Visual acuity and eye parameters in relation to body size, shape and composition, considering maternal undernutrition during pregnancy.

The aims of this study were to analyze the relationship between the presence of the cilioretinal artery (CRA) and the incidence, severity and progression of age-related macular degeneration (AMD) and to estimate the influence of the CRA on choroidal and retinal parameters. A total of 287 patients with AMD and 110 healthy controls were enrolled in the study. CRA occurrence was determined using color fundus images. AMD progression was assessed after 3 years. There was no difference in the incidence of CRA between the AMD and control groups (23.34% vs. 24.55%; p = 0.8). Lower-stage AMD was more frequently observed in eyes with the CRA than in eyes without the artery (p = 0.016). The CRA did not influence disease progression (p = 0.79). The CRA did not influence retinal and choroidal thickness and volume parameters or the retinal vessel caliber and functionality in either the AMD or control groups. There was no relationship between CRA presence and CFH Y402H and ARMS2 A69S risk variants. The results did not show a protective effect of the CRA on the incidence and progression of AMD. The CRA may affect the severity of AMD; however, the mechanism of this phenomenon is unclear.

The effectiveness of nutraceutical drug containing oxycarotenoids, vitamins and trace elements, aimed at inhibiting the progression of the dry form of age-related macular degeneration (AMD) has been demonstrated in clinical studies.The purpose of this research is to evaluate the effectiveness of long-term use of a nutraceutical drug in reducing the risk of intermediate AMD evolving into wet AMD, and assess whether it is worth using in patients with wet AMD to reduce the average yearly number of intravitreal injections of angiogenesis inhibitors.Materials and methods. In the first part of the study, we monitored 46 patients with intermediate AMD threatening the progression of the disease (those with multiple confluent drusen, drusenoid, pigment epithelium detachment) for a year: some of them received the drug while others had no nutraceutical support. We assessed standard visual functions, as well as reading parameters (on the Salzburg Reading Desk device), spatial frequency contrast sensitivity (SFC) according to the Zebra program, and macular pigment optical density (on the MPOD device). Retina parameters were controlled by photofixation using Kowa and Clarus 500 fundus camera, and by optical coherence tomography with angiography using a Cirrus 5000 Angioplex, Carl Zeiss. The disease was considered to be progressing if signs of neovascular AMD were detected. In the second part of the study, 35 patients with newly diagnosed neovascular AMD were followed up for a year and treated with angiogenesis inhibitors according to the following pattern: three loading injections of aflibercept and then pro re nata. Of two groups of patients with signs of neovascular AMD, one group took a nutraceutical drug (Lutrin, S.C. Rompharm Company S.R.L., Romania). The number of intravitreal injections of aflibercept administered according to indications during the year was estimated.Results. In the first part of the study, patients with intermediate AMD taking the drug showed an increase in MPOD from 0.36 ± 0.11 to 0.45 ± 0.15 (p = 0.05) and a stable state of the retina and visual functions throughout the entire observation period. In 2 patients (12.5 %) who did not take the drug, the disease progressed to a neovascular form. In the second part of the study, the patients taking the drug received an average of 3.4 ± 0.7 intravitreal injections of aflibercept during the year, compared with 5.3 ± 1.2 injections in the control group without nutraceutical support.Conclusion. Nutraceutical drugs are effective in reducing the risk of intermediate AMD evolving into wet AMD, and thus advisable for patients with wet AMD to reduce the average yearly number of intravitreal injections of angiogenesis inhibitors.

Purpose To construct a realistic physical model of viscoelastic retinal stretching and, on its basis, derive a universal quantitative criterion of irreversible retinal deformations during age-related macular degeneration. Methods In this work, standard methods of nonlinear fracture mechanics of ductile and viscoelastic materials were applied to study the evolution of retinal deformation progress in patients with neovascular age-related macular degeneration in the area of large druses or subretinal or sub-retinal pigment epithelium fluid accumulation. A two-dimensional rhombic model of viscoelastic Kelvin-Feucht primitives was used to reconstruct the parameters included in the approximation of the creep strain growth rate. A clinical case of a patient with age-related macular degeneration and retinal pigment epithelium detachment in the macula was taken as a basis for theoretical research. The patient underwent retinal optical coherent tomography on DRI Swept-Source OCT. Results A closed realistic theoretical model of retinal stretching in the projection of retinal pigment epithelium elevation due to its detachment or drusen based on a two-dimensional rhombic Kelvin-Feucht primitives model was constructed. The calculation of stress in the retinal tissue with consistent consideration of creep effects was performed. Conclusions The time of critical retinal loading – a new quantitative criterion for the irreversibility of retinal stretching in age-related macular degeneration is proposed. This criterion allows the prediction of the functional outcome of antiangiogenic therapy in patients with age-related macular degeneration with identical initial retinal morphometric parameters.

Introduction: Aflibercept and ranibizumab have become the most used drugs in the treatment of wet age-related macular degeneration. Some patients; however, do not respond to aflibercept and ranibizumab treatment. Our aim was to determine whether the switch from aflibercept to ranibizumab, and then switchback, is effective in a group of patients poorly responding to aflibercept. We assessed best corrected visual acuity, central retinal thickness, and the presence of intra- and subretinal fluid (respectively). Material and methods: We conducted a retrospective comparative case series study. Twenty eyes of 20 patients, who had no inhibition of disease activity after at least one year of treatment with aflibercept, were included in the study. If after switch to ranibizumab the response to the drug was again inadequate, we returned to aflibercept. We divided the study population into two groups: treatment- naïve and patients who had received injections before entering the Drug Program for the Treatment of Age-Related Exudative Macular Degeneration. Results: We observed an improvement in both best corrected visual acuity and central retinal thickness parameters, but only in the treatment-naïve group. We did not observe any statistically credible effects for sub- and intraretinal fluid in the studied groups. Conclusions: Drug conversion may be beneficial for patients poorly responding to primary therapy. Greater improvement is seen in previously untreated patients.

Effect of Subthreshold Nanosecond Laser on Loss of OCT Outer Retinal Bands in Age-Related Macular Degeneration: A LEAD Study Report.

To investigate changes of inner retinal layers and optic nerve head (ONH) in patients with dry age-related macular degeneration (AMD) and demonstrate the pattern of these changes. A total of 76 eyes classified as having dry AMD and 76 control eyes were included. Ophthalmologic evaluations included best-corrected visual acuity (BCVA) assessment, spectral-domain optical coherence tomography (SD-OCT), and Humphrey visual field (VF) test. The drusen area and volume were determined using the automated algorithm of the SD-OCT software. Macular ganglion cell-inner plexiform layer (mGCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses and ONH parameters, as well as VF parameters, were compared between groups. Macular GCIPL thickness was significantly lower in eyes with AMD than in controls (73.83 ± 7.13 vs. 82.00 ± 4.85 μm; P < 0.001), and mGCIPL thinning was observed in a ring-shaped pattern around the fovea. The pRNFL thickness was also significantly lower in eyes with AMD than in controls (88.69 ± 6.93 vs. 93.96 ± 8.33 μm; P < 0.001), but no significant difference in ONH parameters was found. An inverse correlation between drusen area and average mGCIPL thickness was found (r = -0.3253; P = 0.0064). Best-corrected visual acuity and VF parameters were worse in AMD eyes than in controls. The pattern of VF defects was mostly consistent with foveal or parafoveal scotoma. In eyes with dry AMD, mGCIPL and pRNFL thicknesses were lower than measurements in control eyes, and the average mGCIPL thickness was negatively correlated with the drusen area. However, the pattern of these changes differed from glaucomatous abnormalities.

To investigate whether there is an association between the magnitude of retinal haemodynamic abnormalities in patients with age-related macular degeneration (AMD) and the degree of severity of the AMD. A retinal laser Doppler system (Canon CLBF 100) was used to measure retinal arterial haemodynamic parameters in 25 eyes of 25 patients with AMD and nine eyes of nine age-matched control subjects. Severity of AMD was classified into Mild (n=11), Moderate (n=7), or Severe (n=7). The pulsatility ratio (PR), the pulsatility index (PI), and the resistivity index (RI) were determined. PR, PI, and RI in the patients with AMD were each significantly higher than in the control group, and increased monotonically with increasing severity of AMD. However, there were no differences in mean blood velocity, arterial diameter, or blood flow rate among the groups. This suggests that the increased blood flow pulsatility in the retinal arteries of the eyes with AMD is not due to increased distal vascular resistance, but instead is likely due to a loss of compliance in the arterial vasculature leading to the eye. Our results suggest that an increasing vascular rigidity in the systemic arterial circulation is directly associated with an increasing severity of AMD.

The retina is the innermost neural layer of the eye, and is the site of transformation of light energy into a neural signal. Knowledge and assessment of the human retinal structural parameters are important for the appropriate diagnosis and management of various ocular diseases. For instance, potentially blinding eye diseases, such as glaucoma and age-related macula degeneration, cause structural changes in the retina. Clinical evidence with ocular coherence tomography also suggests that eyes with glaucoma lose retinal nerve fibre layer and ganglion cells axons before loss of visual function. These losses appear as a visible change in the optic nerve head and can be seen before visual field abnormalities are noticed by the patient. This review discusses certain aspects (anatomical structures, structural changes with eye diseases and assessment methods) involving the human retina, their clinical importance and factors that may influence them. The content of this article will be useful to optometrists and ophthalmologists who assess these parameters in normal patients as well as in those with eye conditions such as glaucoma.Keywords: Retinal parameters; optic disc; nerve fibre layer thickness; macula thickness; glaucoma

Maternal high fat diet programming of the endocrine system

Individuals with excess body mass are usually characterised by a more robust skeleton and greater muscle mass than their leaner counterparts. The aim of this study was to evaluate the skeletal robustness, bone and muscle mass as well as physical fitness of Polish children and adolescents with and without excess body mass. The study group consisted of 3292 individuals (1705 girls and 1587 boys). Body height, mass, triceps skinfold, humerus, femur and bistyloid breadths, as well as thigh and mid-upper arm circumferences, were measured. BMI, Frame Index, bone and muscle mass were calculated. Results of handgrip strength, standing broad jump, sit-and-reach and shuttle-run tests were obtained. Participants were categorised as normal-weight or with overweight/obesity according to Cole's cut-offs. Statistical differences were calculated using two-way ANOVA (independent variables: age category, BMI group; dependent variable: analysed characteristic). Individuals in the overweight/obese category had larger absolute bone and muscle mass, as well as values of associated measurements and results of handgrip strength than their leaner counterparts. The normal-weight individuals had a greater relative bone, muscle mass and achieved better results in most fitness tests, including relative dynamometric force. In conclusion, individuals in the overweight/obese category were characterised by an increased absolute mass of bone and muscle tissue, as well as greater values of associated measurements, in comparison to their leaner counterparts. However, those advantages did not translate into better physical fitness. It may be associated with the fact that in proportion to the total body weight, bone and muscle mass were greater among participants in the normal-weight category.

Objectives: To evaluate the effects of intravitreal ranibizumab on retinal nerve fiber layer (RNFL) thickness and optic disc parameters in patients treated for exudative age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO). Methods: This retrospective study analyzed the clinical records of 60 patients who received intravitreal ranibizumab injections for macular edema secondary to AMD, DME, or RVO between October 2014 and January 2016. All patients received intravitreal ranibizumab at a dose of 0.5 mg. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were recorded at baseline and during follow-up. RNFL thickness and optic disc parameters were assessed using optical coherence tomography (OCT) and Heidelberg Retina Tomograph III (HRT-3). Measurements were obtained before treatment and at 1 week, 1 month, 3 months, and 6 months after injection. Comparisons were performed within and between disease groups. Results: Of the 60 patients, 31 (51.7%) had DME, 20 (33.3%) had AMD, and 9 (15.0%) had RVO. Best-corrected visual acuity improved significantly during the follow-up period. Mean RNFL thickness measured by OCT showed a significant reduction in the DME and RVO groups (p = 0.0001 and p = 0.043, respectively). In contrast, no significant changes in RNFL thickness were detected using HRT-3, and no consistent alterations in other optic disc parameters were observed. Changes in optic disc parameters varied among disease groups. Conclusions: Intravitreal ranibizumab treatment was associated with a reduction in mean RNFL thickness measured by OCT in patients with DME and RVO during a six-month follow-up period, whereas no corresponding RNFL thinning was detected using HRT-3 in any disease group. The observed optic disc parameter changes appeared to be disease specific. Given the absence of untreated control eyes and the exclusion of patients with glaucoma, these findings apply only to non-glaucomatous eyes and should not be extrapolated to patients with glaucoma. Further prospective studies with larger cohorts, appropriate control groups, and longer follow-up durations are warranted to clarify the long-term effects of anti-VEGF therapy on the optic nerve.

PURPOSE:Age-related macular degeneration (ARMD) is the leading cause of irreversible blindness worldwide and Nepal is one among them. We aimed to determine the relationship between outer retinal layer thickness parameters with central visual field indices in early dry ARMD cases among Nepalese population.MATERIALS AND METHODS:The subjects for this descriptive, cross-sectional study comprised 40 patients with early dry ARMD from the ophthalmology department of a tertiary level hospital of Nepal. The retinal layer thickness was measured with spectral-domain optical coherence tomography (SD-OCT), and the visual field indices were assessed using the 10-2 protocol of Humphrey visual field analyzer (HFA). Thus, the retinal layer structures correlated with visual field indices among our population.RESULTS:Among our early dry ARMD population, the foveal threshold (FT) was found to be significantly correlated with retinal pigment epithelium (RPE) elevation (P < 0.01, r = −0.541), outer segment (OS) length (P = 0.02, r = 0.465), and inner segment ellipsoid (ISe) band disruption (P = 0.01, r = −0.499), but not with presence of hyperreflective foci (P = 0.464), RPE thickness (P = 0.612), and central macular thickness (P = 0.214). However, no significant correlation between mean deviation and pattern standard deviation of visual field with retinal layer thickness parameters was identified.CONCLUSION:In early dry ARMD, a reduced FT is significantly correlated with the integrity of the ISe band, thinning of OS length, and drusen-associated RPE elevation. The results highlight the utility of both SD-OCT retinal layer measurement and central visual field testing by HFA in ARMD to monitor the progression of the disease.

Epidemiological studies have indicated that susceptibility of human adults to hypertension and cardiovascular disease may result from intrauterine growth restriction and low birth weight induced by maternal undernutrition. Although the 'foetal origins of adult disease' hypothesis has significant relevance to preventative healthcare, the origin and biological mechanisms of foetal programming are largely unknown. Here, we investigate the origin, embryonic phenotype and potential maternal mechanisms of programming within an established rat model. Maternal low protein diet (LPD) fed during only the preimplantation period of development (0-4.25 days after mating), before return to control diet for the remainder of gestation, induced programming of altered birthweight, postnatal growth rate, hypertension and organ/body-weight ratios in either male or female offspring at up to 12 weeks of age. Preimplantation embryos collected from dams after 0-4.25 days of maternal LPD displayed significantly reduced cell numbers, first within the inner cell mass (ICM; early blastocyst), and later within both ICM and trophectoderm lineages (mid/late blastocyst), apparently induced by a slower rate of cellular proliferation rather than by increased apoptosis. The LPD regimen significantly reduced insulin and essential amino acid levels, and increased glucose levels within maternal serum by day 4 of development. Our data indicate that long-term programming of postnatal growth and physiology can be induced irreversibly during the preimplantation period of development by maternal protein undernutrition. Further, we propose that the mildly hyperglycaemic and amino acid-depleted maternal environment generated by undernutrition may act as an early mechanism of programming and initiate conditions of 'metabolic stress', restricting early embryonic proliferation and the generation of appropriately sized stem-cell lineages.

Purpose: Fetal stress and postnatal overfeeding are associated with programming of cardiometabolic diseases, but their relative role is not clearly established. By using specific animal models we aimed to address this issue comparing the perinatal alterations induced in several organs key for cardiometabolic control. Methods: Fetal stress was induced by maternal undernutrition (MUN) during pregnancy. MUN rats were fed ad libitum with standard chow from gestational day 1 to 10; with 50% of their daily intake from day 11 to the end of pregnancy and returned back to ad libitum during lactation (12 pups/litter). Postnatal overfeeding (POF) was induced in the offspring from ad libitum fed dams by reducing litter size during lactation (4 pups/litter). Control animals were offspring from dams ad libitum fed both during pregnancy and lactation (12 pups/litter). Tibial length and body, heart, kidney, liver and fat adipose tissue weights, as well as adipocites size, were assessed in the offspring at weaning (21 days). A group of MUN offspring was followed to measure body weight along perinatal development. Results: MUN offspring showed reduced tibial length and body weight from birth with progressive catch-up growth until month two, when body weight reached similar values to control rats. By weaning MUN offspring rats exhibited: 1) hyperglycemia; 2) heart and liver hypertrophy, 3) reduced kidney weight and 4) increased subcutaneous and periorganic fat deposits and adipocite size. POF offspring also exhibited increased glycemia together with liver, fat and body weight and adipocite size, but heart and kidney weights were not altered. There were no sex-related differences in either MUN or POF models in any of the parameters studied. Conclusions: We conclude that accelerated growth during postnatal life, rather than fetal stress, seems to be critical for metabolic control organs alterations. On the other hand, fetal stress induces changes in heart and kidney at an early age which might have a direct role on later cardiovascular disease development.

Age-related macular degeneration (AMD) significantly impacts central vision, fixation site and stability and reading abilities. This work aims to analyze the relationship between retinal fixation parameters measured using microperimetry and reading performance in patients with AMD. We identified the role of fixation stability measurement in the evaluation of reading abilities and discussed its implications both in clinical practice and in clinical trials. Our analysis highlights the importance of retinal fixation assessment as a precise surrogate for evaluating reading ability outcomes in AMD patients and as new clinical endpoint to demonstrate the functional effects of present and emerging target therapies.