Pupil Size in Outdoor Environments

Calculation of solar ultraviolet influx in the eye considering the field of view and pupillary dilation due to sunglasses

The media and even the specialized literature report that the ultraviolet (UV) protection for sunglasses is critical, on the grounds that sunglasses can have a counter effect if the lenses do not provide adequate UV protection. They reason that the primary and natural mechanism is that the pupil of the eye contracts to attenuate radiation and protect the inner eye under sun exposure. Therefore, if dark lenses do not provide appropriate UV protection, there is an increased UV incidence in the inner eye due to pupil dilation, which enhances the adverse effects and impacts the ocular tissues more severely than in situations without UV protection. However, no existing literature properly quantified or supported this argument. In this work, the influx of solar UV throughout the pupil of the eye was calculated in two situations: when a person wear sunglasses and when he/she does not. In both situations, the pupil dilation and the field of view (squint) were considered with their dependence on the brightness of the ambient, calculated by modeling the solar irradiation. Finally, it was assessed whether sunglasses with poor UV protection actually increase the UV influx throughout the dilated pupil compared to the non-dilated pupil. A set of 214 sunglasses lenses were tested and the results show that pupil dilation does not play an important role in the UV influx throughout the pupil. It was observed that the FOV is the main player, surpassing the pupil size contribution by up to 314.3%, disproving the common explanation. Because of the major role of the FOV, our results show that sunglasses with UV-A protection below 86% may have a slight potential to increase hazards to the eye compared to not wearing sunglasses at all. These results can have direct impact on sunglasses standards regarding the UV protection linked to the category of the lenses.

Congenital aniridia beyond black eyes: From phenotype and novel genetic mechanisms to innovative therapeutic approaches

Congenital PAX6-aniridia, initially characterized by the absence of the iris, has progressively been shown to be associated with other developmental ocular abnormalities and systemic features making congenital aniridia a complex syndromic disorder rather than a simple isolated disease of the iris. Moreover, foveal hypoplasia is now recognized as a more frequent feature than complete iris hypoplasia and a major visual prognosis determinant, reversing the classical clinical picture of this disease. Conversely, iris malformation is also a feature of various anterior segment dysgenesis disorders caused by PAX6-related developmental genes, adding a level of genetic complexity for accurate molecular diagnosis of aniridia. Therefore, the clinical recognition and differential genetic diagnosis of PAX6-related aniridia has been revealed to be much more challenging than initially thought, and still remains under-investigated. Here, we update specific clinical features of aniridia, with emphasis on their genotype correlations, as well as provide new knowledge regarding the PAX6 gene and its mutational spectrum, and highlight the beneficial utility of clinically implementing targeted Next-Generation Sequencing combined with Whole-Genome Sequencing to increase the genetic diagnostic yield of aniridia. We also present new molecular mechanisms underlying aniridia and aniridia-like phenotypes. Finally, we discuss the appropriate medical and surgical management of aniridic eyes, as well as innovative therapeutic options. Altogether, these combined clinical-genetic approaches will help to accelerate time to diagnosis, provide better determination of the disease prognosis and management, and confirm eligibility for future clinical trials or genetic-specific therapies.

Geometrical scaling of the developing eye and photoreceptors and a possible relation to emmetropization and myopia

In this study the role of vergence in relation to age-dependent scaling of eye and photoreceptor parameters is studied. The underlying hypothesis is that the size and packing of outer segments is matched to the pupil size outdoors in photopic conditions. Vergence is analysed in relation to the angular spectrum of waves being incident using age-dependent data from the literature for the actual geometry and density of photoreceptor cones and rods. This approach is used to derive simple relations for the angular confinement of light along outer segments. Only with a small photopic pupil can leakage and crosstalk for both central and peripheral photoreceptors be entirely ruled out due to the finite length of the outer segments. A limiting 3 mm pupil size is found for children in the school age. Larger pupils will increase the likelihood of leakage and crosstalk that may therefore impact on emmetropization. This study has introduced a new paradigm in myopia research by considering vergence across the 3-D retina as being matched to the angular spectrum of waves being incident from the eye pupil. Emmetropization suggests a delicate balance between photoreceptor outer segment length and density in relation to pupil size. Only when balanced will leakage and crosstalk between adjacent outer segments be effectively suppressed thereby ensuring the highest possible light capture efficiency by visual pigments in the outer segments whether an image is formed on the retina or not.

Predicting zonular strength based on maximum pupillary mydriasis in patients with pseudoexfoliation syndrome

Pseudoexfoliation Syndrome (PXFS) is considered a systemic disorder with significant ocular manifestations ranging from corneal decompensation, non-dilating pupil, zonular weakness, subluxated lens, and glaucoma. PXFS may lead to increased complications during routine cataract surgery. Zonular dialysis is a common complication during or after cataract surgery in such patients. However, not all patients with pseudoexfoliation are at a higher risk. We hypothesize that there is an inverse correlation between the maximum pupillary dilation and the degree of zonular disintegration. Available evidence supporting the hypothesis is discussed. We propose a new clinical classification for predicting the zonular strength based on the maximum pupillary dilation so that it can serve as a guide to identify PXFS patients who are at high risk of complications during or after cataract surgery.