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Lauriston S. Taylor lecture: nontargeted effects of radiation: implications for low-dose exposures.

Traditional thinking has been that the biological effects of ionizing radiation occur in irradiated cells as a consequence of the DNA damage they incur. This implies that (1) biological effects occur only in irradiated cells, (2) radiation traversal through the nucleus of the cell is a prerequisite to produce a biological response, and (3) DNA is the target molecule in the cell. Evidence has been emerging, however, for non-DNA targeted effects of radiation; that is, effects including mutations, chromosomal aberrations, and changes in gene expression that occur in cells that in themselves receive no radiation exposure. Two of these phenomena will be described in this paper. The first is radiation-induced genomic instability whereby biological effects, including elevated frequencies of mutations and chromosomal aberrations, arise in the distant descendants of irradiated cells. The second phenomenon has been termed the "bystander effect," whereby in a mixed population of irradiated and nonirradiated cells, biological effects arise in those cells that receive no radiation exposure. The damage signals are transmitted from cell to cell through gap junction channels, and the genetic effects observed in bystander cells appear to result from an upregulation of oxidative stress. The possible influence of these nontargeted effects of radiation on the response to low-dose exposures is discussed.

Bystander Effect↗

Kersley lecture: eye believe in contact lenses: contact lenses and/or refractive surgery.

PURPOSE: Media publicity has made patients increasingly aware that surgical vision correction is available. This article gives an overview on refractive surgery and contact lenses. METHODS: Contact lens and refractive surgery possibilities are highlighted for patients with myopia, hyperopia, astigmatism, presbyopia, aphakia, and keratoconus. Therapeutic, pediatric, and cosmetic indications are discussed. RESULTS: Refractive surgery is beneficial for low refractive errors. The use of contact lenses is mandatory in cases of monovision and strabismus before refractive surgery and beneficial for therapeutic use postoperatively. CONCLUSION: Although many patients are always best corrected with contact lenses, only the right synergism of contact lenses and refractive surgery will benefit patients.

Contact Lenses↗

Conjunctival epithelial involvement by eyelid sebaceous carcinoma. The 2003 J. Howard Stokes lecture.

PURPOSE: To determine incidence and distribution of conjunctival epithelial involvement by eyelid sebaceous carcinoma and to make recommendations regarding its management. METHODS: The medical records were reviewed retrospectively on patients with histopathologically confirmed sebaceous carcinoma of the eyelids managed at the Oncology Service at Wills Eye Hospital. Those tumors with involvement of the conjunctival epithelium were identified and selected for further study. The incidence and distribution of epithelial involvement was determined, based on histopathology of resected tumors and map biopsies. The incidence of metastasis and tumor-related mortality was determined. Based on these findings and personal surgical experience, recommendations are made regarding management of eyelid sebaceous carcinoma with involvement of the conjunctival epithelium. RESULTS: Of 60 patients with sebaceous carcinoma, epithelial involvement of the conjunctiva was identified in 28 (47%). Of the 28 cases, the neoplasm affected the following sites: superior tarsal and fornical conjunctiva in 28 (100%), inferior tarsal conjunctiva in 19 (68%), inferior fornical conjunctiva in 18 (64%), superior bulbar conjunctiva in 19 (68%), and inferior bulbar conjunctiva in 16 (57%). The caruncle was involved in 15 (54%) and the cornea in 11 (39%). Metastasis occurred in 3 of the 28 cases (11%). Map biopsies, combined with cryotherapy, topical chemotherapy, local surgical resection, and orbital exenteration, were used to achieve local control. CONCLUSIONS: Eyelid sebaceous carcinoma was found to exhibit epithelial involvement of the conjunctiva in 47% of cases, predominantly in the superior tarsal and fornical conjunctiva and less often in the inferior tarsal conjunctiva, caruncle, and cornea. Treatment of this condition is challenging, and map biopsy, cryotherapy, topical chemotherapy, and newer surgical methods are being used more often by our group.

Adenocarcinoma, Sebaceous↗

The Glenn A. Fry Award Lecture 2003: Vision in elders--summary of findings of the SKI study.

PURPOSE: To assess a broad range of vision functions in a large older population, to investigate the impact of vision function loss on visual performance measures, and to determine whether low contrast vision measures can predict future loss of visual acuity. METHODS: A large battery of vision functions, including spatial vision measures, glare tests, visual fields, stereopsis, color vision, temporal sensitivity, reading performance, and face recognition, was administered to a population of 900 community-living older observers (mean age, 75.5 years; SD, 9.3 years; range, 58 to 102 years). A subsample (N = 596) was retested on average 4.4 years later (SD, 1.0 years). RESULTS: Each vision function is affected differentially by aging. Some functions show little change with age (e.g., standard clinically measured high contrast visual acuity), whereas others demonstrate drastic losses with increasing age. For the oldest age group (>90 years), vision function losses ranged from 1.2 times worse than young observers (critical flicker/fusion frequency) to 18 times worse than young observers (low contrast acuity in glare). Visual performance measures, such as reading or face recognition, are also significantly affected by aging even in those with intact visual acuity. The results demonstrate that low contrast vision functions can successfully predict subsequent loss of high contrast visual acuity. CONCLUSION: Nonstandard vision function measures show significant losses with age that cannot be predicted by standard clinical measures. Measures of low contrast vision function allow clinicians to identify and monitor those patients at high risk for future vision loss.

Aged↗

The Max Schapero Memorial Award Lecture 2004: contact lenses on and in the cornea, what the eye needs.

PURPOSE: The aim of this study is to review the advances made in understanding the needs of the cornea and the way in which it responds to contact lens wear and corneal implants. METHODS: The review is based on personal knowledge and involvement of the author and colleagues from the 1970s to 2005. RESULTS: Development of silicone hydrogel contact lenses is presented as well as development of synthetic materials for implantation on the corneal surface (corneal onlay). CONCLUSIONS: The future of vision correction involves developing highly porous and biocompatible lens materials. For contact lenses, a better understanding of the effects of contact lens wear on the ocular surfaces, including the tear film, and development of lens materials with greater bacterial resistance are required. For those who require new solutions to permanent vision correction, corneal onlays (implantable contact lenses) are a minimally invasive and totally reversible procedure that can be removed or replaced as visual needs change over time.

Contact Lenses↗

The Charles F. Prentice Award Lecture 2005: optics of the human eye: progress and problems.

The history of measurements of ocular aberration is briefly reviewed and recent work using much-improved aberrometers and large samples of eyes is summarized. When on-axis, higher-order, monochromatic aberrations are averaged, undercorrected, positive, fourth-order spherical aberration dominates; other Zernike wavefront aberration coefficients have average values near zero. Individually, however, many eyes show substantial amounts of third-order and other fourth-order aberrations; the value of these varies idiosyncratically about zero. Most normal eyes show only small amounts of axial monochromatic aberration for photopic pupils up to around 3 mm; the limits to retinal image quality are then usually set by diffraction, uncorrected or imperfectly corrected spherocylindrical refractive error, accommodation error, and chromatic aberration. Longitudinal chromatic aberration varies very little across the population. With larger mesopic and scotopic pupils, monochromatic aberration plays a more important optical role, but overall visual performance is increasingly dominated by neural factors. Some remaining problems in measuring and modeling the eye's optical performance are discussed.

Aging↗

The Glenn A. Fry award lecture 2005. The pathogenesis of contact lens-related keratitis.

Bacterial infection of the cornea is a rare, but sight-threatening, complication of contact lens wear that was first reported shortly after soft lenses were introduced onto the market in the 1970s. During the past 3 decades, various attempts to solve the problem with new lens types and lens care products have failed to make a significant impact on its incidence. Eliminating contact lens-related infections will likely require a better understanding of the ocular defense system, microbial virulence strategies, how they affect one another, and the effects of contact lens wear on both. Each of these topics is complex. Although research in this area is therefore challenging and necessitates a multidisciplinary approach, what we are learning along the way has significance beyond contact lens-related infection and could ultimately lead to the development of new strategies to prevent this and a range of other sight- and life-threatening diseases.

Awards and Prizes↗