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PubMed2004

Nonmetro residence and impaired vision among elderly Americans.

PURPOSE: Nonmetro and metro elderly people are contrasted in their risk of having (relative to lacking) an impairment in distance vision and in near vision. METHODS: Using the 1995-1996 panel (Wave 2) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey, the prevalence of 5 eye-threatening conditions (cardiovascular disease, cataract, diabetes, glaucoma, and hypertension), a variety of medical treatments for these conditions, the number of talks/visits with doctors in the 2 years before Wave 2, and several relevant demographic characteristics of the 6,817 respondents were controlled. FINDINGS: Nonmetro and metro elders have the same risk of impairment in distance vision. After controlling for other factors, nonmetro elders have a higher risk than their metro peers of an uncorrected impairment in near vision (probably presbyopia). CONCLUSIONS: Nonmetro elders may confront more impediments to updating their corrective lenses for presbyopia. Implications for public health policy are discussed.

Aged↗
PubMed1998

Accommodation dynamics in aging rhesus monkeys.

Accommodation, the mechanism by which the eye focuses on near objects, is lost with increasing age in humans and monkeys. This pathophysiology, called presbyopia, is poorly understood. We studied aging-related changes in the dynamics of accommodation in rhesus monkeys aged 4-24 yr after total iridectomy and midbrain implantation of an electrode to permit visualization and stimulation, respectively, of the eye's accommodative apparatus. Real-time video techniques were used to capture and quantify images of the ciliary body and lens. During accommodation in youth, ciliary body movement was biphasic, lens movement was monophasic, and both slowed as the structures approached their new steady-state positions. Disaccommodation occurred more rapidly for both ciliary body and lens, but with longer latent period, and slowed near the end point. With increasing age, the amplitude of lens and ciliary body movement during accommodation declined, as did their velocities. The latent period of lens and ciliary body movements increased, and ciliary body movement became monophasic. The latent period of lens and ciliary body movement during disaccommodation was not significantly correlated with age, but their velocity declined significantly. The age-dependent decline in amplitude and velocity of ciliary body movements during accommodation suggests that ciliary body dysfunction plays a role in presbyopia. The age changes in lens movement could be a consequence of increasing inelasticity or hardening of the lens, or of age changes in ciliary body motility.

Accommodation, Ocular↗
PubMed2006

The zonula, lens, and circumlental space in the normal iridectomized rhesus monkey eye.

PURPOSE: To document zonular orientation and suspension of the lens during accommodation, and age-related changes of the circumlental space (CLS) at rest and during accommodation, in living iridectomized rhesus monkey eyes. METHODS: The CLS was measured in 34 iridectomized eyes of 24 living rhesus monkeys, age 5.7 to 26 years, in the resting and accommodated state, and the orientation of the zonula and suspension of the lens during accommodation was assessed qualitatively. RESULTS: The nonaccommodated CLS decreased significantly with age in both the nasal and temporal quadrants and tended to do so at a slightly faster rate in the temporal quadrant. The CLS correlated significantly with the accommodative amplitude: the greater the CLS the greater the accommodative amplitude. Multiple regression analysis indicated that age and CLS together are better predictors of accommodative amplitude than is age alone. The zonula appeared taut in the nonaccommodated eye throughout the age range despite the age-related decline in CLS. CONCLUSIONS: Characterization of age-related changes in the accommodative apparatus may help to model the system for hypothesis testing. The CLS may be an indicator of presbyopia-related processes in surrounding tissues. However, these results do not prove that the width of the CLS, in and of itself, has a causal relationship with accommodative amplitude, or that changes in the CLS play a pathophysiological role in presbyopia.

Accommodation, Ocular↗
PubMed1997

The artist and defective sight (a book review and commentary).

BACKGROUND: Many authors have wondered if an artist "sees" things differently because of a vision disorder. For example, if a famous artist has a color deficiency, what would the effect be on his paintings? Would a painting be affected by a cataractous eye--or by presbyopia--or by diabetic retinopathy? Such questions have always interested the eye and vision specialist. METHODS/RESULTS: A 1970 book entitled The World Through Blunted Sight, written by British ophthalmologist Patrick Trevor-Roper, attempts to answer those questions. CONCLUSIONS: Interesting speculations are offered about the effects of myopia, astigmatism, presbyopia, and altered color vision on the works of such well-known artists as Monet, Holbein, Whistler, Gainsborough, and many others.

Art↗
PubMed1997

Complications of combined radial thermokeratoplasty and incisional keratotomy.

PURPOSE: To report complications of radial thermokeratoplasty (RTK) when used in combination with either radial keratotomy (RK) or astigmatic keratotomy (AK). METHODS: RTK is a technique for the surgical correction of hyperopia and presbyopia. 600 degrees C burns are applied to the peripheral cornea for 0.3 seconds using a specialized cautery probe. The thermal energy generated shrinks stromal collagen and flattens the peripheral cornea. The central cornea is steepened producing a myopic shift. RESULTS: Two patients who had RTK in combination with either RK or AK are reported. Patient 1 was bilaterally hyperopic and presbyopic. The patient had RTK performed on the left eye in an attempt to make that eye myopic. The goal was to allow the left eye to be used for near vision. After RTK, the left eye was significantly overcorrected. The patient then had RK in the left eye which resulted in profound overcorrection with return of hyperopia. Postoperatively, examination revealed gaping of the RK incisions and poor epithelial wound healing. The patient also complained of severe ocular pain. Despite suturing the RK incisions, the eye remained hyperopic. The patient underwent two additional RTK procedures which failed to correct the induced hyperopia. The second patient had induced hyperopic astigmatism after undergoing RK. RTK was then performed to correct the hyperopia. However, the result was a worsening of the astigmatism. Two t-cut astigmatic keratotomies were then performed which improved the astigmatism but subsequently exacerbated the hyperopia. A second RTK procedure was then performed; however, it failed to correct the induced hyperopia. CONCLUSIONS: RTK is an unproved surgical technique for the correction of hyperopia and presbyopia that needs much further evaluation before broad clinical application can be supported.

Cornea↗
PubMed1999

Age-related changes in the kinetics of water transport in normal human lenses.

Magnetic resonance microscopy (MRM) has been used to study the kinetics of water transport in human eye lenses. Fresh lenses obtained from the Queensland Eye Bank were incubated at 34.5 degrees C in artificial aqueous humour (AAH) containing nutrients and metabolites similar to those that are present in vivo. MR images were acquired over approximately a 20 hr period following replacement of H(2)O based AAH with deuterium oxide (D(2)O) based AAH. NMR signal intensity from the lenses decreased with time corresponding to a decrease in concentration of H(2)O within the lenses. A statistically significant correlation (P<0.001) was found between the rate of NMR signal loss from the lens nuclei and increasing age of the lenses. The results show that as lenses age, there is a reduction in the rate at which water and presumably also water soluble low molecular weight metabolites, can enter the cells of the lens nucleus via the epithelium and cortex. A decrease in the rate of transport of water, nutrients and anti-oxidants (e.g. glutathione) would be expected to lead to progressive oxidative damage to lenses with age, and may ultimately contribute to presbyopia and senile nuclear cataract.

Aging↗
PubMed2001

Structural evidence of human nuclear fiber compaction as a function of ageing and cataractogenesis.

This study was conducted to quantify structural change associated with human nuclear fiber compaction as a function of ageing and nuclear cataract formation. Normal donor lenses in three age ranges, young (15--25 years), middle-aged (36--46 years) and aged (59--81 years) were compared to each other and to age-related nuclear cataracts (55--81 years) surgically removed by extracapsular extraction. Several structural modifications which occurred as a manifestation of fiber compaction were noted. In the fetal nucleus (FN), the average anterior and posterior fiber angles decreased approximately 20% with age. Additionally, there was a reduction in the thickness of both the anterior and posterior segments of fetal fibers with age. On average, the anterior--posterior (A--P) axis in the embryonic nucleus (EN) decreased 33% with age. The average length of EN fibers decreased significantly (37%) as a function of age. This change in EN fiber length was accomplished by effecting compaction folds along fiber length. By comparison, in nuclear cataracts the anterior and posterior angles of FN fibers were about 12% smaller than comparably aged normal lenses. Similarly, the A--P axis and the length of EN fibers were 13% smaller than age-matched normals. Nuclear fiber compaction in early adulthood was significant and may contribute to the lens hardening and loss of accommodative ability symptomatic of presbyopia. 3D-CAD reconstructions of fiber compaction show how the reduction in the spacing of lateral interdigitations along fiber length causes an increase in the fiber membrane complexity along the A--P axis in relation to fiber cytoplasm as light passes through lenses. These results may explain, at least in part, how an increase in large particle scatter occurs as light is transmitted through fiber membranes, resulting in reduced lens optical quality as a function of age. By extrapolation, the significantly increased compaction of nuclear fibers in age-related nuclear cataracts may be a contributing factor for excessive scatter in nuclear opacification.

Adolescent↗
PubMed1986

The Basel longitudinal study on aging (1955-1978). Ophthalmo-gerontological research results.

In the prospective Basel longitudinal study on aging (1955-1978) 123 men (age at entry from 6-61 years) were investigated in 2 year (average) intervals. Complete case histories are available on 67 subjects over the entire period (19.6 +/- 0.85 years). Part I of the study was to confirm the hypothesis of Bernstein and of Steinhaus, according to which life expectancy can be estimated from the speed of development of presbyopia. Parallel to the measurement of accommodation range (after preliminary determination of refraction and visual acuity), the development of height, body weight, vital capacity, expiratory volume, chest circumference, abdominal circumference, blood pressure, ECG and pulse wave velocity were measured. Invasive investigations were not undertaken. Only when hypertension was combined with obesity was the diminution of accommodation range striking (Fig. 10c; however there were only 3 subjects in this risk group). Taking everything into consideration there was a concomitance between decrease of accommodation range and changes of medical parameters (Table 6). Intercurrent illness did not influence the accommodation range. Longitudinal measurements and cross-sectional comparisons (data averaged to the same point as of the same age) were carried out. The results did not always coincide. We could not confirm the hypothesis of Bernstein and of Steinhaus. In Part II the results of the objective measurements are given. Apparently growth of the skull does not stop entirely. The increase of interpupillary distance can be complete at 17 years of age, but also can continue to the 30th year. The palpebral fissure increases an average of 3 mm more horizontally between the 6th and the 20th year of life. The corneal diameter remains constant in all age classes, that is, the growth of the cornea should be complete before the 6th year of life. Early arcus senilis changes are found already in the 20-year-old. The increase in the course of time of arcus senilis is obvious, it is most pronounced in obese hypertensives. Still there are persons who at 65 years of age show no arcus senilis. In the 20th year degenerative deposits in the conjunctiva begin. They increase in number and above the 60th year all subjects showed degenerative deposits. Aqueous veins are less visible in younger subjects. With increasing age--as a result of degenerative thinning of the conjunctiva--they are recognizable in ever greater numbers. The depth of the anterior chamber attains its greatest extent between the 20th and the 30th year.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1976

The influence of age on the chronatic aberration of the eye.

The axial chromatic aberration of the eye was measured in 58 persons varying from 10 to 80 years of age. It was found that the chromatic aberration diminished significantly after the onset of presbyopia. It is suggested that this decrease in axial chromatic aberration may be due to increase in the index of refraction of the vitreous thereby producing a negative optical surface in the eye which more or less cancels the chromatic aberration of the cornea and anterior surface of the lens. This supposition is supported by measurements of chromatic aberration made on 10 aphakic patients. It is also observed that at near, older eyes who exhibit very little chromatic aberration, cannot make use of this aberration to spare some of the required accommodation (simulated by ophthalmic lenses in older eyes) as is the case in younger eyes.

Accommodation, Ocular↗
PubMed2002

[Two years experience with the new accommodative 1 CU intraocular lens].

After marked improvement of optical rehabilitation of cataract patients during the last decades due to small incision surgery and foldable intraocular lenses (IOL), presbyopia is now one of the great unsolved questions in ophthalmology. During recent years a new accommodative IOL, the 1CU lens, has been developed based on the concepts of K.D. Hanna and on finite element computer simulation models. The 1CU IOL is designed to transform contracting forces of the ciliary muscle into anterior movement of the IOL optic (optic-shift concept). After the first implantation of a 1CU IOL in Erlangen in June 2000, we have now successfully implanted the 1CU IOL in over 90 patients. Our experiences and the results of several clinical studies indicate good and safe implantability, good centration, no IOL-specific complications, and good distance visual acuity. In comparison to control groups with conventional IOL, patients with the 1CU enjoyed significantly better distance-corrected near visual acuity, a larger accommodative range, and increased anterior and posterior axial movement of the lens optic after medical stimulation or inhibition of the ciliary muscle. We interpret our results as confirmation of the optic-shift concept of the 1CU IOL. Overall, the concept of accommodative IOL appears attractive and may have a great potential in the future. Additional studies including randomized blind multicenter evaluation of the 1CU IOL are necessary to further evaluate long-term and accommodative results.

Accommodation, Ocular↗
PubMed2002

[Dynamic aberrometry during accommodation of phakic eyes and eyes with potentially accommodative intraocular lenses].

Since the introduction of potentially accommodative intraocular lenses (IOLs), it was hard to perform an objective evaluation of the accommodative amplitude in pseudophakic eyes. Laser interferometric measurements were performed to evaluate anterior chamber depth changes, which provides information on the functionality of potentially accommodative IOLs. By means of wavefront analysis, the dynamic behaviour of potentially accommodative IOLs can be determined. All measurements in this study were performed using a Hartmann-Shack aberrometer at a frequency of 7 Hz. Six to 8 weeks after implantation of potentially accommodative IOLs (CrystaLens AT-45, C&C Vision, 1CU, Humanoptics), 43 eyes were investigated using this dynamic wavefront analysis. Patients focussed at a distance target for 10 s, followed by focussing at a near target for 10 s and then again at a distance target for a further 10 s. During these 30 s, a total of 200 single measurements were performed. The same measurements were also conducted in healthy eyes of young persons as well as in eyes after implantation of standard IOLs for comparative purposes. The dynamic course of changes in low-order aberrations (defocus, astigmatism) as well as high-order (e.g., fourth-order spherical aberration) were analysed. Dynamic wavefront analysis allowed objective and observer-independent measurement of changes in accommodation in phakic and pseudophakic eyes. Dynamic aberrometry is capable of objectively quantifying the effect of any surgical option for the treatment of presbyopia. We recommend use of this technology in addition to the common psychophysical examinations to attain objective information on the efficacy of the treatment modality used.

Accommodation, Ocular↗
PubMed1984

Analysis of human crystalline lens curvature as a function of accommodative state and age.

Slit-lamp photographs from four human subjects, aged 11, 19, 29, and 45 were reanalyzed using computer-based digitization and curve-fitting methods in order to obtain more complete information on internal lens curvature changes during accommodation. All discernible curves (N = 742) could be fit to parabolas with chi 2 less than or equal to 0.001 irrespective of lens age, accommodative state, or curve location within the lens. For each lens, the coefficients of the parabolas, when displayed in graphic form, exhibit a linear relationship between location within the lens and the coefficient of the chi 2 term. The slope of this line remains unchanged over accommodation for a given lens, but is shifted in position. The slope changes as a function of age. The age 45 lens exhibits these characteristics to a limited extent only, the differences possibly related to the development of presbyopia. The further a given curve is located from the lens surface, the smaller the region of its arc that can be considered approximately circular. A roughly hourglass figure is generated by these circular bounds; the waist of the hourglass decreases with increasing accommodation, since changes in radius of curvature with accommodation are more pronounced internally. Calculations of arc lengths as a function of increasing accommodation indicate that these lengths change very little over the entire accommodative range.

Accommodation, Ocular↗
PubMed1994

In vivo determination of the biomechanical properties of the component elements of the accommodation mechanism.

A method of obtaining in vivo information about the component elements of the accommodation mechanism is described. Changes in axial lens thickness during accommodation are measured continuously by ultrasonographic biometry. The measurements are fitted with a dynamic biomechanical model of the mechanism of accommodation. This gives a time constant that depends both on the direction of accommodation and on the properties of the lens, zonules and choroid. Two ratios can be calculated that give information about the visco-elastic properties of the lens, zonules and choroid. This information is especially useful to evaluate the changes that lead to presbyopia.

Accommodation, Ocular↗
PubMed1994

Aging of the human crystalline lens and anterior segment.

Changes in the unaccommodated human crystalline lens were characterized as a function of subject age for 100 normal emmetropes over the age range 18-70 yr by Scheimpflug slit-lamp photography. With increasing age, the lens becomes thicker sagittally, but since the distance from the cornea to the posterior lens surface remains unchanged, this indicates that the center of lens mass moves anteriorly and the anterior chamber becomes shallower. Sagittal nuclear thickness is independent of age, but both anterior and posterior cortical thicknesses increase with age, shifting the location of the nucleus and the central sulcus in the anterior direction. The amount of light scattered by the lens at high angles, as represented by normalized and integrated lens densities from the digitized images, increases with increasing age in an exponential fashion. Similar relationships to age are observed for the major anterior zone of discontinuity (maximum density) and the central sulcus (minimum density). The relationships of these results to accommodation and presbyopia are discussed.

Accommodation, Ocular↗
PubMed2005

Can reliable values of Young's modulus be deduced from Fisher's (1971) spinning lens measurements?

The current textbook view of the causes of presbyopia rests very largely on a series of experiments reported by R.F. Fisher some three decades ago, and in particular on the values of lens Young's modulus inferred from the deformation caused by spinning excised lenses about their optical axis (Fisher 1971) We studied the extent to which inferred values of Young's modulus are influenced by assumptions inherent in the mathematical procedures used by Fisher to interpret the test and we investigated several alternative interpretation methods. The results suggest that modelling assumptions inherent in Fisher's original method may have led to systematic errors in the determination of the Young's modulus of the cortex and nucleus. Fisher's conclusion that the cortex is stiffer than the nucleus, particularly in middle age, may be an artefact associated with these systematic errors. Moreover, none of the models we explored are able to account for Fisher's claim that the removal of the capsule has only a modest effect on the deformations induced in the spinning lens.

Adolescent↗
PubMed1995

Why does the human visual system age in the way it does?

The tentative observation that the decrease of lenticular glutathione in man and in cattle may be under genetic control is extended to other biological functions which show a systematic reduction with age. Ocular and visual parameters are shown to decline consistently with the view that the human eye has evolved in keeping with other biological functions sustaining a life-span of approximately 120 years. Analysis of the data suggests that presbyopia represents an outlier in the distribution of ocular attributes, and should not be used as a biomarker for ageing.

Aged↗
PubMed2001

Making sense of refractive surgery in 2001: why, when, for whom, and by whom?

Surgical alteration of the focusing or refractive properties of the eye has been performed on millions of patients. An array of procedures to correct myopia, hyperopia, astigmatism, and presbyopia have been introduced over the past 25 years with varying degrees of success. Improved technology has increased patient and physician satisfaction and enthusiasm. Currently available surgical procedures can be categorized as incisional, surface-altering, lamellar, and intraocular. The choice of procedure depends on individual patient indications and contraindications based on results of ocular examinations, eg, corneal pachymetry to measure corneal thickness, keratometry to measure the corneal curvature, basal tear secretory rate, and dark-adapted pupil size. The postoperative uncorrected visual acuity depends, in large part, on the quality of the preoperative evaluation and refraction. Before scheduling a patient for surgery, the ophthalmologist must ensure that the patient understands the potential risks of the procedure and has realistic expectations for the postoperative level and quality of uncorrected visual acuity. Postoperative complications include corneal flap displacement, undercorrection and overcorrection, and epithelial ingrowth under the corneal flap and inflammatory keratitis. Postoperative dry eye, infection, and inflammation are usually treated medically. Ongoing technological innovations to customize the surgical approach to an individual patient's eye continue to improve outcomes.

Astigmatism↗
PubMed2002

Age-related changes in refractive index distribution and power of the human lens as measured by magnetic resonance micro-imaging in vitro.

We report a new technique for non-invasively mapping the refractive index distribution through the eye lens using magnetic resonance micro-imaging. The technique is applied to map the refractive index distribution throughout the sagittal plane of 18 human eye lenses ranging in age from 14 to 82 years in vitro. The results are compared with standard models for the human eye lens. They confirm that the refractive index distribution, when plotted as a function of normalised lens radius, is a function of lens age and differs both between the equatorial and axial directions and between the anterior and posterior halves of the optical axis. The refractive index of the lens nucleus exhibits a significant reduction with age amounting to 3.4+/-0.6 x 10(-4) years(-1). The contribution of the gradient index (GRIN) to the lens power decreases by 0.286+/-0.067 D/year, accounting almost entirely for the estimated overall change in lens power with age for these lenses, which were probably in their most accommodated state. The results provide experimental verification of hypothesised changes in the GRIN that have previously been invoked as contributing to presbyopia and support the hypothesis that changes in the GRIN are sufficient to offset effects of increasing curvature of human lenses with age in their unaccommodated state.

Accommodation, Ocular↗