Risk Factors for Age-Related Maculopathy

Age-related maculopathy (ARM) is the leading cause of blindness in the elderly. Although beneficial therapeutic strategies have recently begun to emerge, much remains unclear regarding the etiopathogenesis of this disorder. Epidemiologic studies have enhanced our understanding of ARM, but the data, often conflicting, has led to difficulties with drawing firm conclusions with respect to risk for this condition. As a consequence, we saw a need to assimilate the published findings with respect to risk factors for ARM, through a review of the literature appraising results from published cross-sectional studies, prospective cohort studies, case series, and case control studies investigating risk for this condition. Our review shows that, to date, and across a spectrum of epidemiologic study designs, only age, cigarette smoking, and family history of ARM have been consistently demonstrated to represent risk for this condition. In addition, genetic studies have recently implicated many genes in the pathogenesis of age-related maculopathy, including Complement Factor H, PLEKHA 1, and LOC387715/HTRA1, demonstrating that environmental and genetic factors are important for the development of ARM suggesting that gene-environment interaction plays an important role in the pathogenesis of this condition

Errata

Errata to the author's paper "Note on Level-Debt-Service Municipal Bidding", in Management Science, Vol. 13, No. 3 (November 1966).

Apolipoprotein E genotype is associated with macular pigment optical density.

PURPOSE: Age-related macular degeneration (AMD) is the most common cause of blindness in older people in developed countries, and risk factors for this condition may be classified as genetic and environmental. Apolipoprotein E is putatively involved in the transport of the macular pigment (MP) carotenoids lutein (L) and zeaxanthin (Z) in serum and may also influence retinal capture of these compounds. This study was designed to investigate the relationship between macular pigment optical density (MPOD) and ApoE genotype. METHODS: This was a cross-sectional study of 302 healthy adult subjects. Dietary intake of L and Z was assessed by food frequency questionnaire, and MPOD was measured by customized heterochromatic flicker photometry. Serum L and Z were measured by HPLC. ApoE genotyping was performed by direct polymerase chain reaction amplification and DNA nucleotide sequencing from peripheral blood. RESULTS: Genotype data were available on 300 of the 302 (99.3%) subjects. The mean (+/- SD) age of the subjects in this study was 47.89 +/- 11.05 (range, 21-66) years. Subjects were classed into one of three ApoE genotype groups, as follows: group 1, epsilon2epsilon2 or epsilon2epsilon3; group 2, epsilon3epsilon3; group 3, epsilon2epsilon4 or epsilon3epsilon4 or epsilon4epsilon4. All three groups were statistically comparable in terms of age, sex, body mass index, cigarette smoking, and dietary and serum levels of L and Z. There was a statistically significant association between ApoE genotype and MPOD. Subjects who had at least one epsilon4 allele had a higher MPOD across the macula than subjects without this allele (group 1 MPOD area, 0.70 +/- 0.40; group 2 MPOD area, 0.67 +/- 0.42; group 3 MPOD area, 0.85 +/- 0.46; one-way ANOVA, P = 0.014. CONCLUSIONS: These results suggest that ApoE genotype status is associated with MPOD. This association may explain, at least in part, the putative protective effect of the epsilon4 allele for AMD and is consistent with the view that apolipoprotein profile influences the transport and/or retinal capture of circulating L and/or Z

Surgical and visual outcomes following exchange of opacified Hydroview® intraocular lenses

AIM: To report the clinical and surgical outcomes following exchange of opacified Hydroview® intraocular lenses (IOLs), and to relate the final visual and anatomic results to clinical and surgical variables. METHODS: This is a prospective study of seventy‐three eyes that underwent exchange of opacified Hydroview® IOLs in Waterford Regional Hospital, Ireland. Preoperative, intraoperative and postoperative details were recorded. RESULTS: This study comprised 73 eyes of 71 consecutive patients undergoing IOL exchange, performed at mean (±SD) intervals of 36.64 (±9.9) months following the primary cataract surgery. The mean (±SE) follow‐up following the exchange procedure was 13 (±1) months (range: 1–45 months). The secondary IOL was placed in the capsular bag, in the sulcus, and in the anterior chamber in 22 (30.1%), 24 (32.9%) and 27 (37%) cases, respectively. The IOL exchange procedure was uneventful in 36 eyes (49.3%), whereas intraoperative events such as posterior capsule rupture, vitreous loss and zonular dehiscence were seen in the remainder (50.7%). Following the IOL exchange procedure, a significant improvement in best corrected visual acuity (BCVA) was noted at one and at three months, and at the final visit (Wilcoxon signed ranks test: p<0.001, p = 0.006, and p<0.001, respectively). Following exclusion of eyes with visually consequential ocular comorbidity, a better final BCVA was noted among those eyes where the secondary IOL was placed in the capsular bag or in the sulcus when compared with placement of the secondary IOL in the anterior chamber (IOL in the bag or sulcus: 26 eyes (35.6%), median (IQR) final BCVA: 0.2 (0.10–0.40); IOL in the anterior chamber: 19 eyes (26.02%), median (IQR) final BCVA: 0.5 (0.20–0.60); Mann Whitney U Test: p = 0.004). CONCLUSION: IOL exchange is a technically challenging, but visually rewarding procedure. However, placement of the secondary IOL in the anterior chamber is associated with a poorer visual outcome when compared with placement of the secondary IOL in the sulcus or in the capsular bag

Augmentation of Macular Pigment Following Implantation of Blue Light-Filtering Introcular Lenses at the Time of Cataract Surgery

PURPOSE. (Photo)-oxidative stress is believed to play a role in the pathogenesis of age-related macular degeneration (AMD), with the threshold for retinal damage being lowest for short-wavelength (blue) light. Macular pigment (MP), consisting of the carotenoids lutein (L), zeaxanthin (Z) and meso-Z, has a maximum absorption at 460 nm and protects the retina from (photo)-oxidative injury. This study was designed to investigate whether the blue light–filtering properties of the Alcon AcrySof Natural intraocular lens (ANIOL) implanted during cataract surgery affects MP optical density (MPOD). METHODS. Forty-two patients scheduled for cataract surgery were recruited for the study. These patients all had a preoperative best corrected visual acuity rating (BCVAR) of at least 0.5 (logMAR) in the study eye. The patients were randomized to have either the standard Alcon AcrySof three-piece acrylic intraocular lens (AIOL) (controls) or the ANIOL implanted at the time of cataract surgery. The spatial profile of MPOD (i.e., at 0.25°, 0.5°, 1.0°, and 1.75° eccentricity) was measured with customized heterochromatic flicker photometry (cHFP) 1 week before and 1 week after surgery, and at 3, 6, and 12 months after surgery. Serum concentrations of L and Z were also measured at each study visit. RESULTS. There was a highly significant and positive correlation between all MPODs (e.g., at 0.25°) recorded 1 week before and after surgery in eyes with an AIOL implant (r = 0.915, P 0.05). There were no significant time or lens effects observed for serum L over the study period (P > 0.05). There was a significant time effect for serum Z over the study period (P 0.05). CONCLUSIONS. Customized HFP can reliably measure the MPOD spatial profile in the presence of lens opacity, and cataract surgery does not artifactually alter MPOD readings. This study also provides evidence that implanting an IOL that filters blue light is associated with augmentation of MPOD in the absence of raised serum concentrations of L and Z. However, further and longitudinal study is needed to assess whether the observed increase in MPOD after implantation of blue-filtering IOLs is associated with reduced risk of AMD development and/or progression