The aging human lens: structure, growth, and physiological behaviour

Proposed Role for Internal Lens Pressure as an Initiator of Age-Related Lens Protein Aggregation Diseases

The process that initiates lens stiffness evident in age-related lens protein aggregation diseases is thought to be mainly the result of oxidation. While oxidation is a major contributor, the exposure of lens proteins to physical stress over time increases susceptibility of lens proteins to oxidative damage, and this is believed to play a significant role in initiating these diseases. Accordingly, an overview of key physical stressors and molecular factors known to be implicated in the development of age-related lens protein aggregation diseases is presented, paying particular attention to the consequence of persistent increase in internal lens pressure.

The human lens: An antioxidant-dependent tissue revealed by the role of caffeine

Cataract is the leading cause of blindness worldwide and surgery is the only option to treat the disease. Although the surgery is considered to be relatively safe, complications may occur in a subset of patients and access to ophthalmic care may be limited. Due to a growing and ageing population, an increase in cataract prevalence is expected and its management will become a socioeconomic challenge. Hence, there is a need for an alternative to cataract surgery. It is well known that oxidative stress is one of the main pathological processes leading to the generation of the disease. Antioxidant supplementation may, therefore, be a strategy to delay or to prevent the progression of cataract. Caffeine is a widely consumed high-potency antioxidant and may be of interest for the prevention of the disease. This review aims to give an overview of the anatomy and function of the lens, its antioxidant and reactive oxygen species (ROS) composition, and the role of oxidative stress in cataractogenesis. Also, the pharmacokinetics and -dynamics of caffeine will be described and the literature will be reviewed to give an overview of its anti-cataract potential and its possible role in the prevention of the disease.

Association of alkaptonuria and low dose nitisinone therapy with cataract formation in a large cohort of patients

Homogentisic acid (HGA) lowering, disease modifying off‐label nitisinone therapy has been used in the United Kingdom National Alkaptonuria Centre (NAC) since 2012. This study evaluated the serendipitous observation of cataract in a large cohort of patients with the very rare disease alkaptonuria (AKU), over a 5‐year period. Patients with AKU who attended the NAC since 2012. Standard physical examination and ocular assessment, including photographs of the crystalline lens were taken before commencement of nitisinone 2 mg daily and annually over 5 years. Photographs were randomised and graded by two independent observers using the WHO cataract classification. AKU patients who did not receive nitisinone were included as a control group. HGA was measured on acidified 24 h urine (u‐HGA₂₄) and HGA and tyrosine in fasting acidified serum samples (sHGA, sTYR) at each visit. Patients without suitable lens images were excluded. Cataract (mean grade 1) was noted at baseline in 47 out of 62 (76%) with a mean (SD) age of 44 (14) years. In nitisinone‐treated patients, there were significant increases in the mean grade of nuclear (0.18, p < 0.01) and cortical (0.38, p < 0.01) lens opacities over the mean duration of 4.93 years of the study. Worsening of the nuclear cataract and cortical lens opacities by at least 1 grade was noted in 14 out of 46 (30%) and 11 out of 46 (24%) patients, respectively. There is an increased prevalence and progression of cataract in AKU and a possible association of nitisinone with cataract progression.

Near infrared spectroscopy reveals instability in retinal mitochondrial metabolism and haemodynamics with blue light exposure at environmental levels

Blue light (~400-470 nm) is considered potentially detrimental to the retina but is present in natural environmental light. Mitochondrial density is highest in the retina, and they exhibit a prominent optical absorption around 420 nm arising from the Soret band of their porphyrins, including in cytochrome-c-oxidase in their respiratory chain. We examine the impact of continuous 420 nm at environmental energy levels on retinal mitochondrial metabolism and haemodynamics in vivo in real time using broadband near-infrared spectroscopy. One hour environmental exposure to 420 nm induces significant metabolic instability in retinal mitochondria and blood signals, which continues for up to 1 h post blue exposure. Porphyrins are important in mitochondrial adenosine triphosphate (ATP) production and cytochrome-c-oxidase is a key part of the electron transport chain through which this is achieved. Hence, environmental 420 nm likely restricts respiration and ATP production that may impact on retinal function.

Simulation of defects, flexibility and rupture in biopolymer networks

Networks of biopolymers occur often in nature, and are vulnerable to damage over time. In this work, a coarse grained model of collagen IV molecules is applied in a 2D hexagonal network and the mechanisms by which these networks can rupture are explored. The networks are stretched linearly in order to study their structural limits and mechanism of rupture over timescale of up to 100 μs. Metrics are developed to track the damage networks suffer over time, and qualitatively analyse ruptures that occur. Further simulations repeatedly stretch the networks sinusoidally to mimic the in vivo strains. Defects of increasing levels of complexity are introduced into an ordered network, and their effect on the rupturing behaviour of the biopolymer networks studied. The effect of introducing holes of varying size in the network, as well as strips of finite width to mimic surgical damage are studied. These demonstrate the importance of the flexibility of the networks to preventing damage.

We use a coarse grained polymer model and a simple graph representation to introduce defects into a biopolymer network, then cause them to rupture.

Self assembly of model polymers into biological random networks

The properties of biological networks, such as those found in the ocular lens capsule, are difficult to study without simplified models. Model polymers are developed, inspired by "worm-like" curve models, that are shown to spontaneously self assemble to form networks similar to those observed experimentally in biological systems. These highly simplified coarse-grained models allow the self assembly process to be studied on near-realistic time-scales. Metrics are developed (using a polygon-based framework) which are useful for describing simulated networks and can also be applied to images of real networks. These metrics are used to show the range of control that the computational polymer model has over the networks, including the polygon structure and short range order. The structure of the simulated networks are compared to previous simulation work and microscope images of real networks. The network structure is shown to be a function of the interaction strengths, cooling rates and external pressure. In addition, "pre-tangled" network structures are introduced and shown to significantly influence the subsequent network structure. The network structures obtained fit into a region of the network landscape effectively inaccessible to random (entropically-driven) networks but which are occupied by experimentally-derived configurations.

Laser-induced autofluorescence assisted by multivariate techniques discriminates a cataractous lens from healthy lens tissues of Sprague-Dawley rats

Laser-induced autofluorescence (LIAF), combined with multivariate techniques, has been used to discriminate a cataractous lens from healthy lens tissues. In this study, 405 nm and 445 nm were used as excitation sources to induce the autofluorescence. Results show higher autofluorescence intensity in cataractous lens tissues than in healthy ones. Cataractous lens tissues show a red shift of 0.9 nm and 1.2 nm at 405 nm and 445 nm excitations, respectively. Using principal component analysis (PCA), three principal components (PCs) gave more than 99% variability for both 405 nm and 445 nm excitation sources. Based on the three PCs, Fisher's linear discriminant model was developed. An accuracy of 100% was obtained in classifying the lens tissues using Fisher's linear discriminant analysis (FLDA). The LIAF technique assisted by PCA and FLDA may be used for objective discrimination of cataractous lens from healthy lens tissues of Sprague-Dawley rats.

In vivo SS-OCT imaging of crystalline lens sutures

We demonstrate in vivo three-dimensional (3-D) visualization of crystalline lens sutures in healthy eyes using swept source optical coherence tomography (SS-OCT). Volumetric data sets of the crystalline lenses were acquired and processed to obtain enhanced contrast projection images and to extract suture patterns in both anterior and posterior lens. The results presented different types of the sutures including Y-sutures, simple and complex star sutures. Age-related changes in suture arrangement were characterized quantitatively. Crystalline lens suture imaging with SS-OCT might be a useful tool in fundamental studies on development and ageing of human lens.

Practical Method for Salt Intake Follow-Up in Hypertensive Patients

Background: Obese and hypertensive (HT) patients should restrict salt intake. In excessive salt intake, ouabain-like compounds inhibit Na/K-ATPase (Na+ pump), which increases intracellular Na+ and Ca2+. Ca2+ has a vasotonic effect on arteries and an inotropic effect on the heart and may cause cortical opacities in the lens. To our knowledge, there is still no practical method for salt intake follow-up. This study tested whether salt intake follow-up can be performed with the help of opacity tracking. Methods: In total, 400 HT patients (age 30-69 years) with cortical lens opacities were included in the study. Changes in opacities based on biomicroscopic examination at baseline and after 3 months were recorded digitally with the help of imaging software. Salt intake at 1 and 3 months was evaluated with a 24-hr urine Na assay. Changes in opacities were compared among group 1 (∼50% salt reduction), group 2 (∼10% salt reduction), and group 3 (∼15% salt increase). Results: Age and changes in small opacity diameter (SOD) and large opacity diameter (LOD) were the most important determinants of the 50% salt reduction in the third month. For changes in LOD, the sensitivity was 88.5% [confidence interval (95% CI) 85.2-91.7] and specificity was 95.5% (95% CI 93.1-98.7) for predicting a 50% salt restriction during the 3-month period. For SOD, the values were 85% (95% CI 82.5-87) and 95% (95% CI 92.3-97.5), respectively. Conclusions: Opacity changes are a practical method for predicting a 50% reduction in salt intake over a 3-month period in 30- to 59-year-old HT patients.

Salt, Hypertension, and the Lens

BACKGROUND

Salt is important in the pathogenesis of hypertension (HT). Salt-sensitive hypertension (SSH) accounts for about half of all HT cases. In SSH, sodium/potassium adenosine triphosphatase (Na⁺/K⁺-ATPase) activity is impaired. Impaired Na⁺/K⁺-ATPase activity in the lens epithelium results in cortical opacities in the peripheral equator of the lens. We investigated the sensitivity of cortical lens opacities in detecting SSH.

METHODS

The study included 191 SSH and 159 non-SSH, salt-resistant HT (SRH) patients (350 HT patients total), aged 40-80 years. One hundred twenty-four sex- and age-matched patients without a HT diagnosis made up the control group. Daily salt intake of all groups was calculated from 24-hr urinary Na excretion. SSH was diagnosed when the difference in mean arterial blood pressure values obtained during high- and low-Na diets was ≥10%. Non-SSH, SRH was diagnosed when the difference was <10%.Two researchers examined the presence of cortical lens opacities biomicroscopically using the diffuse, direct, Scheimpflug, and retroillumination from fundus methods.

RESULTS

Total lens opacity was predictive of SSH among all cases (P < 0.001), with a sensitivity and specificity of 75.4% [95% confidence interval (CI): 68.6-81.3] and 83.6% (95% CI: 77.0-89.0), respectively. Its positive and negative predictive values were 84.7% (95% CI: 79.4-88.8) and 73.9% (95% CI: 68.6-78.5), respectively.

CONCLUSIONS

Lens opacities can be used as a finding that can be easily observed in the detection of SSH and excess salt intake.

Metabolic signature of the aging eye in mice

Aging is a major risk factor for age-related ocular diseases including age-related macular degeneration in the retina and retinal pigment epithelium (RPE), cataracts in the lens, glaucoma in the optic nerve, and dry eye syndrome in the cornea. We used targeted metabolomics to analyze metabolites from young (6 weeks) and old (73 weeks) eyes in C57 BL6/J mice. Old mice had diminished electroretinogram responses and decreased number of photoreceptors in their retinas. Among the 297 detected metabolites, 45-114 metabolites are significantly altered in aged eye tissues, mostly in the neuronal tissues (retina and optic nerve) and less in cornea, RPE/choroid, and lens. We noted that changes of metabolites in mitochondrial metabolism and glucose metabolism are common features in the aged retina, RPE/choroid, and optic nerve. The aging retina, cornea, and optic nerve also share similar changes in Nicotinamide adenine dinucleotide (NAD), 1-methylnicotinamides, 3-methylhistidine, and other methylated metabolites. Metabolites in taurine metabolism are strikingly influenced by aging in the cornea and lens. In conclusion, the aging eye has both common and tissue-specific metabolic signatures. These changes may be attributed to dysregulated mitochondrial metabolism, reprogrammed glucose metabolism and impaired methylation in the aging eye. Our findings provide biochemical insights into the mechanisms of age-related ocular changes.

Activation of a Ca2+-dependent cation conductance with properties of TRPM2 by reactive oxygen species in lens epithelial cells

Ion channels are crucial for maintenance of ion homeostasis and transparency of the lens. The lens epithelium is the metabolically and electrophysiologically active cell type providing nutrients, ions and water to the lens fiber cells. Ca2+-dependent non-selective ion channels seem to play an important role for ion homeostasis. The aim of the study was to identify and characterize Ca2+- and reactive oxygen species (ROS)-dependent non-selective cation channels in human lens epithelial cells. RT-PCR revealed gene expression of the Ca2+-activated non-selective cation channels TRPC3, TRPM2, TRPM4 and Ano6 in both primary lens epithelial cells and the cell line HLE-B3, whereas TRPM5 mRNA was only found in HLE-B3 cells. Using whole-cell patch-clamp technique, ionomycin evoked non-selective cation currents with linear current-voltage relationship in both cell types. The current was decreased by flufenamic acid (FFA), 2-APB, 9-phenanthrol and miconazole, but insensitive to DIDS, ruthenium red, and intracellularly applied spermine. H2O2 evoked a comparable current, abolished by FFA. TRPM2 protein expression in HLE-B3 cells was confirmed by means of immunocytochemistry and western blot. In summary, we conclude that lens epithelial cells functionally express Ca2+- and H2O2-activated non-selective cation channels with properties of TRPM2.

Macular Carotenoid Supplementation Improves Visual Performance, Sleep Quality, and Adverse Physical Symptoms in Those with High Screen Time Exposure

The dramatic rise in the use of smartphones, tablets, and laptop computers over the past decade has raised concerns about potentially deleterious health effects of increased "screen time" (ST) and associated short-wavelength (blue) light exposure. We determined baseline associations and effects of 6 months' supplementation with the macular carotenoids (MC) lutein, zeaxanthin, and mesozeaxanthin on the blue-absorbing macular pigment (MP) and measures of sleep quality, visual performance, and physical indicators of excessive ST. Forty-eight healthy young adults with at least 6 h of daily near-field ST exposure participated in this placebo-controlled trial. Visual performance measures included contrast sensitivity, critical flicker fusion, disability glare, and photostress recovery. Physical indicators of excessive screen time and sleep quality were assessed via questionnaire. MP optical density (MPOD) was assessed via heterochromatic flicker photometry. At baseline, MPOD was correlated significantly with all visual performance measures (p < 0.05 for all). MC supplementation (24 mg daily) yielded significant improvement in MPOD, overall sleep quality, headache frequency, eye strain, eye fatigue, and all visual performance measures, versus placebo (p < 0.05 for all). Increased MPOD significantly improves visual performance and, in turn, improves several undesirable physical outcomes associated with excessive ST. The improvement in sleep quality was not directly related to increases in MPOD, and may be due to systemic reduction in oxidative stress and inflammation.

Useful Prediction of Phacodynamics by Scheimpflug Lens Densitometry in Patients over Age 70

PURPOSE

To evaluate the relationship between lens density using the Scheimpflug system and phacodynamics in nuclear cataracts as related to patient age.

METHODS

In 262 eyes with nuclear cataracts, the objective lens density was determined by Pentacam Nucleus Staging (PNS) software while subjective grading was achieved using the Lens Opacities Classification System III (LOCS III).

RESULTS

Overall, cumulated dissipated energy (CDE) had a positive correlation with Scheimpflug lens density and LOCS III nuclear scores. When analysis was done by patient age, LOCS III nuclear scores and Scheimpflug lens density had a positive correlation with CDE for patients in all age groups. Of interest, patients >70 years old showed a higher correlation coefficient (r) with Scheimpflug lens density than with LOCS III nuclear score.

CONCLUSIONS

Scheimpflug lens densitometry may be more useful for predicting phacodynamics than LOCS III scores in nuclear cataract patients, especially in old age (>70 years).

Age-related cataract and drug therapy: opportunities and challenges for topical antioxidant delivery to the lens

Objectives

The search for anticataract drugs has been continuing for decades; some treatments no longer exist but antioxidants are still of much interest.

Key findings

The primary function of the human lens, along with the cornea, is to refract light so that it is correctly focused onto the retina for optimum image quality. With age, the human lens undergoes morphological, biochemical and physical changes leading to opacification. Age-related or senile cataract is one of the main causes of visual impairment in the elderly; given the lack of access to surgical treatment in many parts of the world, cataract remains a major cause of sight loss. Surgical treatment is the only means of treating cataract; this approach, however, has limitations and complications.

Summary

This review discusses the anatomy and physiology of the lens and the changes that are understood to occur with ageing and cataract formation to identify potential areas for effective therapeutic intervention. Experimental techniques and agents used to induce cataract in animal models, the advantages and disadvantages of potential pharmacological treatments specific barriers to delivery of exogenous antioxidants to the lens and the prospects for future research are discussed.

[Posterior capsule opacification]

Posterior capsule opacification (PCO) is the most common complication after cataract surgery, with an incidence of 30%. It tends to be considered a normal event in the natural history of cataract surgery. Better understanding of its pathophysiology and advancement of intraocular lens material and design along with the improvement of phacoemulsification technique have contributed to decrease the incidence of PCO. Although treatment by Nd: YAG laser posterior capsulotomy is quick and non-invasive, the opening of the posterior capsule may be associated with numerous complications. Prevention remains the best measure for controlling this pathology.

Cumulative probability and risk analysis for Nd:YAG laser capsulotomy

AIM: To estimate the cumulative probability of Nd:YAG capsulotomy at a teaching institution and evaluate secondary risk factors.

METHODS: The records of all patients who underwent phacoemulsification with intraocular lens (IOL) placement between 2005-2010 were retrospectively reviewed. The cumulative probability of Nd:YAG capsulotomy (capsulotomy) was calculated using Kaplan-Meier survival analysis and secondary risk factors were evaluated using the Cox proportional hazards regression model.

RESULTS: One thousand three hundred and fifty four charts were reviewed. A total of 70 capsulotomies were performed. The mean follow-up was 19.4 mo (standard deviation 17 mo). The cumulative probability of capsulotomy was 4% at 1 year, 5% at 2 years, and 9% at 3 years. Multivariate analysis demonstrated an increased risk with younger age (HR = 1.03, CI 1.01-1.05, P = 0.007), placement of sulcus IOL (HR = 2.57, CI 1.32-4.99, P = 0.005), ocular trauma (HR = 2.34, CI 1.13-4.83, P = 0.02), and phacoemulsification by a more experienced surgeon (HR = 4.32, CI 1.89-9.87, P = 0.001).

CONCLUSION: Cumulative probability of capsulotomy was lower than previously reported. Posterior capsule opacification was strongly associated with younger age and factors associated with high-risk cataract surgery. Surgeon awareness to the risk factors that correlate with posterior capsulotomy may allow for more thorough pre-operative disclosure and enhance patient satisfaction.

Identification of a nonselective cation channel in isolated lens fiber cells that is activated by cell shrinkage

The initiation of lens cataract has long been associated with the development of a membrane "leak" in lens fiber cells that depolarizes the lens intracellular potential and elevates intracellular Na(+) and Ca(2+) concentrations. It has been proposed that the leak observed in cataractous lenses is due to the activation of a nonselective cation (NSC) conductance in the normal electrically tight fiber cells. Studies of the membrane properties of isolated fiber cells using the patch-clamp technique have demonstrated a differentiation-dependent shift in membrane permeability from K(+)-dominated in epithelial and short fiber cells toward larger contributions from anion and NSC conductances as fiber cells elongate. In this study, the NSC conductances in elongating lens fiber cells are demonstrated to be due to at least two distinct classes: a Gd(3+)-sensitive, mechanosensitive channel whose blockade is essential for obtaining viable isolated fiber cells, and a second Gd(3+)-insensitive, La(3+)-sensitive conductance that appears to be activated by cell shrinkage. This second conductance was eliminated by the replacement of extracellular Na(+) with the impermeant cation N-methyl-d-glucamine and was potentiated by both hypertonic stress and isosmotic cell shrinkage evoked by the replacement of extracellular Cl(-) with the impermeant anion gluconate. This additional cation conductance may play a role in normal lens physiology by mediating regulatory volume increase under osmotic or other physiological challenges. Since the inappropriate activation of NSC channels is implicated in the initiation of lens cataract, they represent potential targets for the development of novel anticataract therapies.

The role of the lens in pigment dispersion syndrome

In patients with pigment dispersion syndrome, changes of the iris configuration can occur with accommodation, blinking, miotics, and following a laser iridotomy. This observational case series looks at the changes following cataract surgery in 3 eyes with signs of pigment dispersion, symptomatic cataracts, and no previous laser iridotomy that were imaged with optical coherence tomography. The iris was concave posteriorly in dark and light lighting conditions, and became flat following an uncomplicated cataract operation. This may be explained by the elimination of iridolenticular contact, which contributes to the mechanism of reverse pupil block. These iris changes suggest the lens plays an important role in the mechanism of pigment dispersion.

Lens aging: effects of crystallins

The primary function of the eye lens is to focus light on the retina. The major proteins in the lens--alpha, beta, and gamma-crystallins--are constantly subjected to age-related changes such as oxidation, deamidation, truncation, glycation, and methylation. Such age-related modifications are cumulative and affect crystallin structure and function. With time, the modified crystallins aggregate, causing the lens to increasingly scatter light on the retina instead of focusing light on it and causing the lens to lose its transparency gradually and become opaque. Age-related lens opacity, or cataract, is the major cause of blindness worldwide. We review deamidation, and glycation that occur in the lenses during aging keeping in mind the structural and functional changes that these modifications bring about in the proteins. In addition, we review proteolysis and discuss recent observations on how crystallin fragments generated in vivo, through their anti-chaperone activity may cause crystallin aggregation in aging lenses. We also review hyperbaric oxygen treatment induced guinea pig and 'humanized' ascorbate transporting mouse models as suitable options for studies on age-related changes in lens proteins.

Australia and New Zealand survey of glaucoma practice patterns

BACKGROUND

To evaluate current glaucoma practices among consultant ophthalmologists in Australia and New Zealand.

METHODS

A postal questionnaire of 25 questions regarding current glaucoma practices and the use of antimetabolites and steroids in trabeculectomy surgery was sent to all practising Australian and New Zealand Fellows of the Royal Australian and New Zealand College of Ophthalmologists (as of June 2005). This paper looked at glaucoma practice patterns and consisted of questions on demographic data, the definition of glaucoma, intraocular pressure measurements, central corneal thickness, gonioscopy, optic disc assessment, preferred first-line glaucoma medications and laser trabeculoplasty.

RESULTS

The overall response rate was 78% (627 out of 808). Ninety-one per cent stated that they managed glaucoma of which 12% considered themselves as a glaucoma subspecialist. Eighty-two per cent of ophthalmologists defined glaucoma as an optic neuropathy and 66% measured the intraocular pressure themselves. Pachymetry was routinely measured by 37%. When performing gonioscopy, 56% did this (more than 50% of the time) but only 13% repeated it. Fifty-eight per cent assessed the optic disc by objective means and 18% used this to follow glaucoma patients. Eighty-two per cent preferred a prostaglandin analogue as first-line treatment of primary open angle glaucoma and 79% did less than 10 argon laser trabeculoplasties in 2004.

CONCLUSIONS

This survey shows a wide range of glaucoma practice patterns among Australian and New Zealand ophthalmologists. Gonioscopy (initial and repeat) and objective assessment of the optic disc were poorly done.

Ageing changes in the eye

Ageing changes occur in all the structures of the eye causing varied effects. This article attempts to review the parameters of what is considered within the "normal limits" of ageing so as to be able to distinguish those conditions from true disease processes. Improving understanding of the ageing changes will help understand some of the problems that the ageing population faces.

Regulation of potassium transport in human lens epithelial cells

The major K influx pathways and their response to thiol modification by N-ethylmaleimide (NEM) and protein kinase and phosphatase inhibitors were characterized in human lens epithelial B3 (HLE-B3) cells with Rb as K congener. Ouabain (0.1 mM) and bumetanide (5 microM) discriminated between the Na/K pump ( approximately 35% of total Rb influx) and Na-K-2Cl cotransport (NKCC) ( approximately 50%). Cl-replacement with nitrate or sulfamate revealed <10% residual [ouabain+bumetanide]-insensitive K-Cl cotransport (KCC). At 0.3-0.5 mM, NEM stimulated the Na/K pump by 2-fold independent of external Na, KCC between 2 and 4-fold, and abolished approximately 90% of NKCC. Calyculin-A, a serine/threonine protein phosphatase-1 inhibitor, did not affect NKCC but inhibited KCC, whereas 10 microM staurosporine, a serine/threonine kinase inhibitor, abolished NKCC, and stimulated KCC only when followed by NEM treatment. The tyrosine-kinase inhibitor genistein, at concentrations >100 microM, activated the Na/K pump and abolished NKCC but did not affect KCC. The data suggest at least partial inverse regulation of KCC and NKCC in HLE-B3 cells by signaling cascades involving serine, threonine and tyrosine phosphorylation/dephosphorylation equilibria.

Surface modification of silicone intraocular implants to inhibit cell proliferation

Photo-cross-linkable polymers bearing cinnamic, sulfonate, and carboxylate groups were synthesized by radical polymerization leading to randomly distributed copolymers. These polymers were used to coat silicone intraocular lenses in order to reduce posterior capsule opacification, also named "secondary cataract". We previously demonstrated that polymers containing both carboxylate and sulfonate groups inhibit cell proliferation, and formulations with the ratio R = COO-/(COO- + SO3-) equal to 0.64 provided the highest inhibitory effect. Ionic polymers with this formulation were synthesized to contain a monomer with pendant siloxane groups in order to get compatibility with the silicone matrix of the intraocular lenses. Anchorage of the ionic polymer at the surface of the silicone implant was achieved by a cycloaddition reaction of the photosensitive groups according to two options. These modified silicone surfaces grafted onto intraocular lenses were shown to inhibit cell proliferation to 60%.

Vitamin E supplementation and cataract: randomized controlled trial

OBJECTIVE

To determine whether treatment with vitamin E (500 IU daily) reduces either the incidence or rate of progression of age-related cataracts.

DESIGN

A prospective, randomized, double-masked, placebo-controlled clinical trial entitled the Vitamin E, Cataract and Age-Related Maculopathy Trial.

PARTICIPANTS

Of 1906 screened volunteers, 1193 eligible subjects with early or no cataract, aged 55 to 80 years, were enrolled and followed up for 4 years.

INTERVENTION

Subjects were assigned randomly to receive either 500 IU of natural vitamin E in soybean oil encapsulated in gelatin or a placebo with an identical appearance.

MAIN OUTCOME MEASURES

The incidence and progression rates of age-related cataract were assessed annually with both clinical lens opacity gradings and computerized analysis of Scheimpflug and retroillumination digital lens images obtained with a Nidek EAS-1000 lens camera. The analysis was undertaken using data from the eye with the more advanced opacity for each type of cataract separately and for any cataract changes in each individual.

RESULTS

Overall, 87% of the study population completed the 4 years of follow-up, with 74% of the vitamin E group and 76% of the placebo group continuing on their randomized treatment allocation throughout this time. For cortical cataract, the 4-year cumulative incidence rate was 4.5% among those randomized to vitamin E and 4.8% among those randomized to placebo (P = 0.87). For nuclear cataract, the corresponding rates were 12.9% and 12.1% (P = 0.77). For posterior subcapsular cataract, the rates were 1.7% and 3.5% (P = 0.08), whereas for any of these forms of cataract, they were 17.1% and 16.7%, respectively. Progression of cortical cataract was seen in 16.7% of the vitamin E group and 18.4% of the placebo group (P = 0.76). Corresponding rates for nuclear cataract were 11.4% and 11.9% (P = 0.84), whereas those of any cataract were 16.5% and 16.7%, respectively. There was no difference in the rate of cataract extraction between the 2 groups (P = 0.87). Lens characteristics of the participants withdrawn from the randomized medications were not different from those who continued.

CONCLUSIONS

Vitamin E given for 4 years at a dose of 500 IU daily did not reduce the incidence of or progression of nuclear, cortical, or posterior subcapsular cataracts. These findings do not support the use of vitamin E to prevent the development or to slow the progression of age-related cataracts.

Autofluorescence methods in ophthalmology

An overview of the fluorophores of the eye, the methods used to measure ocular fluorescence, and the existing or ready-to-market instrumentation for the early diagnosis and monitoring of ophthalmic pathologies is presented. Emphasis is given to the impact that a more detailed knowledge of the fluorophores of the eye, their age and pathology relationship, and the considerable technology-driven progress in optical devices and components has had on the development of new compact yet powerful instruments for population screening and for patient follow-ups, using fluorometry alone or in combination with other optical techniques such as light scattering.

Modulating fibroblast cell proliferation with functionalized poly(methyl methacrylate) based copolymers: chemical composition and monomer distribution effect

Poly(methyl methacrylate)-based terpolymers bearing sulfonate and carboxylate groups have been synthesized by radical copolymerization leading to polymers with random distributions of ionic monomer units. Fibroblast cells were seeded on terpolymers of various molar compositions of ionic groups. Kinetics of the cell proliferation were examined and systematically compared to the nonfunctionalized control polymer, poly(methyl methacrylate). Modulation of cell proliferation was observed on 15% ionic monomer content copolymers of various compositions (R = COO(-)/(COO(-) + SO(3)(-)) and varies from 0 to 1). The inhibition percentage of cell proliferation calculated for each polymer by comparison to the cell proliferation on the control was plotted against R and gave a maximum value for R close to 0.55. Copolymers with ionic group contents higher or lower than 15% exhibit inhibition percentages fitting with those previously observed for the same R values, showing that the hydrophilic properties are not sufficient to explain the modulation effect of this material toward cells. Moreover, for each polymer tested, cells, even if inhibited in growth, were shown to be viable, indicating that the synthesized terpolymers exhibit cytostatic properties excluding any cytotoxic effect. Such polymers may be used for the fabrication of biocompatible intraocular lenses and prevent secondary cataract.

The development of in vitro biocompatibility tests for the evaluation of intraocular biomaterials

Recent developments in ocular implant technology require the in vitro evaluation of ocular compatibility in early stage development programs. This requires an understanding and appreciation of the biological interactions which occur in the ocular environment and their relevance with respect to the clinical complications associated with surgical implantation of devices. This paper describes the development of a series of clinically reflective in vitro assays for assessing the potential ocular compatibility of novel intraocular lens materials. Staphylococcus epidermidis attachment, fibrinogen adsorption, mouse embryo fibroblast 3T3 adhesion and proliferation, primary rabbit lens cell adhesion, human peripheral blood macrophage adhesion and granulocyte activation tests were employed to evaluate two widely used intraocular biomaterials poly(methyl methacrylate) (PMMA) and silicone, and a novel biomimetic phosphorylcholine-based coating (PC). The performance of these materials in the in vitro assays was compared to their ability to reduce postoperative inflammation in vivo in a rabbit model. The results demonstrated that the in vitro assays described here are predictive of in vivo ocular compatibility. These assays offer a more relevant means of assessing the ocular compatibility of biomaterials than those presently required by the authorities for regulatory approval of medical devices and implants.

Cataracts in systemic diseases and syndromes

In the past year, harmony has developed among diverse areas of research in cataractogenesis. A number of epidemiologic studies have identified new, or strengthened the role of previous, risk factors in the development of cataract. Age, tobacco smoking, alcohol consumption, and inhaled corticosteroids have been implicated. Clinical observation of cataract in diseases such as cystic fibrosis, atopic dermatitis, Alzheimer's disease, and mitochondrial cytopathy have led to hypotheses of formation. The basic science research has, in some cases, given support to the clinical hypotheses, especially with respect to the role of estrogens and protein condensation in cataract as well as other systemic diseases. Although oxidative stress continues to be the leading proposed mechanism of cataractogenesis, genetic mechanisms are gaining increasing popularity. Finally, the results of previously contraindicated surgical management of cataract in the setting of advanced diabetic ocular disease and age-related macular disease are highlighted.