Alcohol and the Eye

Evaluatıon of the protective role of melatonın ın methanol ınduced optıc neuropathy

PURPOSE

To investigate the effects of intraperitoneal melatonin administration on the optic nerve and retina following acute methanol exposure.

MATERIALS AND METHODS

Twenty-four female albino Wistar rats weighing 200-300 g and aged between 3 and 6 months were utilized. The rats were divided into three groups, each consisting of eight rats: healthy control (C), methanol (M), and methanol + melatonin (MM) groups. Initially, rats in groups M and MM were administered intraperitoneal methotrexate at a dose of 0.3 mg/kg. One week later, the same groups were orally given methanol at a concentration of 20% and a dose of 3 g/kg to induce methanol toxicity. To ensure survival, four hours after oral methanol administration, ethanol was orally administered at a concentration of 20% and a dose of 0.5 g/kg. Additionally, starting from the next day, the MM group received intraperitoneal melatonin at a dose of 20 mg/kg/day for 14 days. On the 14th day, rats were sacrificed, and their eyes, including the optic nerves, were enucleated for histopathological examinations. Myelin basic protein (MBP), retinal ganglion cell (RGC), glial cell degeneration and optic nerve thickness were evaluated.

RESULTS

The experiment was completed with a total of twenty-four rats, with each group consisting of eight rats. When evaluating RGC, glial cell degeneration, and optic nerve thickness, the results for Group MM were significantly better than those for Group M (p < 0.0001, p < 0.0001, p < 0.0001, respectively). There was no significant difference between Group MM and Group C, which was not subjected to alcohol intoxication (p: 0.89, p: 0.82, p: 0.77, respectively). There was no significant difference in MBP values ​​between the groups (p: 0.44, p: 0.17, p: 0.80, respectively).

CONCLUSION

Intraperitoneal administration of melatonin has a significant positive effect on the structure of the retina and optic nerve resulting from methanol exposure. Melatonin should be considered in future studies as a potential therapy for methanol-induced toxic optic neuropathy.

The retinal age gap: an affordable and highly accessible biomarker for population-wide disease screening across the globe

Traditional biomarkers, such as those obtained from blood tests, are essential for early disease detection, improving health outcomes and reducing healthcare costs. However, they often involve invasive procedures, specialized laboratory equipment or special handling of biospecimens. The retinal age gap (RAG) has emerged as a promising new biomarker that can overcome these limitations, making it particularly suitable for disease screening in low- and middle-income countries. This study aimed to evaluate the potential of the RAG as a biomarker for broad disease screening across a vast spectrum of diseases. Fundus images were collected from 86 522 UK Biobank participants aged 40-83 (mean age: 56.2 ± 8.3 years). A deep learning model was trained to predict retinal age using 17 791 images from healthy participants. The remaining images were categorized into disease/injury groups based on clinical codes. Additionally, 8524 participants from the Brazilian Multilabel Ophthalmological Dataset (BRSET) were used for external validation. Among the 159 disease/injury groups from the 2019 Global Burden of Disease Study, 56 groups (35.2%) exhibited RAG distributions significantly different from healthy controls. Notable examples included chronic kidney disease, cardiovascular disease, blindness, vision loss and diabetes. Overall, the RAG shows great promise as a cost-effective, non-invasive biomarker for early disease screening.

Interpretable Machine Learning for Predicting Anterior Uveitis in Axial Spondyloarthritis

BACKGROUND

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, with anterior uveitis (AU) as a common extra-articular manifestation. Predicting AU onset in axSpA patients is challenging, as traditional statistical methods often fail to capture the disease's complexity.

METHODS

This study aimed to develop an interpretable machine learning (ML) model to predict AU onset in axSpA patients through a historical cohort analysis of 1508 patients from a tertiary medical center. Clinical data involving 54 variables were preprocessed through imputation, factorization, oversampling, outlier capping, and standardization. Recursive feature elimination identified 12 key predictors. Subsequently, 10 ML algorithms were assessed using performance metrics and visualization techniques.

RESULTS

The gradient boosting machine model incorporating 12 key factors showed high accuracy in predicting AU risk. Shapley additive explanations analysis revealed that hip involvement, nonsteroidal anti-inflammatory drug use, and smoking were the most influential predictors. The model's interpretability provided clear insights into the contribution of each feature to AU risk, supporting early diagnosis and personalized treatment.

CONCLUSION

The gradient boosting machine model predicts AU risk in axSpA patients, helping identify high-risk cases for early intervention and personalized treatment to prevent complications such as vision loss.

Sex-Specific Multimorbidity-Multibehaviour Patterns in Primary Care Populations

BACKGROUND

A conceptual shift in healthcare emphasises multimorbidity and multibehaviours as interconnected phenomena, highlighting dose-response associations and sex-specific differences. Data-driven approaches have been suggested for overcoming methodological challenges, of multimorbidity research. By using exploratory factor analysis, this study aimed to identify sex specific lifestyle associative multimorbidity patterns, providing valuable evidence to primary care providers and informing future multimorbidity guidelines.

METHODS

A retrospective observational study examined the electronic health records of three general practices in the UK between 2015 and 2018. The participants were aged 18+ with lifestyle multimorbidity, having engaged with multiple health risk behaviours. Stratified exploratory factor analysis with oblique rotation was used to identify sex specific lifestyle associative multimorbidity patterns.

RESULTS

The study included N = 7560 patients, with females comprising 53.9%. Eight independent lifestyle associative multimorbidity patterns were identified and distributed as follows. For females, three patterns emerged: cardiometabolic-neurovascular spectrum disorders (42.97% variance), respiratory conditions (8.08%), and sensory impairment (5.63%), with 25.4% assigned to these patterns. For males, five patterns were revealed: cardiometabolic-vascular spectrum disorders (34.10%), genitourinary (9.19%), respiratory-vision (8.20%), ocular (5.70%), and neurovascular-gastro-renal syndrome (4.54%), with 43%.

CONCLUSIONS

We revealed eight different sex-specific lifestyle-associated patterns, implying the need for tailored clinical approaches. The application of exploratory factor analysis yielded clinically valuable and scientifically rigorous multimorbidity patterns. Clinically, the findings advocate for a paradigm shift towards person-centred care, integrating multimorbidity and SNAP multibehaviours to enhance the complexity of inquiry and treatment of high-risk populations.

[Neurology in Bohemian Lights]

INTRODUCTION

Valle-Inclán's Bohemian Lights is the inaugural work of the esperpento, a literary genre that was born with the intention of offering distorted images of reality as a way of accessing it in a reflexive way.

MATERIAL AND METHODS

Critical reading of the editio princeps of the work to analyze its neurological content.

RESULTS

The character of Max Estrella, inspired by the figure of Alejandro Sawa, would not meet the criteria for encephalitis. The diagnoses of Charles Bonnet syndrome and death due to stroke are more likely. The characters at the wake discuss the differential diagnosis between death and catalepsy, and one of them suffers a non-epileptic event.

CONCLUSIONS

Bohemian Lights reflects different social, political and cultural aspects contemporary to the author. Health and disease are also addressed, with a preponderant role for neurology.

Spray Characteristics of Mist Aerosol Containing Emulsifier-free Oil-in-water Emulsions as Mist Aerosol Formulation

We examine the spray characteristics of mist aerosol containing emulsifier-free oil-in-water (EF-O/W) emulsion, which are prepared by ultrasonic emulsification of only oil and water in the absence of any emulsifiers such as surfactants, as a mist aerosol formulation. We found the unique spray characteristics of mist aerosol containing EF-O/W emulsion, which is a larger angle of mist sprayed and the resulting larger mist area, compared to the water and ethanol as a mist aerosol formulation. The unique spray characteristics observed for mist aerosol containing EF-O/W emulsion were not related to the physical properties of mist aerosol formulations, concentration of oil in EF-O/W emulsions, size of oil droplets in EF-O/W emulsions, size of droplets in mist sprayed from mist aerosol and flow rate of mist aerosol formulation in the actuator. By monitoring the liquid film sprayed from the actuator of mist aerosol, the splitting of liquid film sprayed from mist aerosol containing EF-O/W emulsion occurs at shorter distance from the actuator compared to the splitting of liquid film sprayed from mist aerosol containing water and ethanol. Namely, the earlier splitting of liquid film sprayed from mist aerosol results in the mist with larger angle and larger area of mist sprayed while the later splitting of liquid film sprayed from mist aerosol leads to the mist with smaller angle and smaller area of mist sprayed.

Transcriptional patterns of human retinal pigment epithelial cells under protracted high glucose

BACKGROUND

The retinal pigment epithelium (RPE) is essential for retinal homeostasis. Comprehensively exploring the transcriptional patterns of diabetic human RPE promotes the understanding of diabetic retinopathy (DR).

METHODS AND RESULTS

A total of 4125 differentially expressed genes (DEGs) were screened out from the human primary RPE cells subjected to prolonged high glucose (HG). The subsequent bioinformatics analysis is divided into 3 steps. In Step 1, 21 genes were revealed by intersecting the enriched genes from the KEGG, WIKI, and Reactome databases. In Step 2, WGCNA was applied and intersected with the DEGs. Further intersection based on the enrichments with the GO biological processes, GO cellular components, and GO molecular functions databases screened out 12 candidate genes. In Step 3, 13 genes were found to be simultaneously up-regulated in the DEGs and a GEO dataset involving human diabetic retinal tissues. VEGFA and ERN1 were the 2 starred genes finally screened out by overlapping the 3 Steps.

CONCLUSION

In this study, multiple genes were identified as crucial in the pathological process of RPE under protracted HG, providing potential candidates for future researches on DR. The current study highlights the importance of RPE in DR pathogenesis.

Visual Impairment and Its Associated Factors Among Hypertensive Patients in Amhara Region Referral Hospitals, Ethiopia

Background

Visual impairment is one of the most common long-term effects of high blood pressure. It affects one's quality of life, independence, and mobility. There is a paucity of information regarding the prevalence of visual impairment due to hypertension in Ethiopia. Therefore, this study aimed to determine the prevalence of visual impairment and its associated factors among hypertensive patients in referral hospitals of the Amhara region, Ethiopia, 2021.

Methods

An institution-based cross-sectional study was conducted among 423 study participants, which were selected by systematic random sampling technique. Data were collected by using an interviewer-administered structured questionnaire and physical measurements. The collected data were entered into Epi-data version 4.6. Then, exported into SPSS Version 26 for analysis. The crude and adjusted odds ratios and 95% Confidence intervals were calculated. Both bivariable and multivariable logistic regression analyses were done. Variables with a p-value of ≤0.05 were stated as significantly associated with visual impairment.

Results

The overall prevalence of visual impairment among hypertensive patients was 32.4% (95% CI: 27.9-37.9). Duration of hypertension ≥ 5 years (AOR =3.06, 95% CI: 1.86-4.95), history of ocular trauma (AOR =2.50, 95% CI: 1.3-4.73), and ever alcohol drinking (AOR = 2.72, 95% CI: 1.32-5.62) were significantly associated with visual impairment.

Conclusion

Nearly one-third of hypertensive patients were visually impaired from the study participants. Duration of hypertension ≥5 years, history of ocular trauma, and ever alcohol drinking was significantly associated with visual impairment among hypertensive patients. Therefore, in addition to providing medical care and follow-up services for hypertension patients, health education is needed for early and proper management of visual impairment, and to decrease their level of alcohol consumption. Furthermore, better to do this study by prospective cohort study design to identify cause-and-effect relationships.

Clinical impact and misdiagnosis of functional ophthalmological symptoms: a case report

BACKGROUND

There is a high prevalence of somatoform disorders and medically unexplained symptoms. When it comes to deciding whether a patient is able to work, it is essential to differentiate a somatoform disorder from a factitious disorder. The case presented demonstrates the impact on disability benefits and the subsequent psychosocial repercussions of misdiagnosing between a factitious disorder and a somatoform disorder.

CASE PRESENTATION

A 42-year-old Caucasian woman worked as a 100% fiduciary accountant until the age of 32 when she was placed on medical leave due to persistent trigeminal neuralgia. Afterward, she developed total blindness, not explained by a physiological process, accompanied by distress in a crucial emotional context. We evaluated the patient for a revision of a disability income after a diagnosis of factitious disorder with severe consequences such as disability income suspension and family conflict. Our psychiatric examination concluded the diagnoses of pain disorders related to psychological factors and a dissociative neurological symptom disorder with visual disturbance.

CONCLUSIONS

Blindness not explained by a physiological process may accompany trauma and psychological distress. Differentiating this pathology from factitious disorder or simulation is essential from an insurance medicine point of view, but also for its treatment.

Delayed reversal of methanol-induced blindness in an adult by a combination of erythropoietin and a high dose of methylprednisolone: a case report

BACKGROUND

The clinical manifestation following methanol toxicity accounts for a life-threatening problem that contributes to metabolic disorders, neurological complications, blindness, and even death. There is no completely effective treatment to retain the patient's vision. Herein, we apply a new therapeutic strategy for the recovery of bilateral blindness in a patient who had ingested methanol.

CASE PRESENTATION

A 27-year-old Iranian man with complete bilateral blindness was referred 3 days after accidental ingestion of methanol to the poisoning center at Jalil Hospital, Yasuj, Iran, in 2022. After taking his medical history, performing neurologic and ophthalmologic examinations, and routine laboratory tests, ordinary management was undertaken and counterpoisons were given for 4-5 days; however, the blindness did not reverse. Following the 4-5 days of unsuccessful standard management, he was given ten doses of subcutaneous erythropoietin 10,000 IU/12 hours twice daily, folinic acid 50 mg/12 hours, and methylprednisolone 250 mg/6 hours for 5 days. After five days, vision of both eyes recovered, reaching 1/10 in the left and 7/10 in the right eye. He remained under daily supervision until his release from the hospital, and he was discharged from the hospital 15 days post admission. In outpatient follow-up, his visual acuity was improved without having any side effects at 2 weeks after discharge.

CONCLUSION

A combination of erythropoietin and a high dose of methylprednisolone were useful for relieving the critical optic neuropathy and improved the optical neurological disorder following methanol toxicity.

Evaluation of the effects of ethanol and mitomycin on survival of rat limbal stem cells: an in vitro study

PURPOSE

Ethanol and mitomycin C (MMC) are clinically used to treat corneal diseases such as LASEK and LASIK surgery. In this study, we investigated the effects of time-dependent alcohol and MMC in cultured rat limbal stem cells (LSCs) to determine the appropriate time for the use of this compound in the clinical setting.

METHODS

LSCs (N = 10 eyes) isolated from male Wistar rats were cultured and characterized; then, isolates were divided into three groups. One group was exposed to a 20% concentration of ethanol for 5, 10, 15, 20, 25, and 30 s, and cell viability was assessed one, three, and five days following ethanol exposure using an MTT assay. To investigate the effect of MMC, cells in the second group were treated with 0.02% MMC in various periods (i.e., 15 s, 30 s, 60 s, 90 s, and 120 s) and time-dependent responses of cultured LSCs were recorded. Cells in the third group were co-treated with ethanol and MMC; then, dose and time dependency was evaluated.

RESULTS

In comparison with the viable cells in the control group, ethanol markedly decreased the viability of cells in a time-dependent manner in days one and three. On day five, the viability of LSCs was improved significantly (p < 0.05) in comparison with day one. The number of viable progenitor cells was significantly decreased after MMC treatment in a time-dependent manner, as determined by the MTT assay (p < 0.001). The use of mitomycin, along with alcohol, decreased cell viability in all groups treated with ethanol + MMC compared to the control on days one, three, and five (p < 0.0001).

CONCLUSIONS

Our findings suggest that ethanol and MMC reduced cell viability in cultured LSCs in a time-dependent manner. In addition, when LSCs were exposed to alcohol alone, they had a better recovery process within 5 days in comparison to when exposed to mitomycin alone or mitomycin + alcohol.

Intravenous plus intravitreal erythropoietin for management of methanol toxicity optic neuropathy: A case report and brief review

Methanol can inhibit cellular aerobic respiration pathway and causes cell hypoxia specially in optic neurons. Despite using many drugs, methanol-induced optic neuropathy (MION) still has a poor prognosis. Here we present a case of MION which is managed by a combination of intravenous and intravitreal erythropoietin in addition to corticosteroids.

Early Lifetime Substance Use and Development of Visual Impairment: Analysis of the National Survey on Drug Use and Health Data

Purpose

To investigate the association between early lifetime substance use on the development of severe visual acuity impairment or blindness on a national level.

Methods

National Survey of Drug Use and Health data was used to identify cases of substance use before 21* years of age, within the past year, and cases of self-reported blindness or visual impairment. Univariable and multivariable binary logistic regression with time-dependency was performed to evaluate odds of visual impairment influenced by 16 substances separated into three classes: prescription, non-prescription, and illicit drugs. Adjusted variables of interest included gender, marital status, race, level of education, total family income, poverty level, population density, and history of chronic disease.

Results

55,824 total responses were analyzed with 2577 (4.6%) cases of self-reported blindness or significant visual impairment. All early-use substance categories, including prescription, non-prescription, and illegal substances, were significantly associated with self-reported VI (OR 2.068, CI 1.451-2.949, p<0.001; OR 1.352, CI 1.227-1.489, p<0.001); OR 1.211, CI 1.086-1.352, p<0.001), respectively). Non-prescription substances displayed parallel significances amongst all constituents (alcohol, cigarettes, inhalants, and marijuana) (OR=1.227, CI 1.12-1.344, p<0.001; OR 1.363, CI 1.243-1.495, p<0.001; OR 1.418, CI 1.134-1.774; OR 1.388, CI 1.27-1.518, p<0.001, respectively). Univariable and multivariable analysis revealed several significant demographical and clinical adjustors.

Conclusion

Early lifetime use of all three classes of substances is associated with enhanced odds of subsequent visual impairment or blindness. Several readily available and commonly used substances have a greater risk. These findings may help clinicians and public health agencies in mitigation ventures including education, prevention, and rehabilitation efforts.

Acil Servise Başvuran Metil Alkol Zehirlenmelerinin Geriye Dönük Analizi

Objective: Methyl alcohol poisoning remains a significant cause of mortality and morbidity. This poisoning is still one of the important reasons for admission to emergency services. We aimed to examine the admission complaints, laboratory findings, treatment methods, clinical outcomes and examine the factors affecting the mortality of patients diagnosed with methyl alcohol poisoning in the emergency department. Methods: In this retrospective descriptive study, we analysed the patients who were considered to be diagnosed with methyl alcohol intoxication among those who came to our emergency department due to alcohol intoxication from June 1, 2018 to June 1, 2020. Results: The study included 20 (4.86%) individuals with methyl alcohol poisoning among 411 people who presented to the emergency department due to ethyl and methyl alcohol intake and resulting effects.The mean age of the patients was 47.35±14.2 years and 85% (n=17/20) were male. Upon reviewing the patients' admission symptoms, 70% were observed to have visual problems, 60% complaints of vomiting, 45% shortness of breath, and 40% changes in consciousness. In the study, it was revealed that 18.2%(n=2/11) females and 81.8%(n=9/11) males died, and the mortality rate was calculated as 55%(n=11/20). Conclusions: The presence of visual problems, hypotension, and coma in clinical findings, high anion gap metabolic acidosis, marked osmolar gap, an increase in lactate level, and hyperglycemia in laboratory findings may be the early signs of mortality in patients with methyl alcohol poisoning. Therefore, patients with these signs should be followed up more closely and treated.

Use of Visual Electrophysiology to Monitor Retinal and Optic Nerve Toxicity of Medications

It is important for clinicians to consider exposure to toxic substances and nutritional deficiencies when diagnosing and managing cases of vision loss. In these cases, physiologic damage can alter the function of key components of the visual pathway before morphologic changes can be detected by traditional imaging methods. Electrophysiologic tests can aid in the early detection of such functional changes to visual pathway components, including the retina or optic nerve. This review provides an overview of various electrophysiologic techniques, including multifocal electroretinogram (mfERG), full-field ERG (ffERG), electrooculogram (EOG), pattern electroretinogram (PERG), and visual evoked potential (VEP) in monitoring the retinal and optic nerve toxicities of alcohol, amiodarone, cefuroxime, cisplatin, deferoxamine, digoxin, ethambutol, hydroxychloroquine, isotretinoin, ocular siderosis, pentosane, PDE5 inhibitors, phenothiazines (chlorpromazine and thioridazine), quinine, tamoxifen, topiramate, vigabatrin, and vitamin A deficiency.

Comprehensive visual electrophysiological measurements discover crucial changes caused by alcohol addiction in humans: Clinical values in early prevention of alcoholic vision decline

Alcohol addiction often compromises vision by impairing the visual pathway, particularly the retina and optic nerve. Vision decline in alcoholics consists of a sequential transition from reversible functional deterioration of the visual pathway to irreversible clinical vision degeneration or vision loss. Thus, the control of alcoholic vision decline should focus on prevention before permanent damage occurs. Visual electrophysiology is a promising method for early detection of retinal dysfunction and optic neuropathy, including full-field electroretinography (ffERG) and pattern-reversal visual evoked potential (PR-VEP). So far, however, research studying the electrophysiological characteristics in the preclinical stage of vision decline caused by alcohol addiction is still lacking. Here we conducted a retrospective study with 11 alcoholics and 14 matched control individuals to address this need. We had performed comprehensive visual electrophysiological tests, including ffERG and PR-VEP. We next analyzed all electrophysiological parameters using multivariate statistical analyses and discovered some highly sensitive alterations to alcohol addiction. We found severely reduced amplitudes in scotopic ffERG oscillatory potentials (OPs) in alcohol addicts. These changes indicate the alcohol-induced disturbances of amacrine cells and retinal circulation. In subjects with alcohol addiction, the amplitudes of b-waves diminish significantly in scotopic but not photopic ffERG, implying the impaired function of the retinal rod system and the dysfunction of the inner retina. PR-VEPs elicited by checkerboard stimuli with large 1 degree (°) checks mainly reflect the state of the optic nerve and ganglion cells, and PR-VEPs provoked by small 0.25° checks mainly reflect the function of the macular. We performed both measurements and observed a robust amplitude reduction in all three peaks (N75–P100, P100–N135) and a significant peak time extension in P100. Our research provides an affordable and non-invasive tool to accurately evaluate visual pathway conditions in alcohol addicts and help clinicians take targeted treatment.

A Review of Ocular Complications Associated with Medications Used for Anxiety, Depression, and Stress

This review of commonly prescribed psychotropic drugs aims to update the clinician on possible ophthalmic side effects that may include dry eye, diplopia, mydriasis, and cataracts. This review summarizes our current knowledge of known ocular side effects of psychotropic drugs based on reviews, case reports, case-control studies, a case series, and cross-sectional observational studies reported in the recent literature. The review covers disorders related to depression, anxiety, and stress which are commonly encountered within society and can have debilitating impacts on an individual's quality of life that may require chronic therapeutic management. The main medications used in the treatment and management of these conditions typically target receptors, metabolic enzymes, or transport pumps that alter the pre- and/or post-synaptic levels of neurotransmitters such as serotonin, norepinephrine, dopamine, gamma-aminobutyric acid, and opioids to improve mood and/or relieve pain and anxiety. Novel non-therapeutic options are undergoing clinical trials, and some patients may seek alternative therapies or have associated substance abuse issues to alleviate their symptoms. This review summarizes some of the clinical signs of depression and the main therapeutic options and their reported ocular side effects which may be pertinent today given the rise in use of psychotropic medications used to manage depression, anxiety, and stress.