Myopia Control Dose Delivered to Treated Eyes by a Dual Focus Myopia Control Contact Lens

SIGNIFICANCE Consistent with closed-loop models of regulated eye growth, a successful dual-focus (DF) myopia-control contact lens focused a significant proportion of light anterior to the central retina in eyes of treated children viewing near and distant targets. PURPOSE This study examined the optical impact of a DF contact lens during near viewing in a sample of habitual DF lens wearing children. METHODS Seventeen myopic children aged 14 to 18 years who had completed 3 or 6 years of treatment with a DF contact lens (MiSight 1 Day; CooperVision, Inc., San Ramon, CA) were recruited and fit bilaterally with the DF and a single-vision (Proclear 1 Day; CooperVision, Inc.) contact lens. Right eye wavefronts were measured using a pyramidal aberrometer (Osiris; CSO, Florence, Italy) while children accommodated binocularly to high-contrast letter stimuli at five target vergences. Wavefront error data were used to compute pupil maps of refractive state. RESULTS During near viewing, children wearing single-vision lenses accommodated on average to achieve approximate focus in the pupil center but, because of combined accommodative lag and negative spherical aberration, experienced up to 2.00 D of hyperopic defocus in the pupil margins. With DF lenses, children accommodated similarly achieving approximate focus in the pupil center. When viewing three near distances (0.48, 0.31, and 0.23 m), the added +2.00 D within the DF lens treatment optics shifted the mean defocus from +0.75 to -1.00 D. The DF lens reduced the percentage of hyperopic defocus (≥+0.75 D) in the retinal image from 52 to 25% over these target distances, leading to an increase in myopic defocus (≤-0.50 D) from 17 to 42%. CONCLUSIONS The DF contact lens did not alter the accommodative behavior of children. The treatment optics introduced myopic defocus and decreased the amount of hyperopically defocused light in the retinal image

Prediction of Accommodative Optical Response in Young and Pre-Presbiopic Human Eyes Using Ultrasound Biomicroscopy

Purpose: Clinical accommodation testing involves measuring either the accommodative optical response (AOR) or the accommodative biometric changes in the ocular anterior segment. Currently, it is not possible to measure both with a single instrument. Measuring the AOR and the accommodative biometric changes are important for evaluating accommodation restoration concepts. The specific goals of this research are: 1) to perform automated, objective measurements of accommodative biometric changes from ultrasound biomicroscopy (UBM) images in young phakic eyes; 2) to measure the static AOR using a Grand Seiko (GS) autorefractor and infra-red photorefraction (PR) in young eyes and to predict the AOR from UBM measured biometric changes; 3) to measure the AOR using GS and PR and the biometric changes using UBM in pre-presbyopes to predict the AOR; 4) to calculate and correct the spatial and optical distortion in Visante optical coherence tomography corneal images; 5) to construct accommodative schematic eye models for individual eyes for each of the young and pre-presbyopic subjects and calculate refraction and AOR from the schematic eye models. Methods: Experiments were 1) Accommodative anterior segment biometric changes were measured in response to 0 D to 6 D accommodative stimuli in 1 D steps in 26 young human subjects using a 35 MHz UBM and an A-scan ultrasound. 2) Static AOR to the same stimulus demand were measured with GS and PR in the same group of young subjects. AOR was predicted from UBM measured biometry parameters using linear regression, 95% confidence intervals and 95% prediction intervals. 3) Static AOR to 0 D to maximal stimulus demand in at least 0.25 D steps was measured with GS and PR in 25 pre-presbyopic human subjects. Accommodative anterior segment biometric changes were measured using UBM and A-scan ultrasound. AOR was predicted from UBM measured biometry parameters as described in experiment 2. 4) Five contact lenses of known front and back surface radii of curvature and central thicknesses were imaged using the Visante to calculate spatial and optical distortion corrections which were then applied to corneal images captured from the young and pre-presbyopic subjects. 5) Ocular biometry parameters (Visante, A-scan and UBM) from Experiments 1, 3 and 4 in young and pre-presbyopic subjects were used to construct paraxial schematic eye models for each individual subject for each accommodative stimulus demand. Results: 1) Standard deviations of UBM measured parameters were smaller than A-scan measures. 2) Mean prediction errors of AOR using linear regression in young subjects for various biometry parameters ranged from 0.56 D to 0.91 D. 3) Mean prediction errors of AOR using linear regression in pre-presbyopic eyes ranged from 0.41 D to 0.62 D. 4) Root mean square (RMS) error of the power of the contact lens surfaces after distortion correction was 0.18 D for the front and 0.11 D for the back surfaces, respectively. 5) Mean ± SD of prediction errors of AOR from individual schematic eyes for the young and pre-presbyopic subjects were 0.50 ± 0.39 D and 0.50 ± 0.37 D, respectively. Conclusions: The results show: 1) the utility of automated image analysis to get accurate, rapid and objective measurements of anterior segment biometry from UBM images; 2) how spatial distortion in UBM images can be corrected to get accurate measurements and the ability of each UBM measured biometry parameter to predict the AOR; 3) how UBM, despite having low axial resolution, can predict AOR in pre-presbyopic eyes with low accommodative amplitudes; 4) how spatial and optical distortions in Visante images can be corrected to get accurate corneal biometry that can be used for schematic eye modeling; 5) how individual schematic eye predictions of the AOR are better than predictions using LR from individual UBM measured biometry parameters.Optometry, College o

Two-Year Follow-up of Necrotic Herpetic Retinopathy in a Renal Transplant Recipient

Visual disturbances are common in patients who received renal transplant. Visual acuity is reduced in 60% of renal transplant patients after 10-year posttransplant. The most common causes are cataracts, diabetic retinopathy, and hypertensive retinopathy. However, infectious causes of visual loss are rare and most commonly associated with cytomegalovirus and toxoplasmosis infections. Here, we report a 32-year-old male who developed visual loss 6 months after receiving a live-related kidney transplant. The patient had a history of varicella infection in the immediate posttransplant period. The visual loss was secondary to acute retinal necrosis probably secondary to a Varicella infection. This rare manifestation is even more unique in a posttransplant scenario which is usually associated with progressive outer retinal necrosis. The patient had developed irreversible visual loss secondary to the retinal necrosis. Here, we report this rare association as well as 2-year ophthalmological follow-up of this patient

Mucormycosis-Associated Colon Perforation in the Early Postrenal Transplant Period

The incidence of colon perforation in the posttransplant period is 1.3% based on various single-center studies. We report the case of a 32-year-old male, a known case of chronic kidney disease and end-stage renal disease who received a live-related ABO-compatible transplant. The patient was started on tacrolimus, mycophenolate mofetil, and steroids; no induction was given. The patient had a delayed graft function, and his creatinine was persistently high. Hence, a biopsy was done on postoperative day 4, which revealed an acute tubular injury with features of calcineurin inhibitor toxicity. His tacrolimus dose was reduced and his output improved until day 13, after which his renal function worsened. The repeat tacrolimus level was low. Hence, the patient was started on pulse steroids and discharged after the patient improved symptomatically (discharge creatinine: 2.1). The patient was readmitted 3 days after discharge with severe abdominal pain. The patient’s blood pressure was 90/30 mmHg; he was drowsy and tachypneic. His abdomen was distended. Computed tomography of the abdomen revealed pneumoperitoneum, and the patient was subjected to an explorative laparotomy. There was colonic perforation. The peritoneum and colon revealed multiple punched-out lesions and a right hemicolectomy was done. A biopsy revealed suppurative inflammation involving all three layers with multiple giant cells, and tissue staining revealed ribbon-like aseptate hyphae with 90° angulation suggestive of mucormycosis. The patient expired in the immediate postoperative period. The final diagnosis of mucormycosis-associated colon perforation was made. Only one such case has been reported previously

A Case of Posttransplant Recurrence of Focal Segmental Glomerulosclerosis with Donor-derived Immunoglobulin A Nephropathy and Banff IIA Acute Cell-mediated Rejection: A Therapeutic Challenge

Primary focal segmental glomerulosclerosis (FSGS) recurrence varies between 10% and 60% and is an important predictor of graft survival. Here, we report the case with a combination of recurrence of FSGS, acute cell-mediated rejection, and donor-derived immunoglobulin A (IgA) nephropathy which required treatment with plasmapheresis and antithymocyte globulin. This patient is an 18-year-old female whose native kidney disease was a biopsy-proven FSGS and underwent ABO compatible live-related renal transplant with her mother as a donor. No induction agents were given and the patient was put on triple immunosuppression with Calcineurin inhibitors (CNIs), Mycophenolate mofetil (MMF), and steroids. On postoperative Day 2, the patient developed nephrotic range proteinuria. A transplant kidney biopsy was done. Biopsy revealed acute cell-mediated rejection, Banff II A with i3, t3, ptc1, v1, and C4d negative. There was also an increase in mesangial cellularity with IgA 3+ and C3 1+ on immunofluorescence which is IgA nephropathy, likely donor derived. Electron microscopy revealed significant effacement of podocytes. CNI levels are adequate. Pulse methylprednisolone 5 doses given. The patient was given two sessions of plasmapheresis with albumin and a single dose of rabbit antithymocyte globulin (ATG) 1.5 mg/kg was given. Plasmapheresis was withheld in view of studies reporting the removal of ATG following plasmapheresis. There was a gradual worsening of renal function with peak serum creatinine of 9 mg/dL which required three sessions of hemodialysis. The second renal biopsy on Day 13 showed features of acute tubular injury with borderline changes suspicious of acute cell mediated rejection (ACMR)–i1, t1. Currently, the patient is on regular follow-up with normal renal function with urine polymerase chain reaction of 0.4. We report this case which presented with a puzzling combination of ACMR, possible recurrence of native disease, and likely donor-derived IgA nephropathy that provided us with challenges in management. Treatment protocols with optimal dosing strategies and assessing response to treatment in these situations are still unclear due to the lack of large randomized trials

Genomic designing for biotic stress resistance in sugarcane.

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