Presbyopia and the aging eye: Existing refractive approaches and their potential impact on dry eye signs and symptoms

Every part of the human body is subject to aging, including the eye. Increased prevalence of dry eye disease with age is widely acknowledged: aging threatens ocular surface homeostasis, altering the normal functioning of the lacrimal functional unit and potentially leading to signs and symptoms of dry eye. Parallelly, two additional degenerative processes take place within the crystalline lens, leading to presbyopia and cataractogenesis. With continuously increasing life expectancies both conditions are expected to impact society further. Correction strategies for presbyopia and cataracts either directly or indirectly challenge ocular surface additionally. On one hand, contact lens presbyopic correction has gained many adepts in recent years. Contact lenses disturb the normal structure of the tear film and interact negatively with the ocular surface eventually initiating the closed loop of inflammation vicious circle, similarly to dry eye. On the other hand, cataract and corneal refractive surgeries sever corneal nerves and disrupt corneal epithelium and ocular surface, further inducing dryness. In the present review we address the invasive nature of the different contact lens and refractive surgery correction strategies. In addition, we deeply discuss how contact lenses, cataract surgery and various types of corneal refractive surgical strategies play a role in inducing/worsening signs and symptoms of dryness in an aging population

Artiflex Toric Phakic Intraocular Lens Implantation in Congenital Nystagmus

Case: A 44-year-old woman with congenital nystagmus and myopic astigmatism in both eyes who was submitted to phakic intraocular lens (pIOL) implantation. Methods: Full ophthalmologic examination including refractive status, corrected (CDVA) and uncorrected (UCVA) monocular and binocular visual acuities, ocular motility, slit-lamp evaluation, tonometry and fundoscopy before and after implantation of toric pIOLs (Artiflex; Ophtec BV, The Netherlands) in both eyes. Results: Preoperative logMAR CDVA were 0.699 and 0.420 in the right and left eye, respectively. Three months after surgery, logMAR UCVA were 0.398 and 0.182, reaching binocular logMAR UCVA of 0.132. There were no changes in nystagmus characteristics after surgery. Conclusions: pIOL implantation may be a safe and suitable treatment to correct high refractive errors in patients with congenital nystagmus. Significant improvement in CDVA and UCVA can be achieved

Response of the aging eye to first day of modern material contact lens wear

Objectives: To investigate the ocular surface of an aged population wearing a daily disposable contact lens over their first day of wear. Methods: Forty eyes from forty presbyopic subjects were fitted a daily CL (Delefilcon A). Tear osmolarity, tear meniscus area (TMA) and ocular surface aberrations (total higher order root means square (RMS)) were assessed at baseline (t0), at 20 minutes (t1) and after 8 hours (t2) of wear. Fluorescein corneal and conjunctival staining and tear break up time (TBUT) were performed at t0 and t2. Results: No statistically significant changes were found between t0, t1 and t2 for TMA, and between t0 and t2 for fluorescein corneal and conjunctival staining. TBUT worsened by the end of the day from 10.4±0.4 seconds t0 to 9.0±0.3 seconds t2 (P <0.05). Osmolarity showed significant changes between t0 306.9±2.3 mOsm/L and t1 312.4±2.4 mOsmol/L (P = 0.02), but returned to baseline values at 8 hours (310.40±2.26 mOsm/L; P = 0.09). Total higher order root means square (RMS) showed significant changes between t0 0.38±0.02 μm and t1 0.61±0.04 μm (P ≤ 0.001) and between t0 and t2 0.64±0.41 μm (P ≤ 0.001). Conclusions: Delefilcon A may induce measures changes (osmolarity and TBUT values) in a presbyopic population, however TMA and vital staining were maintained at the baseline level over the day

Retinal straylight and light distortion phenomena in normal and post-LASIK eyes

Purpose To assess the relationship between measures of light distortion and retinal straylight in normal and post- LASIK subjects. Design Cross-sectional, non-randomized, masked observational case series Setting Clinica Oftalmologica Novovision, Madrid, Spain. Methods Thirty eyes from 30 healthy subjects (mean age 33.9±8.3 years old; mean spherical equivalent (MSE) −2.06± 1.40 D) and thirty six eyes from thirty six refractive surgery patients (mean age 36.1±7.7 years old; mean preop MSE −3.43±2.23 D) were examined with the Starlights and the C-Quant straylightmeter in a case-control study. Results The age of both treated and control groups was not statistically different (p>0.05). Statistically significant differences between controls and post-LASIK eyes were found for luminous distortion index (LDI), but not for retinal straylight. Correlation analysis yielded significant correlation between retinal straylight Log(s) values and BCVA measures (r=0.379, p=0.002). Control subjects showed significant correlation between MSE and retinal straylight Log(s) values (r=-0.650, p<0.001), while post-LASIK eyes showed a significant correlation between LDI and Log(s) values (r= 0.338, p=0.044) and between Log(s) values and BCVA (r= 0.460, p=0.005). Correlation between measures obtained by both methods was higher after LASIK than in control eyes, although values were quite scattered in any case. Conclusion Light distortion phenomena and retinal straylight measures are correlated in both normal and postsurgical eyes. Both parameters are increased in LASIK subjects compared to control non-operated subjects.This research was supported in part by a Universitat de Valencia Research Grant (#UV-AE-08-2291#) and a Ministry of Science and Innovation of Spain (#JC2008-00078) to Alejandro Cervino, from the Fundacao para a Ciencia e Tecnologia of Portugal through a Grant to Jose Manuel Gonzalez-Meijome (#PTDC/SAU-BEB/098392/2008#), and from the Ministry of Science and Innovation of Spain (Red Tematica de Investigacion en Optometria, SAF2008-01114-E)

Mindfulness y experiencias psicóticas en estudiantes universitarios

The study of the relation between psychotic experiences and mindfulness in the general population is linked to research into factors of risk and protection against the development of a psychotic disorder. This study looks into the presence of psychotic experiences in a sample of university students and whether there is any variation according to gender. It also analyzes the predictive and discriminant relation of mindfulness with these experiences. The sample consisted of 526 university students (72.8% women) with a mean age of 21.39 years (SD = 3.53). The results showed the presence of psychotic experiences with differing levels of intensity, with variations according to gender, and an inverse relationship between mindfulness and psychotic experiences. Results indicated that students with high scores in psychotic experiences had lower scores in mindfulness. Our findings imply that mindfulness may be a factor of protection against psychotic experiences and its training may have a role to play in the development and implementation of preventive and early intervention programs in risk groups in the general and clinical population.El estudio de la relación entre experiencias psicóticas y mindfulness en la población general se asocia con la investigación de factores de riesgo y protección frente al desarrollo de un trastorno psicótico. Con este estudio se pretende examinar la presencia de experiencias psicóticas en una muestra de estudiantes universitarios y sus diferencias según el sexo, así como analizar la relación predictiva y discriminante de mindfulness con estas experiencias. Los participantes fueron 526 estudiantes universitarios (72.8% mujeres) con una media de edad de 21.39 años (DT = 3.53). Los resultados mostraron la presencia de experiencias psicóticas con diferentes niveles de intensidad, diferencias según el sexo en las mismas, y una relación inversa entre mindfulness y las experiencias psicóticas, y se encontró que las personas con altas puntuaciones en experiencias psicóticas contaron con menores puntuaciones en mindfulness. Estos resultados suponen que mindfulness puede ser un factor de protección en la experimentación de experiencias psicóticas y su entrenamiento puede ser útil para implementación y desarrollo de programas preventivos y de intervención precoz en grupos de riesgo en población general y clínica

Nonsurgical Procedures for Keratoconus Management

Objectives. To describe the past 20 years’ correction modalities for keratoconus and their visual outcomes and possible complications. Methods. A review of the published literature related to the visual outcomes and possible complications in the context of keratoconus management using nonsurgical procedures for the last 20 years (glasses and contact lenses) was performed. Original articles that reported the outcome of any correction modalities of keratoconus management were reviewed. Results. The most nonsurgical procedure used on keratoconus management is the contact lens fitting. Soft contact lenses and soft toric contact lenses, rigid gas-permeable contact lenses, piggyback contact lens system, hybrid contact lenses, and scleral and corneoscleral contact lenses form the contemporary range of available lens types for keratoconus management with contact lenses. All of them try to restore the vision, improve the quality of life, and delay surgical procedures in patients with this disease. Complications are derived from the intolerance of using contact lens, and the use of each depends on keratoconus severity. Conclusions. In the context of nonsurgical procedures, the use of contact lenses for the management of keratoconic patients represents a good alternative to restore vision and improve the quality of live in this population

Measurements of anterior chamber depth, white-to-white distance, anterior chamber angle, and pupil diameter using two Scheimpflug imaging devices

Purpose: To compare the ocular anterior chamber depth, white-to-white distance, anterior chamber angle, and pupil diameter, as measured with two different Scheimpflug imaging devices. Methods: This transversal study included 80 right eyes from 80 subjects aged from 20 to 40 years. Their spherical equivalents ranged from -4.25 to +1.00 diopters (D). Each eye's anterior chamber depth, white-to-white distance, anterior chamber angle, and pupil diameter, were measured for far vision using both the Galilei G4 (double Scheimpflug camera) and the Pentacam HR (single Scheimpflug camera) systems. Results: Mean anterior chamber depths were calculated as 3.12 ± 0.23 mm and 3.19 ± 0.24 mm when measured with the Galilei G4 and the Pentacam HR, respectively. The mean white-to-white distance measured was 11.84 ± 0.31 mm and 11.90 ± 0.43 mm when measured with the Galilei G4 and the Pentacam HR, respectively. Mean pupil diameters were measured as 3.22 ± 0.58 mm and 3.22 ± 0.52 mm when measured with the Galilei G4 and the Pentacam HR, respectively. Finally, the mean anterior chamber angle was 34.30 ± 2.86 degrees when it was measured with the Galilei G4, and 39.26 ± 2.85 degrees when measured with the Pentacam HR. A comparative analysis revealed that the Galilei G4 yielded a significantly lower (P<0.05) measurement for the anterior chamber depth, anterior chamber angle, and pupil diameter, than the Pentacam HR system. Comparable values (P>0.05) for both devices were obtained for the white-to-white distance measurements. Conclusion: The Galilei G4 and Pentacam HR Scheimpflug systems cannot be used interchangeably because they produce significant measurement differences

Comparison of the influence of corneo-scleral and scleral lenses on ocular surface and tear film metrics in a presbyopic population

PURPOSE: To assess and compare the effect of the corneo-scleral lenses (C-ScL) and scleral lenses (ScL) on tear film parameters and central corneal thickness (CCT) in healthy presbyopic subjects. METHODS: Thirty subjects wore two contact lenses (CLs), randomly assigned, of neutral power, but of different diameters, 12.7mm (C-ScL) and 18mm (ScL) and being equal in the others parameters: material (HS100) and centre thickness (0.29mm). At baseline, 20min after insertion and at 8h, the tear meniscus area (TMA) and CCT was measured (with optical coherence tomography) as well as tear osmolarity. RESULTS: TMA revealed statistical differences for both lenses at 20min (p<0.001), and also at 8h (p=0.003), being greater for the C-ScL. CCT showed statistical differences for both lenses at 20min (p=0.002), and also at 8h (p=0.001), being lower for the C-ScL. Osmolarity did not reveal statistical differences at 20min (p=0.29), while it was statistically different at 8h (p=0.03), being lower for the C-ScL. CONCLUSIONS: C-ScL lead to a lesser reduction in the TMA and a lower induced hypoxic stress than the ScL. Osmolarity levels remained within normal values across the day with no clinical difference between lenses. Both designs can represent a good optical platform for correcting presbyopia as well as protecting the ocular surface by vaulting the cornea

Systemic, environmental and lifestyle risk factors for dry eye disease in a mediterranean caucasian population

Objectives: To assess systemic, environmental and lifestyle risk factors for dry eye disease (DED) in a Mediterranean Caucasian population. Methods: A cross-sectional study was performed on 120 Caucasian participants aged between 18 and 89 years (47.0 ± 22.8 years). Medical history, information regarding environmental conditions and lifestyle, Ocular Surface Disease Index, Dry Eye Questionnaire-5, non-Invasive (Oculus Keratograph 5 M) breakup time, tear film osmolarity and ocular surface staining parameters were assessed in a single clinical session to allow DED diagnosis based on the guidelines of the Tear Film and Ocular Surface Society Dry Eye Workshop II Diagnostic Methodology Report. A multivariate logistic regression model was constructed including those variables with a p-value less than 0.15 in the univariate analysis. Results: A prevalence of 57.7 % for DED was found. No age differences were found between those with and without DED (U = 1886.5, p = 0.243). Nevertheless, the DED group had more females (X2 = 7.033, p = 0.008). The univariate logistic regression identified as potential risk factors for DED the following: female sex, sleep hours per day, menopause, anxiety, systemic rheumatologic disease, use of anxiolytics, daily medication, ocular surgery, poor diet quality, more ultra-processed food in diet, not drinking caffeine and hours of exposure to air conditioning per day. Multivariate logistic regression revealed that hours of sleep per day, menopause and use of anxiolytics were independently associated with DED (p ≤ 0.026 for all). Conclusions: DED is associated with systemic, environmental and lifestyle risk factors. These findings are useful to identify potentially modifiable risk factors, in addition to conventional treatments for DED