1
|
Stone RA, Tobias JW, Wei W, Schug J, Wang X, Zhang L, Iuvone PM, Nickla DL. Diurnal retinal and choroidal gene expression patterns support a role for circadian biology in myopia pathogenesis. Sci Rep 2024; 14:533. [PMID: 38177383 PMCID: PMC10767138 DOI: 10.1038/s41598-023-50684-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024] Open
Abstract
The prevalence of myopia (nearsightedness) is increasing to alarming levels, but its etiology remains poorly understood. Because both laboratory and clinical findings suggest an etiologic role for circadian rhythms in myopia development, we assayed gene expression by RNA-Seq in retina and choroid at the onset of unilateral experimental myopia in chick, isolating tissues every 4 h during a single 24-h period from myopic and contralateral control eyes. Occluded versus open eye gene expression differences varied considerably over the 24-h sampling period, with some occurring at multiple times of day but with others showing differences at only a single investigated timepoint. Some of the genes identified in retina or choroid of chick myopia were previously identified as candidate genes for common human myopia. Like differentially expressed genes, pathways identified by Gene Set Enrichment Analysis also varied dramatically by sampling time. Considered with other laboratory data, human genetic and epidemiology data, these findings further implicate circadian events in myopia pathogenesis. The present results emphasize a need to include time of day in mechanistic studies of myopia and to assess circadian biology directly in trying to understand better the origin of myopia and to develop more effective therapies.
Collapse
Affiliation(s)
- Richard A Stone
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - John W Tobias
- Penn Genomics and Sequencing Core, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wenjie Wei
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Schug
- Penn Genomics and Sequencing Core, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xia Wang
- Department of Biomedical Sciences and Disease, New England College of Optometry, Boston, MA, USA
| | - Lixin Zhang
- Department of Biomedical Sciences and Disease, New England College of Optometry, Boston, MA, USA
| | - P Michael Iuvone
- Department of Ophthalmology and Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, USA
| | - Debora L Nickla
- Department of Biomedical Sciences and Disease, New England College of Optometry, Boston, MA, USA
| |
Collapse
|
2
|
Wildsoet C, Schaeffel F, Stone RA. The history of the International Myopia Conference series. Ophthalmic Physiol Opt 2022; 43:296-298. [PMID: 36464848 DOI: 10.1111/opo.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Christine Wildsoet
- Herbert Wertheim School of Optometry & Vision Science University of California Berkeley Berkeley California USA
| | - Frank Schaeffel
- Section Neurobiology of the Eye, Institute of Ophthalmic Research and Zeiss Vision Lab, Institute of Ophthalmic Research University of Tübingen Tübingen Germany
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
| | - Richard A. Stone
- Department of Ophthalmology, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| |
Collapse
|
3
|
Chakraborty R, Landis EG, Mazade R, Yang V, Strickland R, Hattar S, Stone RA, Iuvone PM, Pardue MT. Melanopsin modulates refractive development and myopia. Exp Eye Res 2022; 214:108866. [PMID: 34838844 PMCID: PMC8792255 DOI: 10.1016/j.exer.2021.108866] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023]
Abstract
Myopia, or nearsightedness, is the most common form of refractive abnormality and is characterized by excessive ocular elongation in relation to ocular power. Retinal neurotransmitter signaling, including dopamine, is implicated in myopic ocular growth, but the visual pathways that initiate and sustain myopia remain unclear. Melanopsin-expressing retinal ganglion cells (mRGCs), which detect light, are important for visual function, and have connections with retinal dopamine cells. Here, we investigated how mRGCs influence normal and myopic refractive development using two mutant mouse models: Opn4-/- mice that lack functional melanopsin photopigments and intrinsic mRGC responses but still receive other photoreceptor-mediated input to these cells; and Opn4DTA/DTA mice that lack intrinsic and photoreceptor-mediated mRGC responses due to mRGC cell death. In mice with intact vision or form-deprivation, we measured refractive error, ocular properties including axial length and corneal curvature, and the levels of retinal dopamine and its primary metabolite, L-3,4-dihydroxyphenylalanine (DOPAC). Myopia was measured as a myopic shift, or the difference in refractive error between the form-deprived and contralateral eyes. We found that Opn4-/- mice had altered normal refractive development compared to Opn4+/+ wildtype mice, starting ∼4D more myopic but developing ∼2D greater hyperopia by 16 weeks of age. Consistent with hyperopia at older ages, 16 week-old Opn4-/- mice also had shorter eyes compared to Opn4+/+ mice (3.34 vs 3.42 mm). Opn4DTA/DTA mice, however, were more hyperopic than both Opn4+/+ and Opn4-/- mice across development ending with even shorter axial lengths. Despite these differences, both Opn4-/- and Opn4DTA/DTA mice had ∼2D greater myopic shifts in response to form-deprivation compared to Opn4+/+ mice. Furthermore, when vision was intact, dopamine and DOPAC levels were similar between Opn4-/- and Opn4+/+ mice, but higher in Opn4DTA/DTA mice, which differed with age. However, form-deprivation reduced retinal dopamine and DOAPC by ∼20% in Opn4-/- compared to Opn4+/+ mice but did not affect retinal dopamine and DOPAC in Opn4DTA/DTA mice. Lastly, systemically treating Opn4-/- mice with the dopamine precursor L-DOPA reduced their form-deprivation myopia by half compared to non-treated mice. Collectively our findings show that disruption of retinal melanopsin signaling alters the rate and magnitude of normal refractive development, yields greater susceptibility to form-deprivation myopia, and changes dopamine signaling. Our results suggest that mRGCs participate in the eye's response to myopigenic stimuli, acting partly through dopaminergic mechanisms, and provide a potential therapeutic target underling myopia progression. We conclude that proper mRGC function is necessary for correct refractive development and protection from myopia progression.
Collapse
Affiliation(s)
- Ranjay Chakraborty
- Department of Ophthalmology, Emory University School of Medicine, 1365B Clifton Rd NE, Atlanta, GA 30322, United States,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, United States,College of Nursing and Health Sciences, Optometry and Vision Science, Flinders University, Bedford Park, SA 5001, Adelaide, Australia,Caring Futures Institute, Flinders University, Bedford Park, SA 5042, Adelaide, Australia
| | - Erica G. Landis
- Department of Ophthalmology, Emory University School of Medicine, 1365B Clifton Rd NE, Atlanta, GA 30322, United States,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, United States,Neuroscience Program, Emory University School of Medicine, 1365 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Reece Mazade
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, United States,Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Dr, Atlanta, GA 30332, United States
| | - Victoria Yang
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, United States,Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Dr, Atlanta, GA 30332, United States
| | - Ryan Strickland
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, United States,Neuroscience Program, Emory University School of Medicine, 1365 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Samer Hattar
- Section on Light and Circadian Rhythms, NIMH, NIH, 9000 Rockville Pike, Bethesda, Maryland, USA 20892
| | - Richard A. Stone
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - P. Michael Iuvone
- Department of Ophthalmology, Emory University School of Medicine, 1365B Clifton Rd NE, Atlanta, GA 30322, United States,Department of Pharmacology, Emory University School of Medicine, 1365B Clifton Rd NE, Atlanta, GA 30322, United States
| | - Machelle T. Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, United States,Neuroscience Program, Emory University School of Medicine, 1365 Clifton Rd NE, Atlanta, GA 30322, United States,Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Dr, Atlanta, GA 30332, United States
| |
Collapse
|
4
|
Nickla DL, Sarfare S, McGeehan B, Wei W, Elin-Calcador J, He L, Dhakal S, Dixon J, Maguire MG, Stone RA, Iuvone PM. Visual conditions affecting eye growth alter diurnal levels of vitreous DOPAC. Exp Eye Res 2020; 200:108226. [PMID: 32905843 DOI: 10.1016/j.exer.2020.108226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022]
Abstract
In chicks, the diurnal patterns of retinal dopamine synthesis and release are associated with refractive development. To assess the within-day patterns of dopamine release, we assayed vitreal levels of DOPAC (3,4-dihydroxyphenylacetic acid) using high performance liquid chromatography with electrochemical detection, at 4-h intervals over 24 h in eyes with experimental manipulations that change ocular growth rates. Chicks were reared under a 12 h light/12 h dark cycle; experiments began at 12 days of age. Output was assessed by modelling using the robust variance structure of Generalized Estimating Equations. Continuous spectacle lensdefocus or form deprivation: One group experienced non-restricted visual input to both eyes and served as untreated "normal" controls. Three experimental cohorts underwent monocular visual alterations known to alter eye growth and refraction: wearing a diffuser, a negative lens or a positive lens. After one full day of device-wear, chicks were euthanized at 4-h intervals over 24 h (8 birds per time/condition). Brief hyperopic defocus: Chicks wore negative lenses for only 2 daily hours either in the morning (starting at ZT 0; n = 16) or mid-day (starting at ZT 4; n = 8) for 3 days. Vitreal DOPAC was assayed. In chicks with bilateral non-restricted vision, or with continuous defocus or form-deprivation, there was a diurnal variation in vitreal DOPAC levels for all eyes (p < 0.001 for each). In normal controls, DOPAC was highest during the daytime, lowest at night, and equivalent for both eyes. In experimental groups, regardless of whether experiencing a growth stimulatory input (diffuser; negative lens) or growth inhibitory input (positive lens), DOPAC levels were reduced compared both to fellow eyes and to those of normal controls (p < 0.001 for each). These diurnal variations in vitreous DOPAC levels under different visual conditions indicate a complexity for dopaminergic mechanisms in refractive development that requires further study.
Collapse
Affiliation(s)
- D L Nickla
- Department of Biosciences, The New England College of Optometry, Boston, MA, USA.
| | - S Sarfare
- Department of Biosciences, The New England College of Optometry, Boston, MA, USA
| | - B McGeehan
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - W Wei
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J Elin-Calcador
- Department of Biosciences, The New England College of Optometry, Boston, MA, USA
| | - L He
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - S Dhakal
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - J Dixon
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - M G Maguire
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - R A Stone
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - P M Iuvone
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pharmacology & Chemical Biology, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
5
|
Affiliation(s)
- Richard A Stone
- is the Executive-in-Charge, Veterans Health Administration in Washington, DC
| |
Collapse
|
6
|
Stone RA, Wei W, Sarfare S, McGeehan B, Engelhart KC, Khurana TS, Maguire MG, Iuvone PM, Nickla DL. Visual Image Quality Impacts Circadian Rhythm-Related Gene Expression in Retina and in Choroid: A Potential Mechanism for Ametropias. Invest Ophthalmol Vis Sci 2020; 61:13. [PMID: 32396635 PMCID: PMC7405616 DOI: 10.1167/iovs.61.5.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/21/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose Stimulated by evidence implicating diurnal/circadian rhythms and light in refractive development, we studied the expression over 24 hours of selected clock and circadian rhythm-related genes in retina/retinal pigment epithelium (RPE) and choroid of experimental ametropias in chicks. Methods Newly hatched chicks, entrained to a 12-hour light/dark cycle for 12 to 14 days, either experienced nonrestricted vision OU (i.e., in both eyes) or received an image-blurring diffuser or a minus 10-diopter (D) or a plus 10-D defocusing lens over one eye. Starting 1 day later and at 4-hour intervals for 24 hours, the retina/RPE and choroid were separately dissected. Without pooling, total RNA was extracted, converted to cDNA, and assayed by quantitative PCR for the expression of the following genes: Opn4m, Clock, Npas2, Per3, Cry1, Arntl, and Mtnr1a. Results The expression of each gene in retina/RPE and in choroid of eyes with nonrestricted vision OU varied over 24 hours, with equal levels OU for most genes and times. Altered visual input influenced gene expression in complex patterns that varied by gene, visual input, time, and eye, affecting experimental eyes with altered vision and also contralateral eyes with nonrestricted vision. Discussion Altering visual input in ways known to induce ametropias alters the retinal/RPE and choroidal expression of circadian rhythm-related genes, further linking circadian biology with eye growth regulation. While further investigations are needed, studying circadian processes may help understand refractive mechanisms and the increasing myopia prevalence in contemporary societies where lighting patterns can desynchronize endogenous rhythms from the natural environmental light/dark cycle.
Collapse
Affiliation(s)
- Richard A. Stone
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Wenjie Wei
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Shanta Sarfare
- Department of Bioscience, New England College of Optometry, Boston, Massachusetts, United States
| | - Brendan McGeehan
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - K. Cameron Engelhart
- Department of Bioscience, New England College of Optometry, Boston, Massachusetts, United States
| | - Tejvir S. Khurana
- Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Maureen G. Maguire
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - P. Michael Iuvone
- Departments of Ophthalmology and Pharmacology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Debora L. Nickla
- Department of Bioscience, New England College of Optometry, Boston, Massachusetts, United States
| |
Collapse
|
7
|
Hysi PG, Choquet H, Khawaja AP, Wojciechowski R, Tedja MS, Yin J, Simcoe MJ, Patasova K, Mahroo OA, Thai KK, Cumberland PM, Melles RB, Verhoeven VJM, Vitart V, Segre A, Stone RA, Wareham N, Hewitt AW, Mackey DA, Klaver CCW, MacGregor S, Khaw PT, Foster PJ, Guggenheim JA, Rahi JS, Jorgenson E, Hammond CJ. Meta-analysis of 542,934 subjects of European ancestry identifies new genes and mechanisms predisposing to refractive error and myopia. Nat Genet 2020; 52:401-407. [PMID: 32231278 PMCID: PMC7145443 DOI: 10.1038/s41588-020-0599-0] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 02/24/2020] [Indexed: 01/10/2023]
Abstract
Refractive errors, in particular myopia, are a leading cause of morbidity and disability worldwide. Genetic investigation can improve understanding of the molecular mechanisms that underlie abnormal eye development and impaired vision. We conducted a meta-analysis of genome-wide association studies (GWAS) that involved 542,934 European participants and identified 336 novel genetic loci associated with refractive error. Collectively, all associated genetic variants explain 18.4% of heritability and improve the accuracy of myopia prediction (area under the curve (AUC) = 0.75). Our results suggest that refractive error is genetically heterogeneous, driven by genes that participate in the development of every anatomical component of the eye. In addition, our analyses suggest that genetic factors controlling circadian rhythm and pigmentation are also involved in the development of myopia and refractive error. These results may enable the prediction of refractive error and the development of personalized myopia prevention strategies in the future.
Collapse
Affiliation(s)
- Pirro G Hysi
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK. .,Department of Twin Research and Genetic Epidemiology, King's College London, London, UK. .,UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Hélène Choquet
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Robert Wojciechowski
- Department of Biophysics, Johns Hopkins University, Baltimore, MD, USA.,Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Milly S Tedja
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jie Yin
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mark J Simcoe
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Karina Patasova
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK
| | - Omar A Mahroo
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Khanh K Thai
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Phillippa M Cumberland
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ronald B Melles
- Department of Ophthalmology Kaiser Permanente Northern California, Redwood City, CA, USA
| | - Virginie J M Verhoeven
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Veronique Vitart
- MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Ayellet Segre
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Richard A Stone
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nick Wareham
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alex W Hewitt
- Department of Ophthalmology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - David A Mackey
- Department of Ophthalmology, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Lions Eye Institute, Perth, Western Australia, Australia
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Radboud University Medical Center, Rotterdam, the Netherlands.,Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Stuart MacGregor
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Peng T Khaw
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Division of Genetics and Epidemiology, UCL Institute of Ophthalmology, London, UK
| | | | | | | | - Jugnoo S Rahi
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Ophthalmology and NIHR, Biomedical Research Centre, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Eric Jorgenson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Christopher J Hammond
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK.,Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| |
Collapse
|
8
|
Macchi I, Bunya VY, Massaro-Giordano M, Stone RA, Maguire MG, Zheng Y, Chen M, Gee J, Smith E, Daniel E. A new scale for the assessment of conjunctival bulbar redness. Ocul Surf 2018; 16:436-440. [PMID: 29883738 DOI: 10.1016/j.jtos.2018.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/25/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Current scales for assessment of bulbar conjunctival redness have limitations for evaluating digital images. We developed a scale suited for evaluating digital images and compared it to the Validated Bulbar Redness (VBR) scale. METHODS From a digital image database of 4889 color corrected bulbar conjunctival images, we identified 20 images with varied degrees of redness. These images, ten each of nasal and temporal views, constitute the Digital Bulbar Redness (DBR) scale. The chromaticity of these images was assessed with an established image processing algorithm. Using 100 unique, randomly selected images from the database, three trained, non-physician graders applied the DBR scale and printed VBR scale. Agreement was assessed with weighted Kappa statistics (Kw). RESULTS The DBR scale scores provide linear increments of 10 from 10-100 when redness is measured objectively with an established image processing algorithm. Exact agreement of all graders was 38% and agreement with no more than a difference of ten units between graders was 91%. Kw for agreement between any two graders ranged from 0.57 to 0.73 for the DBR scale and from 0.38 to 0.66 for the VBR scale. The DBR scale allowed direct comparison of digital to digital images, could be used in dim lighting, had both temporal and nasal conjunctival reference images, and permitted viewing reference and test images at the same magnification. CONCLUSION The novel DBR scale, with its objective linear chromatic steps, demonstrated improved reproducibility, fewer visualization artifacts and improved ease of use over the VBR scale for assessing conjunctival redness.
Collapse
Affiliation(s)
- Ilaria Macchi
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA; Department of Ophthalmology, University Campus Biomedico, Rome, Italy
| | - Vatinee Y Bunya
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Richard A Stone
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Maureen G Maguire
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuanjie Zheng
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA; School of Information Science and Engineering, Shandong Normal University, China; Shandong Normal University, School of Information Science and Engineering, Key Lab of Intelligent Computing & Information Security in Universities of Shandong, Institute of Life Sciences, Shandong Provincial Key Laboratory for Distributed Computer Software Novel Technology, Key Lab of Intelligent Information Processing, Jinan, 250358, China
| | - Min Chen
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James Gee
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Institute of Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Eli Smith
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Ebenezer Daniel
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
9
|
Chakraborty R, Ostrin LA, Nickla DL, Iuvone PM, Pardue MT, Stone RA. Circadian rhythms, refractive development, and myopia. Ophthalmic Physiol Opt 2018; 38:217-245. [PMID: 29691928 PMCID: PMC6038122 DOI: 10.1111/opo.12453] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/11/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Despite extensive research, mechanisms regulating postnatal eye growth and those responsible for ametropias are poorly understood. With the marked recent increases in myopia prevalence, robust and biologically-based clinical therapies to normalize refractive development in childhood are needed. Here, we review classic and contemporary literature about how circadian biology might provide clues to develop a framework to improve the understanding of myopia etiology, and possibly lead to rational approaches to ameliorate refractive errors developing in children. RECENT FINDINGS Increasing evidence implicates diurnal and circadian rhythms in eye growth and refractive error development. In both humans and animals, ocular length and other anatomical and physiological features of the eye undergo diurnal oscillations. Systemically, such rhythms are primarily generated by the 'master clock' in the surpachiasmatic nucleus, which receives input from the intrinsically photosensitive retinal ganglion cells (ipRGCs) through the activation of the photopigment melanopsin. The retina also has an endogenous circadian clock. In laboratory animals developing experimental myopia, oscillations of ocular parameters are perturbed. Retinal signaling is now believed to influence refractive development; dopamine, an important neurotransmitter found in the retina, not only entrains intrinsic retinal rhythms to the light:dark cycle, but it also modulates refractive development. Circadian clocks comprise a transcription/translation feedback control mechanism utilizing so-called clock genes that have now been associated with experimental ametropias. Contemporary clinical research is also reviving ideas first proposed in the nineteenth century that light exposures might impact refraction in children. As a result, properties of ambient lighting are being investigated in refractive development. In other areas of medical science, circadian dysregulation is now thought to impact many non-ocular disorders, likely because the patterns of modern artificial lighting exert adverse physiological effects on circadian pacemakers. How, or if, such modern light exposures and circadian dysregulation contribute to refractive development is not known. SUMMARY The premise of this review is that circadian biology could be a productive area worthy of increased investigation, which might lead to the improved understanding of refractive development and improved therapeutic interventions.
Collapse
Affiliation(s)
- Ranjay Chakraborty
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | | | | | - Machelle T. Pardue
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur
| | - Richard A. Stone
- University of Pennsylvania School of Medicine, Philadelphia, USA
| |
Collapse
|
10
|
Pardue M, Chakraborty R, Landis E, Park H, Stone RA, Iuvone PM. Photoreceptor pathways differentially contribute to refractive eye growth in mice. J Vis 2017. [DOI: 10.1167/17.15.34a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Machelle Pardue
- Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology
- Rehab R&D Center of Excellence, Atlanta VA Medical Center
| | - Ranjay Chakraborty
- Rehab R&D Center of Excellence, Atlanta VA Medical Center
- Ophthalmology, Emory University School of Medicine
| | - Erica Landis
- Rehab R&D Center of Excellence, Atlanta VA Medical Center
- Ophthalmology, Emory University School of Medicine
| | - Hanna Park
- Rehab R&D Center of Excellence, Atlanta VA Medical Center
- Ophthalmology, Emory University School of Medicine
| | | | - P. Michael Iuvone
- Ophthalmology, Emory University School of Medicine
- Pharmacology, Emory University School of Medicine
| |
Collapse
|
11
|
Bunya VY, Chen M, Zheng Y, Massaro-Giordano M, Gee J, Daniel E, O'Sullivan R, Smith E, Stone RA, Maguire MG. Development and Evaluation of Semiautomated Quantification of Lissamine Green Staining of the Bulbar Conjunctiva From Digital Images. JAMA Ophthalmol 2017; 135:1078-1085. [PMID: 28910455 DOI: 10.1001/jamaophthalmol.2017.3346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Lissamine green (LG) staining of the conjunctiva is a key biomarker in evaluating ocular surface disease. The disease currently is assessed using relatively coarse subjective scales. Objective assessment would standardize comparisons over time and between clinicians. Objective To develop a semiautomated, quantitative system to assess lissamine green staining of the bulbar conjunctiva on digital images. Design, Setting, and Participants Using a standard photography protocol, 35 digital images of the conjunctiva of 11 patients with a diagnosis of dry eye disease based on characteristic signs and symptoms were obtained after topical administration of preservative-free LG, 1%, solution. Images were scored independently by 2 masked ophthalmologists in an academic medical center using the van Bijsterveld and National Eye Institute (NEI) scales. The region of interest was identified by manually marking 7 anatomic landmarks on the images. An objective measure was developed by segmenting the images, forming a vector of key attributes, and then performing a random forest regression. Subjective scores were correlated with the output from a computer algorithm using a cross-validation technique. The ranking of images from least to most staining was compared between the algorithm and the ophthalmologists. The study was conducted from April 26, 2012, through June 2, 2016. Main Outcomes and Measures Correlation and level of agreement among computerized algorithm scores, van Bijsterveld scale clinical scores, and NEI scale clinical scores. Results The scores from the automated algorithm correlated well with the mean scores obtained from the gradings of 2 ophthalmologists for the 35 images using the van Bijsterveld scale (Spearman correlation coefficient, rs = 0.79), and moderately with the NEI scale (rs = 0.61) scores. For qualitative ranking of staining, the correlation between the automated algorithm and the 2 ophthalmologists was rs = 0.78 and rs = 0.83. Conclusions and Relevance The algorithm performed well when evaluating LG staining of the conjunctiva, as evidenced by good correlation with subjective gradings using 2 different grading scales. Future longitudinal studies are needed to assess the responsiveness of the algorithm to change of conjunctival staining over time.
Collapse
Affiliation(s)
- Vatinee Y Bunya
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Min Chen
- Penn Image Computing and Science Laboratory, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yuanjie Zheng
- School of Information Science and Engineering, Institute of Biomedical Sciences, Shandong Normal University, Jinan, China
| | - Mina Massaro-Giordano
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - James Gee
- Penn Image Computing and Science Laboratory, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ebenezer Daniel
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Ryan O'Sullivan
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eli Smith
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Richard A Stone
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Maureen G Maguire
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia
| |
Collapse
|
12
|
Stone RA, Cohen Y, McGlinn AM, Davison S, Casavant S, Shaffer J, Khurana TS, Pardue MT, Iuvone PM. Development of Experimental Myopia in Chicks in a Natural Environment. Invest Ophthalmol Vis Sci 2017; 57:4779-89. [PMID: 27618415 PMCID: PMC5024671 DOI: 10.1167/iovs.16-19310] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose The hypothesis that outdoor exposure might protect against myopia has generated much interest, although available data find only modest clinical efficacy. We tested the effect of outdoor rearing on form-deprivation myopia in chicks, a myopia model markedly inhibited by high-intensity indoor laboratory lighting. Methods Unilaterally goggled cohorts of White Leghorn chicks were maintained in a species-appropriate, outdoor rural setting during daylight hours to the extent permitted by weather. Control chicks were reared indoors with incandescent lighting. Besides ocular refraction and ultrasound, we determined dopamine and 3,4-dihydroxyphenylacetic acid (DOPAC) content in retina and vitreous and measured mRNA expression levels of selected clock and circadian rhythm-related genes in the retina/RPE. Results Myopia developed in the goggled eyes of all cohorts. Whereas outdoor rearing lessened myopia by 44% at 4 days, a protective effect was no longer evident at 11 days. Outdoor rearing had no consistent effect on retinal or vitreous content of dopamine or DOPAC. Conforming to prior data on form-deprivation myopia, retina and vitreous levels of DOPAC were reduced in goggled eyes. Compared with contralateral eyes, the retinal expression of clock and circadian rhythm-related genes was modestly altered in myopic eyes of chicks reared indoors or outdoors. Conclusions Outdoor rearing of chicks induces only a partial decrease of goggle-induced myopia that is not maintained, without evidence that retinal dopamine metabolism accounts for the partial myopia inhibition under these outdoor conditions. Although modest, alterations in retinal gene expression suggest that studying circadian signals might be informative for understanding refractive mechanisms.
Collapse
Affiliation(s)
- Richard A Stone
- Department of Ophthalmology University of Pennsylvania School of Medicine, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
| | - Yuval Cohen
- Department of Ophthalmology University of Pennsylvania School of Medicine, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
| | - Alice M McGlinn
- Department of Ophthalmology University of Pennsylvania School of Medicine, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
| | - Sherrill Davison
- Laboratory of Avian Medicine and Pathology, University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Kennett Square, Pennsylvania, United States
| | - Susan Casavant
- Laboratory of Avian Medicine and Pathology, University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Kennett Square, Pennsylvania, United States
| | - James Shaffer
- Department of Ophthalmology University of Pennsylvania School of Medicine, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
| | - Tejvir S Khurana
- Department of Physiology and Pennsylvania Muscle Institute, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
| | - Machelle T Pardue
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States 5Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, Georgia, United States
| | - P Michael Iuvone
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States 7Department of Pharmacology, Emory University School of Medicine, Atlanta, Georgia, United States
| |
Collapse
|
13
|
OʼSullivan R, Tom LM, Bunya VY, Nyberg WC, Massaro-Giordano M, Daniel E, Smith E, Brainard DH, Gee J, Maguire MG, Stone RA. Use of Crossed Polarizers to Enhance Images of the Eyelids. Cornea 2017; 36:631-635. [PMID: 28257379 DOI: 10.1097/ico.0000000000001157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe imaging of the external eye with Crossed Polarizers to enhance clinically important features in digital photographs of the eyelids. METHODS External photographs with and without crossed polarizing filters were taken of patients with blepharitis and controls with no clinical eye pathology. RESULTS Photographing eyelid skin through Crossed Polarizers decreased reflections on the skin surface and improved visualization of eyelid telangiectasias and blood vessels in patients with a broad range of skin pigmentation and ethnicities. CONCLUSIONS The use of Crossed Polarizers in imaging the external eye reduces reflections and glare from the eyelid skin and margins, thereby allowing for a more detailed evaluation of underlying structures and analysis of images. These findings suggest that including Crossed Polarizers in clinical photography has informative applications for assessing eyelid disease.
Collapse
Affiliation(s)
- Ryan OʼSullivan
- *Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA; ‡Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA; Departments of §Psychology; and ¶Radiology, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Chua SYL, Ikram MK, Tan CS, Stone RA, Cai S, Gluckman PD, Yap SC, Yap F, Wong TY, Ngo CS, Saw SM. Is there a link between passive smoke exposure and early-onset myopia in preschool Asian children? Ophthalmic Physiol Opt 2016; 36:370-80. [PMID: 27061286 DOI: 10.1111/opo.12285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/21/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the association of passive tobacco smoke exposure with early-onset myopia among three-year-old children in Singapore. METHODS Pregnant mothers who attended their first trimester clinic at two major maternity units were recruited into the GUSTO birth cohort. The current analysis comprised 572 three-year-old children, who underwent cycloplegic autorefraction and axial length (AL) measurements. Myopia was defined as spherical equivalent (SE) of ≤-0.50 dioptres (D). Either parent completed questionnaires describing their child's exposure to passive smoke at six months, one and two years of age. RESULTS There were 197 children (36.2%) who were exposed to passive smoke from birth to before six months. Compared to non-exposed children, children exposed to any passive smoke from birth to before six months experienced greater myopia prevalence (adjusted OR = 2.79; 95% CI: 1.24-6.29; p = 0.01). The odds of myopia in a child was greater if a smoker smokes at home, in the family car, or in the presence of the child (adjusted OR = 3.95; 95% CI: 1.41-11.09; p < 0.01) compared to non-exposed child. In contrast to myopia, childhood exposure to passive smoke did not systematically shift mean values for SE or AL. CONCLUSIONS In this prospective birth cohort study, we found that childhood exposure to passive smoke from birth to before six months slightly increased the risk of early-onset myopia. This may indicate a delayed response to passive smoke exposure before six months and the development of myopia at three years of age. Our study is limited by the small number of myopic children at this young age. Thus, larger prospective studies using more objective cotinine level measures are required to fully establish and understand the influence of tobacco smoke on refractive development in older children.
Collapse
Affiliation(s)
- Sharon Yu Lin Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Mohammad Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,DUKE-NUS Graduate Medical School, School of Public Health, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Richard A Stone
- University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Shirong Cai
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National Health System, Singapore, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science and Technology (A'STAR), Singapore, Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Seng Chong Yap
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science and Technology (A'STAR), Singapore, Singapore
| | - Fabian Yap
- Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,DUKE-NUS Graduate Medical School, School of Public Health, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheryl S Ngo
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,DUKE-NUS Graduate Medical School, School of Public Health, Singapore, Singapore
| | | |
Collapse
|
15
|
Bansal M, Sizintsev M, Eledath J, Sawhney H, Pearson DJ, Stone RA. 3D optic disc reconstruction via a global fundus stereo algorithm. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2013:5877-82. [PMID: 24111076 DOI: 10.1109/embc.2013.6610889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents a novel method to recover 3D structure of the optic disc in the retina from two uncalibrated fundus images. Retinal images are commonly uncalibrated when acquired clinically, creating rectification challenges as well as significant radiometric and blur differences within the stereo pair. By exploiting structural peculiarities of the retina, we modified the Graph Cuts computational stereo method (one of current state-of-the-art methods) to yield a high quality algorithm for fundus stereo reconstruction. Extensive qualitative and quantitative experimental evaluation (where OCT scans are used as 3D ground truth) on our and publicly available datasets shows the superiority of the proposed method in comparison to other alternatives.
Collapse
|
16
|
Li SKL, Banerjee J, Jang C, Sehgal A, Stone RA, Civan MM. Temperature oscillations drive cycles in the activity of MMP-2,9 secreted by a human trabecular meshwork cell line. Invest Ophthalmol Vis Sci 2015; 56:1396-405. [PMID: 25655795 DOI: 10.1167/iovs.14-15834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Aqueous humor inflow falls 50% during sleeping hours without proportional fall in IOP, partly reflecting reduced outflow facility. The mechanisms underlying outflow facility cycling are unknown. One outflow facility regulator is matrix metalloproteinase (MMP) release from trabecular meshwork (TM) cells. Because anterior segment temperature must oscillate due to core temperature cycling and eyelid closure during sleep, we tested whether physiologically relevant temperature oscillations drive cycles in the activity of secreted MMP. METHODS Temperature of transformed normal human TM cells (hTM5 line) was fixed or alternated 12 hours/12 hours between 33°C and 37°C. Activity of secreted MMP-2 and MMP-9 was measured by zymography, and gene expression by RT-PCR and quantitative PCR. RESULTS Raising temperature to 37°C increased, and lowering to 33°C reduced, activity of secreted MMP. Switching between 37°C and 33°C altered MMP-9 by 40% ± 3% and MMP-2 by 22% ± 2%. Peripheral circadian clocks did not mediate temperature-driven cycling of MMP secretion because MMP-release oscillations did not persist at constant temperature after 3 to 6 days of alternating temperatures, and temperature cycles did not entrain clock-gene expression in these cells. Furthermore, inhibiting heat shock transcription factor 1, which links temperature and peripheral clock-gene oscillations, inhibited MMP-9 but not MMP-2 temperature-driven MMP cycling. Inhibition of heat-sensitive TRPV1 channels altered total MMP secretion but not temperature-induced modulations. Inhibiting cold-sensitive TRPM-8 channels had no effect. CONCLUSIONS Physiologically relevant temperature oscillations drive fluctuations of secreted MMP-2 and MMP-9 activity in hTM5 cells independent of peripheral clock genes and temperature-sensitive TRP channels.
Collapse
Affiliation(s)
- Stanley Ka-Lok Li
- Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Juni Banerjee
- Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Christopher Jang
- Department of Biology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Amita Sehgal
- Department of Neuroscience, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Richard A Stone
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Mortimer M Civan
- Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| |
Collapse
|
17
|
|
18
|
Guggenheim JA, McMahon G, Northstone K, Mandel Y, Kaiserman I, Stone RA, Lin X, Saw SM, Forward H, Mackey DA, Yazar S, Young TL, Williams C. Birth order and myopia. Ophthalmic Epidemiol 2013; 20:375-84. [PMID: 24168726 DOI: 10.3109/09286586.2013.848457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE An association between birth order and reduced unaided vision (a surrogate for myopia) has been observed previously. We examined the association between birth order and myopia directly in four subject groups. METHODS Subject groups were participants in (1) the Avon Longitudinal Study of Parents and Children (ALSPAC; UK; age 15 years; N = 4401), (2) the Singapore Cohort Study of Risk Factors for Myopia (SCORM; Singapore; age 13 years; N = 1959), (3) the Raine Eye Health Study (REHS; Australia; age 20 years; N = 1344), and (4) Israeli Defense Force Pre-recruitment Candidates (IDFC; Israel; age 16-22 years; N = 888,277). The main outcome was odds ratios (OR) for myopia in first-born versus non-first-born individuals after adjusting for potential risk factors. RESULTS The prevalence of myopia was numerically higher in first-born versus non-first-born individuals in all study groups, but the strength of evidence varied widely. Adjusted ORs (95% confidence intervals, CIs) were: ALSPAC, 1.31 (1.05-1.64); SCORM, 1.25 (0.89-1.77); REHS, 1.18 (0.90-1.55); and IDFC, 1.04 (1.03-1.06). In the large IDFC sample, the effect size was greater (a) for the first-born versus fourth- or higher-born comparison than for the first-born versus second/third-born comparison (p < 0.001) and (b) with increasing myopia severity (p < 0.001). CONCLUSIONS Across all studies, the increased risk of myopia in first-born individuals was low (OR < 1.3). Indeed, only the studies with >4000 participants provided strong statistical support for the association. The available evidence suggested the relationship was independent of established risk factors such as time outdoors/reading, and thus may arise through a different causal mechanism.
Collapse
|
19
|
Stone RA, Pardue MT, Iuvone PM, Khurana TS. Pharmacology of myopia and potential role for intrinsic retinal circadian rhythms. Exp Eye Res 2013; 114:35-47. [PMID: 23313151 DOI: 10.1016/j.exer.2013.01.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 12/22/2012] [Accepted: 01/02/2013] [Indexed: 12/27/2022]
Abstract
Despite the high prevalence and public health impact of refractive errors, the mechanisms responsible for ametropias are poorly understood. Much evidence now supports the concept that the retina is central to the mechanism(s) regulating emmetropization and underlying refractive errors. Using a variety of pharmacologic methods and well-defined experimental eye growth models in laboratory animals, many retinal neurotransmitters and neuromodulators have been implicated in this process. Nonetheless, an accepted framework for understanding the molecular and/or cellular pathways that govern postnatal eye development is lacking. Here, we review two extensively studied signaling pathways whose general roles in refractive development are supported by both experimental and clinical data: acetylcholine signaling through muscarinic and/or nicotinic acetylcholine receptors and retinal dopamine pharmacology. The muscarinic acetylcholine receptor antagonist atropine was first studied as an anti-myopia drug some two centuries ago, and much subsequent work has continued to connect muscarinic receptors to eye growth regulation. Recent research implicates a potential role of nicotinic acetylcholine receptors; and the refractive effects in population surveys of passive exposure to cigarette smoke, of which nicotine is a constituent, support clinical relevance. Reviewed here, many puzzling results inhibit formulating a mechanistic framework that explains acetylcholine's role in refractive development. How cholinergic receptor mechanisms might be used to develop acceptable approaches to normalize refractive development remains a challenge. Retinal dopamine signaling not only has a putative role in refractive development, its upregulation by light comprises an important component of the retinal clock network and contributes to the regulation of retinal circadian physiology. During postnatal development, the ocular dimensions undergo circadian and/or diurnal fluctuations in magnitude; these rhythms shift in eyes developing experimental ametropia. Long-standing clinical ideas about myopia in particular have postulated a role for ambient lighting, although molecular or cellular mechanisms for these speculations have remained obscure. Experimental myopia induced by the wearing of a concave spectacle lens alters the retinal expression of a significant proportion of intrinsic circadian clock genes, as well as genes encoding a melatonin receptor and the photopigment melanopsin. Together this evidence suggests a hypothesis that the retinal clock and intrinsic retinal circadian rhythms may be fundamental to the mechanism(s) regulating refractive development, and that disruptions in circadian signals may produce refractive errors. Here we review the potential role of biological rhythms in refractive development. While much future research is needed, this hypothesis could unify many of the disparate clinical and laboratory observations addressing the pathogenesis of refractive errors.
Collapse
Affiliation(s)
- Richard A Stone
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Scheie Eye Institute, D-603 Richards Building, Philadelphia, PA 19104-6075, USA.
| | | | | | | |
Collapse
|
20
|
Abstract
Genetic and environmental factors have been shown to control visually-guided eye growth and influence myopia development. However, investigations into the intersection of these two factors in controlling refractive development have been limited by the lack of a genetically modifiable animal model. Technological advances have now made it possible to assess refractive state and ocular biometry in the small mouse eye and therefore to exploit the many genetic mouse mutants to investigate mechanisms of visually-guided eye growth. This review considers the benefits and challenges of studying refractive development in mice, compares the results of refractive error and ocular biometry from wild-type strains and genetic models in normal laboratory visual environments or with disrupted visual input, and discusses some of the remaining challenges in interpreting data from the mouse to validate and standardize methods between labs.
Collapse
Affiliation(s)
- Machelle T Pardue
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
| | | | | |
Collapse
|
21
|
Wang L, Kallem V, Bansal M, Eledath J, Sawhney H, Karp K, Pearson DJ, Mills MD, Quinn GE, Stone RA. Interactive Retinal Vessel Extraction by Integrating Vessel Tracing and Graph Search. ACTA ACUST UNITED AC 2013; 16:567-74. [DOI: 10.1007/978-3-642-40763-5_70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
|
22
|
Roberts CM, Stone RA, Buckingham RJ, Pursey NA, Lowe D. Authors' response. Thorax 2012. [DOI: 10.1136/thx.2011.161299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
23
|
Lehman JS, Kalaaji AN, Rogers RS, Stone RA. Pemphigoid nodularis: a case report. Cutis 2011; 88:224-226. [PMID: 22272483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Several variants of bullous pemphigoid have been reported including pemphigoid nodularis. Patients with pemphigoid nodularis have clinical features of prurigo nodularis in combination with clinical or immunologic characteristics of bullous pemphigoid. We report the case of a 71-year-old woman with pemphigoid nodularis. The diagnosis was suspected clinically and established by positive indirect immunofluorescence (IIF) findings characteristic of pemphigoid. Results of direct immunofluorescence (DIF) testing were negative, which emphasizes the importance of conducting both DIF and IIF when pemphigoid nodularis is suspected.
Collapse
Affiliation(s)
- Julia S Lehman
- Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | | | | |
Collapse
|
24
|
George PM, Stone RA, Buckingham RJ, Pursey NA, Lowe D, Roberts CM. Changes in NHS organization of care and management of hospital admissions with COPD exacerbations between the national COPD audits of 2003 and 2008. QJM 2011; 104:859-66. [PMID: 21622541 DOI: 10.1093/qjmed/hcr083] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The 2003 UK Chronic Obstructive Pulmonary Disease (COPD) audit revealed wide variability between hospital units in care delivered. AIMS To assess whether processes of care, patient outcomes and organization of care have improved since 2003. DESIGN A UK national audit was performed in 2008 to survey the organization and delivery of clinical care provided to patients admitted to hospital with COPD. METHODS All UK acute hospital Trusts (units) were invited to participate. Each unit completed cross-sectional resource and organization questionnaires and a prospective clinical audit comprising up to 60 consecutively admitted cases of COPD exacerbation. Comparison between 2003 and 2008 includes aggregated statistics for units participating in both audit rounds. RESULTS A total of 192 units participated in both audit rounds (6197 admissions in 2003 and 8170 in 2008). In 2008, patients were older and of a poorer functional class. Overall mortality was unchanged but adjusting for age and performance status, inpatient mortality (P = 0.05) and 90-day mortality (P = 0.001) were both reduced in 2008. More patients were discharged under a respiratory specialist (P < 0.01), treated with non-invasive ventilation if acidotic (P < 0.001) and accepted onto early discharge schemes (P < 0.01) while median length of stay fell from 6 to 5 days (P < 0.001). Within these mean data, however, there remains considerable inter-unit variation in organization, resources and outcomes. CONCLUSION Overall improvements in resources and organization are accompanied by reduced mortality, shorter admissions and greater access to specialist services. There remains, however, considerable variation in the quality of secondary care provided between units.
Collapse
Affiliation(s)
- P M George
- Chest and Allergy Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | | |
Collapse
|
25
|
Stone RA, McGlinn AM, Baldwin DA, Tobias JW, Iuvone PM, Khurana TS. Image defocus and altered retinal gene expression in chick: clues to the pathogenesis of ametropia. Invest Ophthalmol Vis Sci 2011; 52:5765-77. [PMID: 21642623 DOI: 10.1167/iovs.10-6727] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Because of the retina's role in refractive development, this study was conducted to analyze the retinal transcriptome in chicks wearing a spectacle lens, a well-established means of inducing refractive errors, to identify gene expression alterations and to develop novel mechanistic hypotheses about refractive development. METHODS One-week-old white Leghorn chicks wore a unilateral spectacle lens of +15 or -15 D for 6 hours or 3 days. With total RNA from the retina/(retinal pigment epithelium, RPE), chicken gene microarrays were used to compare gene expression levels between lens-wearing and contralateral control eyes (n = 6 chicks for each condition). Normalized microarray signal intensities were evaluated by analysis of variance, using a false discovery rate of <10% as the statistical criterion. Selected differentially expressed genes were validated by qPCR. RESULTS Very few retina/RPE transcripts were differentially expressed after plus lens wear. In contrast, approximately 1300 transcripts were differentially expressed under each of the minus lens conditions, with minimal overlap. For each condition, low fold-changes typified the altered transcriptome. Differentially regulated genes under the minus lens conditions included many potentially informative signaling molecules and genes whose protein products have roles in intrinsic retinal circadian rhythms. CONCLUSIONS Plus or minus lens wear induce markedly different, not opposite, alterations in retina/RPE gene expression. The initial retinal responses to defocus are quite different from those when the eye growth patterns are well established, suggesting that different mechanisms govern the initiation and persistence or progression of refractive errors. The gene lists identify promising signaling candidates and regulatory pathways for future study, including a potential role for circadian rhythms in refractive development.
Collapse
Affiliation(s)
- Richard A Stone
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Scheie Eye Institute, Philadelphia, Pennsylvania 19104-6075, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Roberts CM, Stone RA, Buckingham RJ, Pursey NA, Harrison BDW, Lowe D, Potter JM. A randomised trial of peer review: the UK National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project. Clin Med (Lond) 2010; 10:223-7. [PMID: 20726448 DOI: 10.7861/clinmedicine.10-3-223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Peer review has been widely employed within the NHS to facilitate health quality improvement but has not been rigorously evaluated. This article reports the largest randomised trial of peer review ever conducted in the UK. The peer review intervention was a reciprocal supportive exercise that included clinicians, hospital management, commissioners and patients which focused on the quality of the provision of four specific evidence-based aspects of chronic obstructive pulmonary disease care. Follow up at 12 months demonstrated few quantitative differences in the number or quality of services offered in the two groups. Qualitative data in contrast suggested many benefits of peer review in most but not all intervention units and some control teams. Findings suggest peer review in this format is a positive experience for most participants but is ineffective in some situations. Its longer term benefits and cost effectiveness require further study. The generic findings of this study have potential implications for the application of peer review throughout the NHS.
Collapse
Affiliation(s)
- C M Roberts
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians
| | | | | | | | | | | | | |
Collapse
|
27
|
Stone RA, Ying GS, Pearson DJ, Bansal M, Puri M, Miller E, Alexander J, Piltz-Seymour J, Nyberg W, Maguire MG, Eledath J, Sawhney H. Utility of digital stereo images for optic disc evaluation. Invest Ophthalmol Vis Sci 2010; 51:5667-74. [PMID: 20505199 DOI: 10.1167/iovs.09-4999] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the suitability of digital stereo images for optic disc evaluations in glaucoma. METHODS Stereo color optic disc images in both digital and 35-mm slide film formats were acquired contemporaneously from 29 subjects with various cup-to-disc ratios (range, 0.26-0.76; median, 0.475). Using a grading scale designed to assess image quality, the ease of visualizing optic disc features important for glaucoma diagnosis, and the comparative diameters of the optic disc cup, experienced observers separately compared the primary digital stereo images to each subject's 35-mm slides, to scanned images of the same 35-mm slides, and to grayscale conversions of the digital images. Statistical analysis accounted for multiple gradings and comparisons and also assessed image formats under monoscopic viewing. RESULTS Overall, the quality of primary digital color images was judged superior to that of 35-mm slides (P < 0.001), including improved stereo (P < 0.001), but the primary digital color images were mostly equivalent to the scanned digitized images of the same slides. Color seemingly added little to grayscale optic disc images, except that peripapillary atrophy was best seen in color (P < 0.0001); both the nerve fiber layer (P < 0.0001) and the paths of blood vessels on the optic disc (P < 0.0001) were best seen in grayscale. The preference for digital over film images was maintained under monoscopic viewing conditions. CONCLUSIONS Digital stereo optic disc images are useful for evaluating the optic disc in glaucoma and allow the application of advanced image processing applications. Grayscale images, by providing luminance distinct from color, may be informative for assessing certain features.
Collapse
Affiliation(s)
- Richard A Stone
- Department of Ophthalmology, University of Pennsylvania, Scheie Eye Institute, Philadelphia, Pennsylvania 19104-3309, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Stone RA, Khurana TS. Gene profiling in experimental models of eye growth: clues to myopia pathogenesis. Vision Res 2010; 50:2322-33. [PMID: 20363242 DOI: 10.1016/j.visres.2010.03.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 03/18/2010] [Accepted: 03/22/2010] [Indexed: 12/22/2022]
Abstract
To understand the complex regulatory pathways that underlie the development of refractive errors, expression profiling has evaluated gene expression in ocular tissues of well-characterized experimental models that alter postnatal eye growth and induce refractive errors. Derived from a variety of platforms (e.g. differential display, spotted microarrays or Affymetrix GeneChips), gene expression patterns are now being identified in species that include chicken, mouse and primate. Reconciling available results is hindered by varied experimental designs and analytical/statistical features. Continued application of these methods offers promise to provide the much-needed mechanistic framework to develop therapies to normalize refractive development in children.
Collapse
Affiliation(s)
- Richard A Stone
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Scheie Eye Institute, Philadelphia, PA 19104-6075, USA.
| | | |
Collapse
|
29
|
Affiliation(s)
- Yossi Mandel
- From the Israel Defense Force Medical Corps Headquarters, Ramat-Gan, Israel; the 2Hebrew University, Center for Bioengineering in the Service of Humanity and Society, Jerusalem, Israel
| | - Richard A. Stone
- the Department of Ophthalmology, University of Pennsylvania, Scheie Eye Institute, Philadelphia, Pennsylvania; and
| | - David Zadok
- the Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Zrifin, Israel
| |
Collapse
|
30
|
Wang Z, Do CW, Avila MY, Peterson-Yantorno K, Stone RA, Gao ZG, Joshi B, Besada P, Jeong LS, Jacobson KA, Civan MM. Nucleoside-derived antagonists to A3 adenosine receptors lower mouse intraocular pressure and act across species. Exp Eye Res 2010; 90:146-54. [PMID: 19878673 PMCID: PMC2789191 DOI: 10.1016/j.exer.2009.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 10/02/2009] [Accepted: 10/07/2009] [Indexed: 11/21/2022]
Abstract
The purpose of the study was to determine whether novel, selective antagonists of human A3 adenosine receptors (ARs) derived from the A3-selective agonist Cl-IB-MECA lower intraocular pressure (IOP) and act across species. IOP was measured invasively with a micropipette by the Servo-Null Micropipette System (SNMS) and by non-invasive pneumotonometry during topical drug application. Antagonist efficacy was also assayed by measuring inhibition of adenosine-triggered shrinkage of native bovine nonpigmented ciliary epithelial (NPE) cells. Five agonist-based A3AR antagonists lowered mouse IOP measured with SNMS tonometry by 3-5 mm Hg within minutes of topical application. Of the five agonist derivatives, LJ 1251 was the only antagonist to lower IOP measured by pneumotonometry. No effect was detected pneumotonometrically over 30 min following application of the other four compounds, consonant with slower, smaller responses previously measured non-invasively following topical application of A3AR agonists and the dihydropyridine A3AR antagonist MRS 1191. Latanoprost similarly lowered SNMS-measured IOP, but not IOP measured non-invasively over 30 min. Like MRS 1191, agonist-based A3AR antagonists applied to native bovine NPE cells inhibited adenosine-triggered shrinkage. In summary, the results indicate that antagonists of human A3ARs derived from the potent, selective A3 agonist Cl-IB-MECA display efficacy in mouse and bovine cells, as well. When intraocular delivery was enhanced by measuring mouse IOP invasively, five derivatives of the A3AR agonist Cl-IB-MECA lowered IOP but only one rapidly reduced IOP measured non-invasively after topical application. We conclude that derivatives of the highly-selective A3AR agonist Cl-IB-MECA can reduce IOP upon reaching their intraocular target, and that nucleoside-based derivatives are promising A3 antagonists for study in multiple animal models.
Collapse
Affiliation(s)
- Zhao Wang
- Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6085, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Cone LA, Stone RA, Schlievert PM, Sneider RA, Rubin AM, Jesser K, Renker SW. An early favorable outcome of streptococcal toxic shock syndrome may require a combination of antimicrobial and intravenous gamma globulin therapy together with activated protein C. ACTA ACUST UNITED AC 2009; 38:960-3. [PMID: 17148061 DOI: 10.1080/00365540500373224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Streptococcal toxic shock syndrome (STSS) associated with a group A beta hemolytic streptococcal infection was described 18 y ago. Since then, although the pathophysiology of the syndrome has been clarified, mortality can be as high as 80%. A middle-aged female developed STSS associated with a group A streptococcal pneumonia. Laboratory studies confirmed respiratory and renal failure as well as disseminated intravascular coagulation with a striking reduction in endogenous procoagulants. The patient, probably due to her HLA DRB1*14 haplotype was unable to generate anti-streptococcal antibodies. She was treated with appropriate antimicrobial therapy together with intravenous gamma globulin and drotrecogin or activated protein C. Her response to this combined therapy was accompanied by a rapid resolution of the multiorgan failure and correction of the accompanying disseminated intravascular coagulation. This rapid response to treatment supports the hypohesis that several host factors including the immune response and loss of procoagulants determine the development and severity of the toxic shock syndromes. Further studies with this combined approach appear warranted.
Collapse
Affiliation(s)
- Lawrence A Cone
- Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA 92270, USA.
| | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
PURPOSE To learn if peripheral nerve pathways are necessary for corneal expansion and anterior segment growth under a 12-hr light:dark cycle or for the inhibition of corneal expansion under constant light rearing. METHODS Recently hatched White Leghorn chicks under anesthesia received unilateral ciliary ganglionectomy (CGx), cranial cervical ganglionectomy (Sx), or section of the ophthalmic nerve (TGx), along with sham-operated and/or never-operated control cohorts. Chicks were reared postoperatively under either a 12-hr light:dark cycle or under constant light. After 2 weeks and with the chicks under anesthesia, corneal radii of curvature and diameters were obtained with a photokeratoscope, refractometry and A-scan ultrasonography were performed, and the axial and equatorial dimensions of enucleated eyes were measured with digital calipers. Corneal areas were calculated from corneal curvatures and diameters. RESULTS Despite the rich peripheral innervation to the eye, the selective denervations performed here exerted remarkably limited effects on corneal expansion and anterior segment development in chicks reared under either lighting condition. Ophthalmic nerve section did reverse in large part the inhibition of equatorial expansion of the vitreous chamber occurring under constant light rearing. CONCLUSIONS The ciliary, sympathetic, or ophthalmic peripheral nerve pathways to the eye are not required either for corneal expansion and anterior segment development under a 12-hr light:dark cycle or for the inhibition of corneal expansion under constant light rearing. The ocular sensory innervation may be a means for regulating vitreous cavity shape.
Collapse
Affiliation(s)
- Richard A Stone
- Department of Ophthalmology, University of Pennsylvania, School of Medicine, Scheie Eye Institute, Philadelphia, Pennsylvania 19104-6075, USA.
| | | | | | | | | |
Collapse
|
33
|
Liu J, McGlinn AM, Fernandes A, Milam AH, Strang CE, Andison ME, Lindstrom JM, Keyser KT, Stone RA. Nicotinic acetylcholine receptor subunits in rhesus monkey retina. Invest Ophthalmol Vis Sci 2008; 50:1408-15. [PMID: 18952912 DOI: 10.1167/iovs.08-2398] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The purpose of this study was to detect and establish the cellular localizations of nicotinic acetylcholine receptor (nAChR) subunits in Rhesus monkey retina. METHODS Retinas were dissected from the eyes of monkeys killed after unrelated experiments. RNA was extracted and analyzed by RT-PCR, using primers designed against human sequences of alpha3-alpha7, alpha9, and beta2-beta4 nAChR subunits. The RT-PCR products were separated by gel electrophoresis and sequenced. Frozen sections of postmortem fixed monkey eyes were immunolabeled with well-characterized and specific monoclonal antibodies against the alpha3, alpha4, alpha6, alpha7, beta2, or beta4 nAChR subunits and visualized with fluorescence labeling. RESULTS Products of the predicted size for the alpha3-alpha7, alpha9, and beta2-beta4 nAChR subunits were detected by RT-PCR in Rhesus monkey retina. Homology between transcripts from monkey retina and human nucleotide sequences ranged from 93 to 99%. Immunohistochemical studies demonstrated that neurons in various cell layers of monkey retina expressed alpha3, alpha4, alpha7, or beta2 nAChR subunits and cells with the morphology of microglia were immunoreactive for the alpha6 or beta4 nAChR subunits. CONCLUSIONS nAChR subunits are expressed in the monkey retina and localize to diverse retinal neurons as well as putative microglia. Besides mediating visual processing, retinal nAChRs may influence refractive development and ocular pathologies such as neovascularization.
Collapse
Affiliation(s)
- Ji Liu
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6075, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
Patients with chronic obstructive pulmonary disease (COPD) have significant end-of-life needs, but are much less likely than patients with cancer to access or receive appropriate palliative care. Little is known about the existing availability or quality of available services within the United Kingdom. We surveyed 100 NHS acute hospitals enquiring into the provision of care for patients with COPD and requesting examples of current good practice that might be used to set standards. Forty-two percent of hospitals had formal palliative care arrangements for patients with COPD, whereas 59% had plans to develop or further develop services. Analysis of qualitative data suggested four strands that highlighted good practice; teams, care pathways, service components and linkages. These data may help to inform the debate leading to the development of standards in end-of-life care for patients with COPD.
Collapse
Affiliation(s)
- C M Roberts
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, London, UK.
| | | | | | | |
Collapse
|
35
|
McLaughlin CW, Karl MO, Zellhuber-McMillan S, Wang Z, Do CW, Leung CT, Li A, Stone RA, Macknight ADC, Civan MM. Electron probe X-ray microanalysis of intact pathway for human aqueous humor outflow. Am J Physiol Cell Physiol 2008; 295:C1083-91. [PMID: 18753314 DOI: 10.1152/ajpcell.340.2008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intraocular pressure (IOP) is regulated by the resistance to outflow of the eye's aqueous humor. Elevated resistance raises IOP and can cause glaucoma. Despite the importance of outflow resistance, its site and regulation are unclear. The small size, complex geometry, and relative inaccessibility of the outflow pathway have limited study to whole animal, whole eye, or anterior-segment preparations, or isolated cells. We now report measuring elemental contents of the heterogeneous cell types within the intact human trabecular outflow pathway using electron-probe X-ray microanalysis. Baseline contents of Na(+), K(+), Cl(-), and P and volume (monitored as Na+K contents) were comparable to those of epithelial cells previously studied. Elemental contents and volume were altered by ouabain to block Na(+)-K(+)-activated ATPase and by hypotonicity to trigger a regulatory volume decrease (RVD). Previous results with isolated trabecular meshwork (TM) cells had disagreed whether TM cells express an RVD. In the intact tissue, we found that all cells, including TM cells, displayed a regulatory solute release consistent with an RVD. Selective agonists of A(1) and A(2) adenosine receptors (ARs), which exert opposite effects on IOP, produced similar effects on juxtacanalicular (JCT) cells, previously inaccessible to functional study, but not on Schlemm's canal cells that adjoin the JCT. The results obtained with hypotonicity and AR agonists indicate the potential of this approach to dissect physiological mechanisms in an area that is extremely difficult to study functionally and demonstrate the utility of electron microprobe analysis in studying the cellular physiology of the human trabecular outflow pathway in situ.
Collapse
|
36
|
Brown JS, Flitcroft DI, Ying GS, Francis EL, Schmid GF, Quinn GE, Stone RA. In vivo human choroidal thickness measurements: evidence for diurnal fluctuations. Invest Ophthalmol Vis Sci 2008; 50:5-12. [PMID: 18719079 DOI: 10.1167/iovs.08-1779] [Citation(s) in RCA: 169] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The authors applied partial coherence interferometry (PCI) to estimate the thickness of the human choroid in vivo and to learn whether it fluctuates during the day. METHODS By applying signal processing techniques to existing PCI tracings of human ocular axial length measurements, a signal modeling algorithm was developed and validated to determine the position and variability of a postretinal peak that, by analogy to animal studies, likely corresponds to the choroidal/scleral interface. The algorithm then was applied to diurnal axial eye length datasets. RESULTS The postretinal peak was identified in 28% of subjects in the development and validation datasets, with mean subfoveal choroidal thicknesses of 307 and 293 microm, respectively. Twenty-eight of 40 diurnal PCI datasets had at least two time points with identifiable postretinal peaks, yielding a mean choroidal thickness of 426 microm and a mean high-low difference in choroidal thickness of 59.5 +/- 24.2 microm (range, 25.9-103 microm). The diurnal choroidal thickness fluctuation was larger than twice the SE of measurement (24.5 microm) in 16 of these 28 datasets. Axial length and choroidal thickness tended to fluctuate in antiphase. CONCLUSIONS Signal processing techniques provide choroidal thickness estimates in many, but not all, PCI datasets of axial eye measurements. Based on eyes with identifiable postretinal peaks at more than one time in a day, choroidal thickness varied over the day. Because of the established role of the choroid in retinal function and its possible role in regulating eye growth, further development and refinement of clinical methods to measure its thickness are warranted.
Collapse
Affiliation(s)
- Jamin S Brown
- Kresge Eye Institute, Wayne State University, Detroit, Michigan 48236, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Cone LA, Brochert A, Schulz K, Stone RA, Kazi A, Greene D. PET Positive Generalized Lymphadenopathy and Splenomegaly Following Interferon-alfa-2b Adjuvant Therapy for Melanoma. Clin Nucl Med 2007; 32:793-6. [PMID: 17885361 DOI: 10.1097/rlu.0b013e318148afa5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Interferon-alfa (IFN-alpha) is used in patients with various inflammatory and neoplastic disorders. We recently encountered fluorodeoxyglucose (FDG) uptake in generalized lymphadenopathy, splenomegaly, and the marrow in a patient receiving high dose interferon-alpha-2b (IFN-alpha) as adjuvant therapy for the treatment of malignant melanoma. Biopsy of an enlarged hypermetabolic axillary lymph node revealed only a reactive node. Discontinuation of IFN-alpha caused regression of splenomegaly and lymphadenopathy within 3 months.A marrow "hyperstimulation" pattern that can include the spleen is a well-recognized phenomenon on (fluorodeoxyglucose) FDG positron emission tomography/computed tomography (PET/CT) scans in patients receiving chemotherapeutic agents like interferon, though classically due to colony stimulating factors, but does not generally include lymphadenopathy. This case, which likely reflects an interferon-induced pseudolymphoma, highlights the importance of a drug history and clinical correlation for the proper interpretation of FDG PET/CT scans.
Collapse
Affiliation(s)
- Lawrence A Cone
- Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA 92270, USA
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
A vision-dependent feedback mechanism contributes to the regulation of postnatal eye growth and refraction; this mechanism is located at least in part in the retina. In chicks and rhesus monkeys, visual deprivation leads to ocular enlargement and a myopic refractive error, and it also reduces the retinal concentration of dopamine. In neonatal chicks, local application of the dopamine agonist apomorphine limits the excessive axial elongation that is associated with visual deprivation. Both D1 and D2 dopamine receptor mechanisms may participate. Remarkably, apomorphine is geometrically selective, not limiting the exaggerated equatorial growth that occurs during visual deprivation. Preliminary results in neonatal rhesus monkeys indicate that apomorphine eye drops also suppress exaggerated axial growth and myopic refractive error during visual deprivation; equatorial diameters were not measured. Our observations are consistent with a retinal hypothesis for emmetropization and suggest that retinal dopamine participates in a mechanism linking ocular growth control to vision. In addition, we conclude that axial and equatorial dimensions are independently regulated in the chick.
Collapse
Affiliation(s)
- R A Stone
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Scheie Eye Institute, Philadelphia 19104-6075
| | | | | | | |
Collapse
|
39
|
McGlinn AM, Baldwin DA, Tobias JW, Budak MT, Khurana TS, Stone RA. Form-deprivation myopia in chick induces limited changes in retinal gene expression. Invest Ophthalmol Vis Sci 2007; 48:3430-6. [PMID: 17652709 PMCID: PMC1983368 DOI: 10.1167/iovs.06-1538] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Evidence has implicated the retina as a principal controller of refractive development. In the present study, the retinal transcriptome was analyzed to identify alterations in gene expression and potential signaling pathways involved in form-deprivation myopia of the chick. METHODS One-week-old white Leghorn chicks wore a unilateral image-degrading goggle for 6 hours or 3 days (n = 6 at each time). Total RNA from the retina/(retinal pigment epithelium) was used for expression profiling with chicken gene microarrays (Chicken GeneChips; Affymetrix, Santa Clara, CA). To identify gene expression level differences between goggled and contralateral nongoggled eyes, normalized microarray signal intensities were analyzed by the significance analysis of microarrays (SAM) approach. Differentially expressed genes were validated by real-time quantitative reverse transcription-polymerase chain reaction (qPCR) in independent biological replicates. RESULTS Small changes were detected in differentially expressed genes in form-deprived eyes. In chickens that had 6 hours of goggle wear, downregulation of bone morphogenetic protein 2 and connective tissue growth factor was validated. In those with 3 days of goggle wear, downregulation of bone morphogenetic protein 2, vasoactive intestinal peptide, preopro-urotensin II-related peptide and mitogen-activated protein kinase phosphatase 2 was validated, and upregulation of endothelin receptor type B and interleukin-18 was validated. CONCLUSIONS Form-deprivation myopia, in its early stages, is associated with only minimal changes in retinal gene expression at the level of the transcriptome. While the list of validated genes is short, each merits further study for potential involvement in the signaling cascade mediating myopia development.
Collapse
Affiliation(s)
- Alice M. McGlinn
- From the Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Donald A. Baldwin
- From the Departments of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John W. Tobias
- From the Department of the Bioinformatics Core, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- From the Department of the Pennsylvania Muscle Institute, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Murat T. Budak
- From the Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Tejvir S. Khurana
- From the Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Richard A. Stone
- From the Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
40
|
Abstract
PURPOSE To explore the effect of dominance and laterality on refractive error and axial length. METHODS Ocular dominance was assessed with the hole-in-the-card test in 543 children during their 2006 follow-up visits for the Singapore Cohort study Of the Risk factors for Myopia (SCORM). Data were compared to cycloplegic refractions and axial lengths measured by ultrasound. RESULTS The spherical equivalent refraction was essentially the same between the right and left eyes, although there was a small but statistically significant longer axial length in the right eyes. Right and left ocular dominance was noted in 58% and 30% of the subjects, respectively, with 12% having no eye preference. There was no significant difference in spherical equivalent refraction (2.56 +/- 2.46 D [mean +/- SD] vs. -2.45 +/- 2.52 D, P = 0.22) or axial length (24.36 +/- 1.19 mm vs. 24.32 +/- 1.18 mm, P = 0.05) between dominant and nondominant eyes. In subjects with anisometropia >or=0.5 D, dominant eyes were more myopic in 52%. Dominant eyes, however, had less astigmatic power (-0.88 +/- 0.80 D versus -1.00 +/- 0.92 D; P < 0.001). CONCLUSIONS Ocular laterality and dominance have no significant effect on spherical equivalent. All axial length and astigmatic differences were small and clinically insignificant. The study findings suggest that in Singaporean children, bias is not present in those investigations that restrict analyses to right or left eyes. Although there is no apparent association between refraction and ocular dominance in young Singaporean children, more research is needed to resolve the disparate results in existing reports.
Collapse
Affiliation(s)
- Audrey Chia
- Singapore Eye Research Institute, Singapore.
| | | | | | | | | | | | | |
Collapse
|
41
|
Aujesky D, Perrier A, Roy PM, Stone RA, Cornuz J, Meyer G, Obrosky DS, Fine MJ. Validation of a clinical prognostic model to identify low-risk patients with pulmonary embolism. J Intern Med 2007; 261:597-604. [PMID: 17547715 DOI: 10.1111/j.1365-2796.2007.01785.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To validate the Pulmonary Embolism Severity Index (PESI), a clinical prognostic model which identifies low-risk patients with pulmonary embolism (PE). DESIGN Validation study using prospectively collected data. SETTING A total of 119 European hospitals. SUBJECTS A total of 899 patients diagnosed with PE. INTERVENTION The PESI uses 11 clinical factors to stratify patients with PE into five classes (I-V) of increasing risk of mortality. We calculated the PESI risk class for each patient and the proportion of patients classified as low-risk (classes I and II). The outcomes were overall and PE-specific mortality for low-risk patients at 3 months after presentation. We calculated the sensitivity, specificity and predictive values to predict overall and PE-specific mortality and the discriminatory power using the area under the receiver operating characteristic curve. RESULTS Overall and PE-specific mortality was 6.5% (58/899) and 2.3% (21/899) respectively. Forty-seven per cent of patients (426/899) were classified as low-risk. Low-risk patients had an overall mortality of only 1.2% (5/426) and a PE-specific mortality of 0.7% (3/426). The sensitivity was 91 [95% confidence interval (CI): 81-97%] and the negative predictive value was 99% (95% CI: 97-100%) for overall mortality. The sensitivity was 86% (95% CI: 64-97%) and the negative predictive value was 99% (95% CI: 98-100%) for PE-specific mortality. The areas under the receiver operating characteristic curve for overall and PE-specific mortality were 0.80 (95% CI: 0.75-0.86) and 0.77 (95% CI: 0.68-0.86) respectively. CONCLUSIONS This validation study confirms that the PESI reliably identifies low-risk patients with PE who are potential candidates for less costly outpatient treatment.
Collapse
Affiliation(s)
- D Aujesky
- Division of General Internal Medicine, University Outpatient Clinic, Clinical Epidemiology Center, University of Lausanne, Lausanne, Switzerland.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Wang Z, Do CW, Avila MY, Stone RA, Jacobson KA, Civan MM. Barrier qualities of the mouse eye to topically applied drugs. Exp Eye Res 2007; 85:105-12. [PMID: 17490649 PMCID: PMC2151915 DOI: 10.1016/j.exer.2007.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 03/02/2007] [Accepted: 03/09/2007] [Indexed: 11/20/2022]
Abstract
The mouse eye displays unusually rapid intraocular pressure (IOP) responses to topically applied drugs as measured by the invasive servo-null micropipette system (SNMS). To learn if the time course reflected rapid drug transfer across the thin mouse cornea and sclera, we monitored a different parameter, pupillary size, following topical application of droplets containing 40 microM (0.073 microg) carbachol. No miosis developed from this low carbachol concentration unless the cornea was impaled with an exploring micropipette as used in the SNMS. We also compared the mouse IOP response to several purinergic drugs, measured by the invasive SNMS and non-invasive pneumotonometry. Responses to the previously studied non-selective adenosine-receptor (AR) agonist adenosine, the A(3)-selective agonist Cl-IB-MECA and the A(3)-selective antagonist MRS 1191 were all enhanced to varying degrees, in time and magnitude, by corneal impalement. We conclude that the thin ocular coats of the mouse eye actually present a substantial barrier to drug penetration. Corneal impalement with even fine-tipped micropipettes can significantly enhance entry of topically-applied drugs into the mouse aqueous humor, reflecting either direct diffusion around the tip or a more complex impalement-triggered change in ocular barrier properties. Comparison of invasive and non-invasive measurement methods can document drug efficacy at intraocular target sites even if topical drug penetration is too slow to manifest convincing physiologic effects in intact eyes.
Collapse
Affiliation(s)
- Zhao Wang
- Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6085
| | - Chi Wai Do
- Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6085
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Marcel Y. Avila
- Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6085
- Department of Physiological Sciences, Facultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia
| | - Richard A. Stone
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6085
| | | | - Mortimer M. Civan
- Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6085
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6085
| |
Collapse
|
43
|
Stone RA, Wilson LB, Ying GS, Liu C, Criss JS, Orlow J, Lindstrom JM, Quinn GE. Associations between childhood refraction and parental smoking. Invest Ophthalmol Vis Sci 2006; 47:4277-87. [PMID: 17003416 DOI: 10.1167/iovs.05-1625] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Motivated by pharmacologic findings linking nicotinic acetylcholine receptors to eye development in chicks, the authors studied whether the refractions of children who were passively exposed to cigarette smoke by their parents differed from those of nonexposed children. METHODS A cross-sectional study was conducted among 323 patients (mean +/- SD age, 8.7 +/- 4.4 years; range, 1-20) in a tertiary care pediatric ophthalmology clinic. Half (162/323) of the subjects had strabismus. The accompanying parent completed a detailed questionnaire on parental smoking history and on putative risk factors for myopia. The results were compared to the subjects' cycloplegic refractions. RESULTS If one or both parents ever smoked, their children had a lower myopia prevalence (12.4% vs. 25.4%; P = 0.004) and more hyperopic mean refractions (1.83 +/- 0.24 vs. 0.96 +/- 0.27 diopters; P = 0.02) than those whose parents never smoked. Smoking by either parent during the mother's pregnancy had a similar effect on the child's refraction. The associations largely persisted, both in multivariate models that included adjustments for the child's age, child's body mass index, child's nearwork activity, parental myopia, and parental education and also in analysis by subgroups stratified by strabismus status. CONCLUSIONS Despite the complex constituents of cigarette smoke, neuropharmacology perspectives may prove useful in the development of new hypotheses to understand the mechanisms governing refractive development, not only in experimental animals but also in children. The associations of less prevalent myopia and a more hyperopic mean refraction with both prenatal and childhood exposures to tobacco smoke suggest that nongenetic, environmental exposures may have long-term influences on refraction and that further study of the role of nicotinic acetylcholine receptors in refractive development is warranted.
Collapse
Affiliation(s)
- Richard A Stone
- Department of Ophthalmology, Scheie Eye Institute, Philadelphia, PA 19104-6075, USA.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Wilson LB, Quinn GE, Ying GS, Francis EL, Schmid G, Lam A, Orlow J, Stone RA. The relation of axial length and intraocular pressure fluctuations in human eyes. Invest Ophthalmol Vis Sci 2006; 47:1778-84. [PMID: 16638981 DOI: 10.1167/iovs.05-0869] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine in human eyes whether diurnal fluctuations in axial length are related to fluctuations in intraocular pressure (IOP) by studying these fluctuations in both eyes of individual subjects and by assessing the regularity of both rhythms on two separate study days. METHODS Ten subjects, ages 18 to 24 years, underwent serial axial length and IOP measurements using highly precise, noncontact partial coherence interferometry and Goldmann applanation tonometry, respectively. Both eyes were measured at six 3-hour intervals during each of two study days, and significant fluctuations were modeled by sine curves. RESULTS Of the 40 data sets, 29 had significant axial length high-low differences and 32 had significant IOP high-low differences (ANOVA, P < 0.05 for each). The magnitude of the significant high-low differences were 38 +/- 22 microm for axial length and 6.0 +/- 1.9 mm Hg for IOP (mean +/- SD). Neither axial length nor IOP fluctuations necessarily occurred bilaterally on the same day, and neither rhythm was regularly observed on two separate days in individual eyes. In eyes in which both parameters fluctuated on the same day, there were no correlations in the amplitude, period or phase of the two rhythms. CONCLUSIONS Both axial length and IOP fluctuate during the day much of the time in most subjects. However, diurnal IOP fluctuations do not appear to cause diurnal axial length fluctuations.
Collapse
Affiliation(s)
- Lorri B Wilson
- Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, PA 19104, USA
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
PURPOSE To determine the risk factors of incident myopia in a school-based cohort study in Singaporean children. METHODS A 3-year prospective cohort study was conducted in Singaporean school children aged 7 to 9 years in three schools at entry. Chinese children without myopia at baseline (n = 994) were included in the analysis. The main outcome was incident myopia, defined as spherical equivalent (SE) at least -0.75 D based on cycloplegic autorefraction. Other definitions of incident myopia, at least -0.5 D and at least -1.0 D, were also assessed. RESULTS After controlling for school, age, gender, income, reading in books per week and intelligence quotient (IQ) test scores, we found the relative risk (RR) of incident myopia defined as -0.75 D to be 1.55 (95% confidence interval [CI] 1.18-2.04) for two versus no myopic parents. The multivariate RR of myopia for IQ in the third versus first tertile was 1.50 (95% CI, 1.19-1.89). However, the RR of incident myopia was 1.01 (95% CI, 0.97-1.05) for every unit increase in books read per week. Similar results were obtained with definitions of -0.5 and -1.0 D for incident myopia. CONCLUSIONS These data provide new prospective evidence of essential links between parental myopia, IQ scores and subsequent myopia development. However, reading in books per week was not associated with incident myopia.
Collapse
Affiliation(s)
- Seang-Mei Saw
- Department of Community, Occupational, and Family Medicine, National University of Singapore, Singapore.
| | | | | | | | | | | | | |
Collapse
|
46
|
Stone RA, Pendrak K, Sugimoto R, Lin T, Gill AS, Capehart C, Liu J. Local patterns of image degradation differentially affect refraction and eye shape in chick. Curr Eye Res 2006; 31:91-105. [PMID: 16421023 DOI: 10.1080/02713680500479517] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate visual blur as a mechanism for modulating eye shape. METHODS Chicks wore a unilateral full goggle or one of several goggles modified with apertures. After 2 weeks, eyes were measured with refractometry, ultrasound, and calipers, and three retinal regions were assayed for dopamine and DOPAC (3,4-dihydroxyphenylacetic acid). RESULTS Goggled eyes were diffusely enlarged or enlarged predominantly along the axial dimension, depending on the goggle. Myopia developed under goggle types inducing primarily axial growth and under some of the goggles inducing diffuse eye expansion. Enlarged eyes remained emmetropic beneath other goggles that caused diffuse eye expansion. Reductions in retinal dopamine and DOPAC were proportional to the eye growth and refraction effects. CONCLUSIONS Localized image degradation can cause myopia with predominantly axial expansion, myopia with more diffuse vitreous chamber expansion, or eye expansion without myopia. Robust expansion of the equatorial diameter alone was not observed. The associated alterations in retinal dopamine metabolism are consistent with a hypothesized role of dopaminergic amacrine cells in the visual regulation of eye growth. Besides refraction and overall size, visual blur can affect eye shape; but the goggle responses do not correspond to a simple summation of blur signals across the retina. Therefore, other mechanisms seemingly are needed to account for the full range of refractions and ocular shapes seen in chicks and, by analogy, in humans.
Collapse
Affiliation(s)
- Richard A Stone
- Department of Ophthalmology, University of Pennsylvania, School of Medicine, Scheie Eye Institute, Philadelphia, Pennsylvania 19104-6075, USA.
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
AIMS To assess the longitudinal changes in biometric parameters and associated factors in young myopic children aged 7--9 years followed prospectively in Singapore. METHODS Children aged 7--9 years from three Singapore schools were invited to participate in the SCORM (Singapore Cohort study Of the Risk factors for Myopia) study. Yearly eye examinations involving biometry measures were performed in the schools. Only myopic children (n=543) with 3 year follow up data were included in this analysis. RESULTS The 3 year increases in axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and corneal curvature were 0.89 mm, -0.02 mm, -0.01 mm, 0.92 mm, and 0.01 mm, respectively. Children who were younger, female, and who had a parental history of myopia were more likely to have greater increases in axial length. After adjustment for school, age, sex, race, parental myopia and reading in books per week, the age (p<0.001), sex (p=0.012), and parental myopia (p=0.027) remained significantly associated with the 3 year change in axial length. Reading in books per week, however, was not associated with axial length change. Children with faster rates of progression of myopia had greater increases in axial length (Pearson correlation coefficient (r)=-0.69) and vitreous chamber depth (r=-0.83). CONCLUSIONS The 3 year change in axial length of Singapore children aged 7--9 years at baseline was high and greater in younger children, females, and children with a parental history of myopia. Myopia progression was driven largely by vitreous chamber depth increase.
Collapse
Affiliation(s)
- S M Saw
- Department of Community, Occupational and Family Medicine, National University of Singapore, 16 Medical Drive, Singapore 117597, Republic of Singapore.
| | | | | | | | | | | |
Collapse
|
48
|
Avila MY, Múnera A, Guzmán A, Do CW, Wang Z, Stone RA, Civan MM. Noninvasive intraocular pressure measurements in mice by pneumotonometry. Invest Ophthalmol Vis Sci 2005; 46:3274-80. [PMID: 16123429 PMCID: PMC1350969 DOI: 10.1167/iovs.04-1188] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To develop a reliable, noninvasive, continuous, and easily implemented system for measuring intraocular pressure (IOP) in mice. METHODS Pneumotonometry was adapted for measurement of mouse IOP. Measurements were compared with those obtained with the servo-null micropipette system (SNMS) and with direct anterior chamber cannulation. Heart rate was monitored by the precordial pulse, EKG, or tail pulse in anesthetized mice. The characteristic ocular hypotensive response to mannitol was assessed as an additional validation of the METHOD RESULTS Measurements of IOP obtained using pneumotonometry agreed closely with values measured by SNMS or by direct cannulation. IOP oscillations were synchronous with the heart rate, with a coherence peak between them of approximately 2 Hz, equal to the pulse frequency. Hypertonic mannitol reduced IOP from 13.7 +/- 0.9 mm Hg by 7.7 +/- 0.7 mm Hg after 15 minutes. CONCLUSIONS Pneumotonometry is a reliable and noninvasive method for the measurement of IOP in mice and may permit comparisons of IOP to hemodynamic factors. This system is simpler and more adaptable for glaucoma research than previously reported methodologies for measuring IOP in mice.
Collapse
Affiliation(s)
- Marcel Y. Avila
- From the Department of Physiological Sciences, Facultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia; and the
- Departments of Physiology
| | - Alejandro Múnera
- From the Department of Physiological Sciences, Facultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia; and the
| | - Arcadio Guzmán
- From the Department of Physiological Sciences, Facultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia; and the
| | | | | | | | - Mortimer M. Civan
- Departments of Physiology
- Medicine, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania
- Corresponding author: Mortimer M. Civan, Department of Physiology, University of Pennsylvania School of Medicine, A303 Richards Building, Philadelphia, PA 19104-6085;
| |
Collapse
|
49
|
Yang H, Avila MY, Peterson-Yantorno K, Coca-Prados M, Stone RA, Jacobson KA, Civan MM. The cross-species A3 adenosine-receptor antagonist MRS 1292 inhibits adenosine-triggered human nonpigmented ciliary epithelial cell fluid release and reduces mouse intraocular pressure. Curr Eye Res 2005; 30:747-54. [PMID: 16146920 PMCID: PMC3471215 DOI: 10.1080/02713680590953147] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Antagonists to A3 adenosine receptors (ARs) lower mouse intraocular pressure (IOP), but extension to humans is limited by species variability. We tested whether the specific A3AR antagonist MRS 1292, designed to cross species, mimicks the effects of other A3AR antagonists on cultured human nonpigmented ciliary epithelial (NPE) cells and mouse IOP. METHODS NPE cell volume was monitored by electronic cell sorting. Mouse IOP was measured with the Servo-Null Micropipette System. RESULTS Adenosine triggered A3AR-mediated shrinkage of human NPE cells. Shrinkage was blocked by MRS 1292 (IC50 = 42 +/- 11 nM, p < 0.01) and by another A3AR antagonist effective in this system, MRS 1191. Topical application of the A3AR agonist IB-MECA increased mouse IOP. MRS 1292 reduced IOP by 4.0 +/- 0.8 mmHg at 25-microM droplet concentration (n = 10, p < 0.005). CONCLUSIONS MRS 1292 inhibits A3AR-mediated shrinkage of human NPE cells and reduces mouse IOP, consistent with its putative action as a cross-species A3 antagonist.
Collapse
Affiliation(s)
- Hui Yang
- Department of Physiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6085, USA
| | | | | | | | | | | | | |
Collapse
|
50
|
|