lig...

We examined familial aggregation and risk of age-related macular degeneration in the Utah population using a population-based case-control study. Over one million unique patient records were searched within the University of Utah Health Sciences Center and the Utah Population Database (UPDB), identifying 4764 patients with AMD. Specialized kinship analysis software was used to test for familial aggregation of disease, estimate the magnitude of familial risks, and identify families at high risk for disease. The population-attributable risk (PAR) for AMD was calculated to be 0.34. Recurrence risks in relatives indicate increased relative risks in siblings (2.95), first cousins (1.29), second cousins (1.13), and parents (5.66) of affected cases. There were 16 extended large families with AMD identified for potential use in genetic studies. Each family had five or more living affected members. The familial aggregation of AMD shown in this study exemplifies the merit of the UPDB and supports recent research demonstrating significant genetic contribution to disease development and progression.

20. A mean visuomotor processing time of 171 ms was estimated for both 1g and -1g trials, on the basis of methods described in . 21. Both the 1g model and the t model use on-line visual information about target position and velocity to trigger an interceptive movement when TTC(t) [see ] reaches a time threshold equal to the visuomotor processing time . However, the 1g model computes T TC(t) under the assumption that the target is accelerated by gravity [Eq. 1 in ], whereas the t model assumes that the target moves at constant speed [TTC(t) 0 ĥ w (t)=v w (t), see (4, 23)]. Therefore, if the brain uses the 1g model to predict target motion, the responses to 1g trials will be correctly timed. By contrast, the t model overestimates the TTC(t) of 1g trials and predicts that the corresponding responses should be systematically late. As a quantitative test, the time of response was computed separately for the five flight durations and was averaged across all trials of all subjects for a given flight duration. For 1g trials, the response times predicted by the 1g model were highly correlated with the experimental values in all subjects (mean r 0 0.998), whereas those predicted by the t model systematically failed to fit the experimental values (mean r 0 -0.5). The root mean square error (RMSE) of the fit to 1g trials was worse by a factor of 1.7 for the t model than for the 1g model. For -1g trials, the response times predicted by the t model were highly correlated with the experimental values in all subjects (mean r 0 0.973), and adequacy of the fit was demonstrated by the random distribution of the residuals around the mean over the data range. Instead, the 1g model fitted the responses to -1g trials less adequately, as shown by a systematic bias of the residuals around the mean (thus r value was not computed for this fit). Accordingly, the RMSE of the fit was 3.6 times worse for the 1g model than for the t model.

Age-related macular degeneration (AMD) is a common cause of severe vision loss. Identification of the genes involved in AMD will lead to a better understanding of this disease at the molecular level, which will eventually lead to early detection, prevention and treatment. Previously, we mapped the ARMD1 gene to 1q25-31 in a large family with AMD. Here, we narrow the ARMD1 locus to 14.9 Mb between LAMB2 and D1S3469, a region containing 50 known genes. Twenty candidate genes within this region were screened for mutations. Only one DNA variation, an A16,263G transition in exon 104 of HEMICENTIN-1, was found to segregate exclusively with the disease haplotype in members of this large family with AMD. This variation produces a non-conservative substitution of arginine for glutamine at amino acid position 5345 (Gln5345Arg). It was also identified in 11 other individuals, all of whom share a haplotype, which envelops HEMICENTIN-1, with the large AMD family. The affected status of all but one of those individuals conforms to the agedependent penetrance observed in AMD. The amino acid at position 5345 of HEMICENTIN-1 was conserved as glutamine in eight species analyzed. RT-PCR analysis demonstrated that exon 104 of HEMICENTIN-1 is alternatively spliced in various cell types. Exclusive segregation of Gln5345Arg with the disease haplotype in this large family, amino acid conservation of glutamine at this position among mammals, the non-conservative nature of the substitution and similarities to EFEMP1 support the conclusion that HEMICENTIN-1 is the ARMD1 gene.

Previous studies have shown that reading rate for very large print (6Њ, 1.86 logMAR character size) is a strong predictor of oral reading rate with low vision devices (LVDs). We investigated whether this would apply using large print sizes more readily available in clinical situations (e.g. 2Њ, 1.4 logMAR), for subjects with macular degeneration. We assessed rauding rates-reading for understanding. A combination of near word visual acuity and large print reading rate (without LVDs) provided the best prediction of oral rauding rates (with LVDs). However, near word visual acuity alone was almost as good. Similarly, silent rauding rate was predicted best by near word visual acuity alone. We give near visual acuity limits as a clinical guide to expected oral and silent reading performance with LVDs for patients with macular degeneration. ᭧

Besides hyperglycemia and hypertension, a recently recognized risk factor for diabetic retinopathy (DR) appears to be hyperlipidemia. While studies using earlier generation lipid lowering agents in DR were disappointing, a randomized trial using HMG-CoA Reductase Inhibitors has strong rationale, though hitherto not attempted. The aim of the present study was to compare the HMG-CoA Reductase Inhibitor, simvastatin, with placebo in patients having DR in a double-blind randomized placebo-controlled trial. Fifty patients with diabetes mellitus (Type 1 and 2) with good glycemic control and hypercholesterolemia and having DR (non-clinically significant macular edema and visual acuity 6/24 or better) in either or both eyes were randomized to simvastatin 20-mg per day or placebo, and were followed up for 180 days. On simvastatin therapy, total cholesterol and low-density lipoprotein cholesterol (LDL-C) decreased (P B0.001, respectively), and the level of high-density lipoprotein cholesterol (HDL-C) increased (P B 0.001). VA improved in four patients using simvastatin, (not statistically different from placebo group) and worsening of VA occurred in seven patients in the placebo group and none in the simvastatin group (P = 0.009). Fundus fluorescein angiography and color fundus photograph showed improvement in one patient in the simvastatin group, while seven patients showed worsening in the placebo group (P = 0.009). The observations of the current study suggest that the HMG-CoA Reductase Inhibitor simvastatin significantly retards the progression of retinopathy in diabetic patients with hypercholesterolemia. The potential of this class of drugs for the primary prevention of DR and other microvascular complications needs to be explored further.

Age-related macular degeneration (AMD) is the most frequent cause of irreversible blindness in the elderly in developed countries. Our previous studies implicated activation of complement in the formation of drusen, the hallmark lesion of AMD. Here, we show that factor H (HF1), the major inhibitor of the alternative complement pathway, accumulates within drusen and is synthesized by the retinal pigmented epithelium. Because previous linkage analyses identified chromosome 1q25-32, which harbors the factor H gene (HF1͞CFH), as an AMD susceptibility locus, we analyzed HF1 for genetic variation in two independent cohorts comprised of Ϸ900 AMD cases and 400 matched controls. We found association of eight common HF1 SNPs with AMD; two common missense variants exhibit highly significant associations (I62V, 2 ‫؍‬ 26.1 and P ‫؍‬ 3.2 ؋ 10 ؊7 and Y402H, 2 ‫؍‬ 54.4 and P ‫؍‬ 1.6 ؋ 10 ؊13). Haplotype analysis reveals that multiple HF1 variants confer elevated or reduced risk of AMD. One common at-risk haplotype is present at a frequency of 50% in AMD cases and 29% in controls [odds ratio (OR) ‫؍‬ 2.46, 95% confidence interval (1.95-3.11)]. Homozygotes for this haplotype account for 24% of cases and 8% of controls [OR ‫؍‬ 3.51, 95% confidence interval (2.13-5.78)]. Several protective haplotypes are also identified (OR ‫؍‬ 0.44-0.55), further implicating HF1 function in the pathogenetic mechanisms underlying AMD. We propose that genetic variation in a regulator of the alternative complement pathway, when combined with a triggering event, such as infection, underlie a major proportion of AMD in the human population.

Address: Department of Psychology, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK Email: Jan Mitchell* - [email protected]; Clare Bradley - [email protected] * Corresponding author ... Abstract Background: The Age-related Macular Degeneration Alliance ...

Purpose To study the association of serum levels of inflammatory mediators and angiogenic factors with genetic polymorphism in Pakistani age-related macular degeneration (AMD) patients. Methods This was a cross-sectional and case-control study that included 90 AMD patients diagnosed through slit-lamp examination, fundoscopy, and ocular coherence tomography. For reference and comparison purposes, 100 healthy age-matched subjects (controls) were also recruited. IL-6, IL-8, VEGF, and CRP levels were estimated in the serum samples of patients and control subjects. Using restriction fragment length polymorphism, single nucleotide polymorphisms were studied in IL-6 (rs1800795, rs1800796, rs1800797), IL-8 (rs4073, rs2227306, rs2227543), VEGF (rs3025039, rs699947), and CRP genes (rs1205, rs1130864). Since the data were obtained from a sample population, the Box–Cox transformation algorithm was applied to reduce heterogeneity of error. Multivariate analyses of variance (M-ANOVA) were applied...

To evaluate the effect of photodynamic therapy (PDT) with verteporfin for age-related macular degeneration (AMD) and non-AMD in Thais, and compare with the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) and Verteporfin in Photodynamic Therapy (VIP) study. The authors prospectively evaluated all data of 51 eyes of 51 patients who had undergone PDT and accomplished a 1-year follow up. The assessments were divided into two categories: group 1 included three subsets of AMD, and group 2 was non-AMD. The first group classified into three subgroups: group 1A: AMD with subfoveal choroidal neovascularization (CNV) and TAP/VIP compatible with recommendation guidelines characteristics, group 1B: AMD with subfoveal CNV and TAP/VIP incompatible, and group 1C: AMD with non-subfoveal CNV. The measurement outcomes comprised of the baseline characteristics, change in visual acuity, and number of treatments. Thirty-eight eyes had CNV-related AMD and 13 eyes were non-AMD...

To assess whether and to what extent macro- and/or microstructural modifications are present in the brain of patients with selective central visual loss due to a juvenile macular degeneration, Stargardt's disease (STGD), taking advantage of the complementary information provided by voxel-based morphometry (VBM) and diffusion tensor imaging (DTI). Eighteen patients with clinical and molecular diagnosis of STGD related to ABCA4 mutations and 23 normally sighted volunteers of comparable age and sex were enrolled. Structural T1-weighted (T1w) volumes, for brain tissue volume assessment by segmentation, and DTI, for the investigation of diffusivity parameters via a tract-based spatial statistics (TBSS) procedure, were acquired at 3 Tesla in all subjects. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA), biomicroscopy, ophthalmoscopy, electroretinography (ERG), microperimetry, and optical coherence tomography (OCT). Correlatio...

We investigated sera from elderly subjects with and without age-related macular degeneration (AMD) for presence of autoantibodies (AAbs) against human macular antigens and characterized their identity. Sera were collected from participants in the Age-Related Maculopathy Ancillary (ARMA) Study, a cross-sectional investigation ancillary to the Health ABC Study, enriched with participants from the general population. The resulting sample (mean age: 79.2±3.9 years old) included subjects with early to advanced AMD (n = 131) and controls (n = 231). Sera were tested by Western blots for immunoreactive bands against human donor macular tissue homogenates. Immunoreactive bands were identified and graded, and odds ratios (OR) calculated. Based on these findings, sera were immunoprecipitated, and subjected to 2D gel electrophoresis (GE). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to identify the targets recognized by circulating AAbs seen on 2D-GE, followed by ELISAs wi...

Two cataract-free-zone projects, one in Brazil and the other in Peru, were designed to provide surgery to all those who need and want it within a defined geographic area. In-home visual acuity screening was accepted by three-fourths of the enumerated population aged 50 years or more. Those with reduced bilateral visual acuity were referred to a community health post for ophthalmic examination. Among those diagnosed as bilaterally blind (-< 20/200), comprising 5% of the screened population, two-thirds were thought to be blind from cataract. Because of other ocular pathology and general health conditions, surgery was not indicated for 30-50%. Two-thirds of those recommended for out-patient surgery accepted. Motivational efforts to convince the refusers were uniformly unsuccessful. The average age of those accepting and those refusing surgery was in the mid-seventies. Those already aphakic were 7-8 years younger. Post-operative acuity was -> 20/50 for only one-half of those operated. A significant number of cases had previously undetected macular degeneration and other causes of decreased vision. These projects have given increased attention to cataract blindness and the need for further operational research to develop effective methods for its control using outpatient surgery.

PURPOSE: To evaluate the safety and efficacy of phacoemulsification, intraocular lens (IOL) implantation, and a single intravitreal injection of bevacizumab in patients with coexisting visually significant cataract and subfoveal neovascularization due to age-related macular degeneration.

The aim of this study was investigate the association between complement Factor H polymorphism (Y402H) and age-related macular degeneration (AMD) in Brazilian patients. Methods: Patients with AMD aged 50 or more and age-matched healthy controls were enrolled in the study. Genomic DNA was isolated from leucocytes of patients and controls; the Y402H polymorphism of complement Factor H gene (CFH) was determined by polymerase chain reaction directed sequencing. Results: The frequency of 1277C allele of Factor H was 56.30% in patients with AMD compared with 36.51% in controls (p-value = 0.001). The genotypic distribution differed significantly between the two groups (1277CC 36.98%, 1277CT 38.65% and 1277TT 24.37% for AMD group; 1277CC 13.16%, 1277CT 46.71% and 1277TT 40.13% for controls, p-value = 0.001). The odds ratio for patients with AMD carrying only one 1277C allele was 1.36 and for those carrying two 1277C alleles was 4.63, when compared to the control group. Conclusions: These results suggest the Y402H polymorphism of CFH is a risk factor to the development of AMD in Brazilian patients. This is in accordance with findings from the majority of previous study population in Europe and North American.

Age-related macular degeneration (AMD) is the most frequent cause of irreversible blindness in the elderly in developed countries. Our previous studies implicated activation of complement in the formation of drusen, the hallmark lesion of AMD. Here, we show that factor H (HF1), the major inhibitor of the alternative complement pathway, accumulates within drusen and is synthesized by the retinal pigmented epithelium. Because previous linkage analyses identified chromosome 1q25-32, which harbors the factor H gene (HF1/CFH), as an AMD susceptibility locus, we analyzed HF1 for genetic variation in two independent cohorts comprised of ≈900 AMD cases and 400 matched controls. We found association of eight common HF1 SNPs with AMD; two common missense variants exhibit highly significant associations (I62V, χ2 = 26.1 and P = 3.2 × 10-7 and Y402H, χ2 = 54.4 and P = 1.6 × 10-13). Haplotype analysis reveals that multiple HF1 variants confer elevated or reduced risk of AMD. One common at-risk haplotype is present at a frequency of 50% in AMD cases and 29% in controls [odds ratio (OR) = 2.46, 95% confidence interval (1.95-3.11)]. Homozygotes for this haplotype account for 24% of cases and 8% of controls [OR = 3.51, 95% confidence interval (2.13-5.78)]. Several protective haplotypes are also identified (OR = 0.44-0.55), further implicating HF1 function in the pathogenetic mechanisms underlying AMD. We propose that genetic variation in a regulator of the alternative complement pathway, when combined with a triggering event, such as infection, underlie a major proportion of AMD in the human population.

To evaluate the efficacy of photobiomodulation (PBM) treatment for patients with dry age-related macular degeneration (AMD). Assessments on 42 eyes with dry AMD (age related eye disease study (AREDS) 2-4) were conducted. Multiwavelength light emitting diode (LED) light comprising of yellow (590 nm), red (670 nm) and near-infrared (790 nm) bandwidths was applied to subjects&#39; eyes for a treatment course of 3 weeks. Outcome measures were changes in best-corrected visual acuity (BCVA), contrast sensitivity (CS), drusen volume and central drusen thickness. Significant improvement in mean BCVA of 5.90 letters (p &lt; 0.001) was seen on completion of the 3-week treatment and 5.14 letters (p &lt; 0.001) after 3 months. Contrast sensitivity improved significantly (log unit improvement of 0.11 (p = 0.02) at 3 weeks and 3 months (log unit improvement of 0.16 (p = 0.02) at three cycles per degree. Drusen volume decreased by 0.024 mm(3) (p &lt; 0.001) and central drusen thickness was signifi...

A multiple-unit artificial retina c hipset (MARC) system t o b enefit t he visually impaired is presented. The rehabilitative device replaces the functionality of defective photoreceptors within p atients s uffering from Retinal Pigmentosa (RP) and Age- Related Macular Degeneration (AMD). The c omponents of the MARC system are characterized, from t he extraocular video camera, v ideo processing chip, and RF generator and p rimary coil, to the intraocular secondary coil, rectifier and regulator, MARC processing and demultiplexing chips, and the electrode array. The fabrication and testing of the first three generation MARC VLSI chips are summarized. The novel RF data protocol t ransfer via RF is outlined, and the c hip&#x27;s decoding circuitry is characterized. A synthesis of the e ngineering, b iological, medical, and p hysical research is offered within the presentation of methods and means for the overall design engineering, po wering, bond ing, p ackaging, and h ermetic sealing ...

for the Age-related Eye Disease Study 2 Ancillary Spectral Domain Optical Coherence Tomography Study Group* Purpose: Drusen and migrating retinal pigment epithelium have been associated with hyperreflective foci (HF) detected by spectral-domain optical coherence tomography (SD-OCT). This study sought to quantify the change in intraretinal HF distribution and its correlation with age-related macular degeneration (AMD) disease progression.

Age-related macular degeneration is the principal cause of registered legal blindness among those aged over 65 in the United States, western Europe, Australia, and Japan. Despite intensive research, the precise etiology of molecular events that underlie age-related macular degeneration is poorly understood. However, investigations on parallel fronts are addressing this prevalent public health problem. Sophisticated biochemical and biophysical techniques have refined our understanding of the pathobiology of drusen, geographic atrophy, and retinal pigment epithelial detachments. Epidemiological identification of risk factors has facilitated an intelligent search for underlying mechanisms and fueled clinical investigation of behavior modification. Gene searches have not only brought us to the cusp of identifying the culpable gene loci in age-related macular degeneration, but also localized genes responsible for other macular dystrophies. Recent and ongoing investigations, often cued by tumor biology, have revealed an important role for various growth factors, particularly in the neovascular form of the condition. Transgenic and knockout studies have provided important mechanistic insights into the development of choroidal neovascularization, the principal cause of vision loss in age-related macular degeneration. This in turn has culminated in preclinical and clinical trials of directed molecular interventions. 293, 2003. Ć 2003 by Elsevier Inc. All rights reserved.) Key words. age-related macular degeneration • choroidal neovascularization • drusen • macular dystrophies

To assess the effects of a single 100-mg dose of sildenafil citrate on visual function in men with early-stage age-related macular degeneration. Randomized double-blind placebo-controlled clinical trial. Nine men (mean age 71 years, range 59-85 years) with early-stage (minimal visual impairment and large drusen in the macula) age-related macular degeneration and 20/40 or better-corrected visual acuity in at least one eye were prospectively randomized to receive either placebo or sildenafil citrate (Viagra; Pfizer Inc, New York, New York) 100 mg as a single oral dose. After 7-14 days, they received the alternate treatment. Subjects underwent visual acuity, Amsler grid, color discrimination (D15), traffic light, Humphrey perimetry, and photo-stress testing in each eye before and at specific intervals within 8 hours after dosing. Compared with placebo, no pattern of errors were evident in any visual function test following sildenafil administration. No statistically or clinically relevant changes from baseline were observed in visual acuity, Humphrey perimetry (corrected pattern standard deviation), D15 color discrimination, or photo-stress tests. No clinically relevant changes were observed in the Amsler grid or traffic light tests. Sildenafil treatment was associated with transient mild or moderate headache, flushing, and rhinitis. There were no visual adverse events spontaneously reported to the investigator. A single 100-mg dose of sildenafil was well tolerated and produced no acute visual effects or exacerbation of preexisting visual impairment in nine men with early-stage age-related macular degeneration.

Aims A National Screening Programme for diabetic eye disease in the UK is in development. We propose a grading and early disease management protocol to detect sight-threatening diabetic retinopathy and any retinopathy, which will allow precise quality assurance at all steps while minimizing false-positive referral to the hospital eye service.

To assess the incremental cost and cost-effectiveness of continuous and discontinuous regimens of bevacizumab (Avastin) and ranibizumab (Lucentis) for neovascular age-related macular degeneration (nAMD) from a UK National Health Service (NHS) perspective.

The color vision of nine patients aged from 13 to 52 years with Stargardt's disease was studied with the following tests: Standard Pseudoisochromatic Plates part 2 (SSP2), Farnsworth-Munsell 100 hue test (FM100), Nagel (red-green) anomaloscope and Besan~on (blue) anomalometer. At the beginning of the disease, a very slight defect in red-green color vision could be demonstrated. Later, a distinct acquired red (pseudo-protanomalous) defect in the Nagel anomaloscope and an abnormal error score in the FM100 test were observed. In advanced stages, the red defect became stronger (scotopization) and the FM100 test showed a red-green axis. In the course of the disease, a blue defect with the SPP2 plates and with the Besan~on anomalometer could also be found. The visual acuities of the patients had a significant correlation with the matching ranges of the Rayleigh equation and the Moreland equation. The duration of the disease did not show any correlation with the color vision tests.

Contemporary data for causes of vision impairment and blindness form an important basis of recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modelling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020. In this systematic review and meta-analysis, we analysed published and unpublished population-based data for the causes of vision impairment and blindness from 1980 to 2014. We identified population-based studies published before July 8, 2014, by searching online databases with no language restrictions (MEDLINE from Jan 1, 1946, and Embase from Jan 1, 1974, and the WHO Library Database). We fitted a series of regression models to estimate the proportion of moderate or severe vision impairment (defined as presenting visual acuity of &lt;6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity of &lt;3/60 in the better eye) by cause, age...

The recent immunological detection of extraordinarily high levels of carboxyethylpyrrole (CEP) modifications of proteins from the retinas of individuals with age-related macular degeneration provided presumptive evidence for the involvement of docosahexaenoate-derived oxidatively truncated phospholipids in retinal pathology. To facilitate the in vivo detection and characterization of the chemistry and biological activities of these postulated naturally occurring molecules, a family of oxidatively truncated phospholipids was prepared by total syntheses. Their formation in oxidation reactions of a docosahexaenoate ester of 2-lysophosphatidylcholine (DHA-PC) was also demonstrated. Free radical-induced oxidative cleavage of DHA-PC promoted by myeloperoxidase or copper ions generates similar mixtures of these phospholipids. The most abundant products were 1-palmitoyl-2-succinoyl-sn-glycero-3-phosphatidylcholine (4.7%) and 2-(6-carboxy-4-oxohex-5-enoyl)-1-palmitoylsn-glycero-3-phosphatidylcholine (1.7%). Both of these oxidatively truncated phospholipids are homologues of biologically active arachidonate-derived phospholipids. A minor product from DHA-PC, 2-(4-hydroxy-7-oxohept-5-enoyl)-1-palmitoyl-sn-glycero-3-phosphatidylcholine (0.4% yield), reacted with the -amino group of a peptide lysyl residue to produce a CEP derivative in 0.7% yield. These observations support the previous conclusion, based on immunological evidence, that CEPs are generated by the reaction of an oxidatively truncated phospholipid with proteins in the retina and further indicate that CEP protein modifications probably represent only a tiny fraction of the products generated upon oxidative damage of DHA-PC in photoreceptor disk membranes.

Introduction: The Virtual Retinal Display (VRD) is a new technology for creating visual images. It was developed at the Human Interface Technology Laboratory (HIT Lab) by Dr. Thomas A. Furness III. The VRD creates images by scanning low power laser light directly onto the retina. This special method results in images that are bright, high contrast and high resolution. In

Age-related macular degeneration (AMD) is the leading cause of vision loss and blindness among older adults in the USA and throughout the developed world. Etiological research suggests that AMD is a complex disease, caused by the actions and interactions of multiple genes and environmental factors. Familial aggregation studies, twin studies, and segregation analyses have provided strong evidence for the heritability

Detachment of the retinal pigment epithelium is a prominent feature of many chorioretinal disease processes, the most prevalent of which is age-related macular degeneration (AMD). Detachment of the retinal pigment epithelium may or may not be associated with choroidal neovascularization and may be caused by different types of pathogenesis, each associated with distinct angiographic features, natural course, visual prognosis, and response to treatment. The phrase ''detachment of the retinal pigment epithelium'' is used quite often, not always in the correct association and with no clear differentiation between its various types. It is important to identify the specific nature of detachment of the retinal pigment epithelium, and to establish an accurate diagnosis and treatment plan. Therefore, we present a review of the existing types of detachment of the retinal pigment epithelium with what we propose as being appropriate nomenclature and classification, and potential treatment recommendations. (Surv Ophthalmol 52:227--243, 2007. Ó 2007 Elsevier Inc. All rights reserved.)