Ulrike Kottler

Prevalence of refractive errors in the European adult population: the Gutenberg Health Study (GHS)

Objective To study the distribution of refractive errors among adults of European descent. Design Population-based eye study in Germany with15 010 participants aged 35–74 years. Methods The study participants underwent a detailed ophthalmic examination according to a standardised protocol. Refractive error was determined by an automatic refraction device (Humphrey HARK 599) without cycloplegia. Definitions for the analysis were myopia <−0.5 dioptres (D), hyperopia >+0.5 D, astigmatism >0.5 cylinder D and anisometropia >1.0 D difference in the spherical equivalent between the eyes. Exclusion criterion was previous cataract or refractive surgery. Results 13 959 subjects were eligible. Refractive errors ranged from −21.5 to +13.88 D. Myopia was present in 35.1% of this study sample, hyperopia in 31.8%, astigmatism in 32.3% and anisometropia in 13.5%. The prevalence of myopia decreased, while the prevalence of hyperopia, astigmatism and anisometropia increased with age. 3.5% of the study sample had no refractive correction for their ametropia. Conclusions Refractive errors affect the majority of the population. The Gutenberg Health Study sample contains more myopes than other study cohorts in adult populations. Our findings do not support the hypothesis of a generally lower prevalence of myopia among adults in Europe as compared with East Asia.

Distribution of Intraocular Pressure and Its Association with Ocular Features and Cardiovascular Risk Factors: The Gutenberg Health Study

PURPOSE To describe the distribution of intraocular pressure (IOP) and its association with ocular features and cardiovascular risk factors in an adult European cohort. DESIGN Population-based, cross-sectional study. PARTICIPANTS This analysis was based on a Gutenberg Health Study (GHS) cohort that included 4335 eligible enrollees from among 5000 subjects who participated in the survey from 2007 through 2008. The age range was 35 to 74 years at enrollment. METHODS Participants underwent a standardized protocol with a comprehensive questionnaire; ophthalmic examination including slit-lamp biomicroscopy, noncontact tonometry, fundus photography, central corneal thickness measurement, and visual field testing; and a thorough general examination focused on cardiovascular parameters, psychological evaluation, and laboratory tests, including genetic analysis. MAIN OUTCOME MEASURES Mean and reference interval of IOP stratified by age, gender, and eye. RESULTS Mean ± standard deviation (SD) IOP was 14.0 ± 2.6 mmHg in both eyes, 13.9 ± 2.7 mmHg in right eyes, and 14.0 ± 2.7 mmHg in left eyes. Mean ± SD IOP in men (n = 2216) and in women (n = 2119) was 14.1 ± 2.7 mmHg and 13.9 ± 2.5 mmHg with an intersex difference (P = 0.009). Positive univariate associations with higher IOP were detected for brown iris color, central corneal thickness, hypertension, diabetes, smoking, obesity, dyslipidemia, body mass index, weight, hip size (women only), waist circumference, and waist-to-hip ratio. Multivariate testing revealed male gender, central corneal thickness, brown iris color, hypertension, smoking, and waist-to-hip ratio to be correlated with higher IOP. In women, age correlated negatively with IOP in the multivariate analysis. CONCLUSIONS Intraocular pressure distribution in this cohort yielded a lower mean IOP than in similar white study populations. Increasing age in women correlated with lower IOP. Association analyses with several systemic characteristics revealed that cardiovascular risk factors correlated with higher IOP. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

The ophthalmic branch of the Gutenberg Health Study: study design, cohort profile and self-reported diseases.

Purpose This paper describes the study design, methodology, cohort profile and self-reported diseases in the ophthalmological branch of the Gutenberg Health Study (GHS). Methods The GHS is an ongoing, prospective, interdisciplinary, single-center, population-based cohort study in Germany. The main goals of the ophthalmological section are to assess the prevalence and incidence of ocular diseases and to explore risk factors, genetic determinants and associations with systemic diseases and conditions. The eye examination at baseline included a medical history, self-reported eye diseases, visual acuity, refractive errors, intraocular pressure, visual field, pachymetry, keratometry, fundus photography and tear sampling. The 5-year follow-up visit additionally encompassed optical coherence tomography, anterior segment imaging and optical biometry. The general examination included anthropometry; blood pressure measurement; carotid artery ultrasound; electrocardiogram; echocardiography; spirometry; cognitive tests; questionnaires; assessment of mental conditions; and DNA, RNA, blood and urine sampling. Results Of 15,010 participants (aged 35-74 years at the time of inclusion), ocular data are available for 14,700 subjects (97.9%). The mean visual acuity (standard deviation), mean spherical equivalent, median decimal visual acuity, and mean intraocular pressure were 0.08 (0.17) logMar, -0.42 (2.43) diopters, 0.9 and 14.24 (2.79) mm Hg, respectively. The frequencies of self-reported strabismus, glaucoma, surgery for retinal detachment and retinal vascular occlusions were 2.7%, 2.3%, 0.2% and 0.4%, respectively. Conclusions The GHS is the most extensive dataset of ophthalmic diseases and conditions and their risk factors in Germany and one of the largest cohorts worldwide. This dataset will provide new insight in the epidemiology of ophthalmic diseases and related medical specialties.

Histological examination of an eye with endogenous Aspergillus endophthalmitis treated with oral voriconazole: a case report.

PurposeTo report the histological findings of an eye with severe Aspergillus endophthalmitis after oral treatment with voriconazole.MethodsCase report.ResultsHistopathological examination revealed no fungal elements in choroidal or retinal vessels. The hyphae were mainly restricted to the vitreal side of the preretinal inflammatory infiltrate. Since the treatment with voriconazole had not been completed at the time of enucleation, the clinical course with potential further limitation or regression of the lesion remains unsettled.ConclusionsEndogenous Aspergillus endophthalmitis is a devastating condition often associated with immunodeficiency. The pathogenesis of this entity implies the primary invasion of choroidal and retinal vessels. The lack of antifungal drugs with high blood–ocular permeability results in an extremely poor visual prognosis. Our histological examination indicates promising activity and ocular penetration of the new antifungal agent voriconazole.

Effect of large positioning holes on capsule fixation of plate-haptic intraocular lenses

Purpose: To compare the centration and fixation of silicone plate‐haptic intraocular lenses (IOLs) with different‐sized positioning holes. Setting: Eye Clinic of the Johannes Gutenberg‐University Mainz, Mainz, Germany. Methods: In a prospective randomized study, 51 Chiroflex C10 and 56 Chiroflex C11 IOLs were implanted under standardized conditions by the same surgeon. The IOL position was documented at the end of surgery and by retroillumination on the first day and 5 months postoperatively. The positioning‐hole area was evaluated by ultrasound biomicroscopy (50 MHz) 5 months postoperatively. Results: One day postoperatively, no IOL in either group was decentered more than 1.0 mm. After 5 months, 33% of the C10 and 42% of the C11 IOLs were decentered between 0.5 and 1.0 mm, and 11% of the C10 and 8% of the C11 IOLs were decentered more than 1.0 mm (maximum 1.23 mm and 1.41 mm, respectively). Up to the first postoperative day, 20% of the C10 and 22% of the C11 lenses were rotated more than 15 degrees. At 5 months, an additional 15% of the C10 and 19% of the C11 lenses were rotated. Ultrasound biomicroscopy showed no tissue or capsule adhesion in the holes in most cases (85% C10 group; 71% C11 group). No difference was statistically significant. Conclusions: Larger positioning holes did not prevent IOL decentration or rotation; thus, this IOL design appears unsuitable for correcting astigmatism. Because tissue in the positioning hole was rare with both lens types, it is doubtful that enlarged plate‐haptic perforations will prevent IOL luxation into the vitreous cavity after capsulotomy.

Ist die Katarakt vermeidbar

ZusammenfassungDer Nutzen einer langjährigen Einnahme antioxidativer Nahrungsergänzungsmittel zur Verzögerung oder Verhinderung altersbedingter Augenleiden wie Katarakt oder Makuladegeneration wird kontrovers diskutiert. Durch Auswertung aktueller Literatur zu den Themen oxidativer Linsenschädigungen und nutritiver Einflussfaktoren sollen Erkenntnisse über den Nutzen und das Risiko solch einer Supplementation gewonnen werden. Der Schwerpunkt dieser Übersichtsarbeit liegt auf den epidemiologischen Längsschnittstudien, da die Identifizierung beeinflussbarer Risikofaktoren eine immense ökonomische Bedeutung erlangen könnte.Die Ergebnisse der ARED-Studie,die keinen protektiven Effekt einer Zufuhr der Antioxidanzien Vitamin C,Vitamin E,Beta-Carotin und Zink auf die Entwicklung einer Katarakt feststellen konnte, stehen teilweise im Widerspruch zu vorausgegangenen epidemiologischen Untersuchungen,die zumindest für bestimmte Kataraktformen einen protektiven Effekt antioxidativer Nahrungssupplemente nachweisen.Obwohl aufgrund experimenteller und epidemiologischer Studien die Einnahme von Antioxidanzien zur Kataraktprophylaxe naheliegt, ist eine generelle Empfehlung der Zufuhr noch verfrüht oder vielleicht sogar falsch, da bis heute ein zwingender Wirksamkeitsnachweis aussteht.Der Wert einer Kataraktprophylaxe wird kritisch diskutiert.AbstractThe benefit of long-term nutrient intake to reduce the risk of age-related ocular disease such as cataract or macular degeneration is subject to controversy.Conclusions about the benefits and risks of antioxidant supplements can be expected after reviewing the current literature concerning oxidative-induced lens damage and nutritional effects. Identification of influenceable risk factors for senile cataracts could achieve immense economical relevance.In contrast to former longitudinal epidemiological studies, the AREDS report failed to verify protective properties of highly concentrated vitamin supplements on cataract formation. Although there are enough epidemiological indications for reducing the risk of cataracts by the intake of antioxidants, a general recommendation for the use of supplements is untimely or even wrong until stringent evidence of efficacy is provided.The usefulness of cataract prevention is discussed.

Correlations between central corneal thickness and general anthropometric characteristics and cardiovascular parameters in a large European cohort from the Gutenberg Health Study.

Purpose: The aim of this study was to evaluate the correlations between general anthropometric features and cardiovascular parameters and central corneal thickness (CCT) in an adult European cohort. Methods: Analysis was based on a Gutenberg Health Study cohort that included 5000 subjects (2540 male, 2460 female), aged 35 to 74 years at enrollment. The participants underwent a standardized protocol with a comprehensive questionnaire; ophthalmic examination (slit-lamp biomicroscopy; autorefractometry; noncontact tonometry; fundus photography; CCT measurements (optical pachymetry); visual field testing; and a thorough general examination focused on cardiovascular parameters, psychosomatic evaluation, and laboratory tests including genetic analysis. Results: Reliable CCT measurements were available for 4708 right eyes (OD, 94.2%), 4721 left eyes (OS, 94.4%), and both eyes (OU) in 4698 subjects (94.0%). The mean CCT was 555 ± 35 &mgr;m in men and 549 ± 35 &mgr;m in women. In multiple linear regression analysis, the CCT was associated with gender [P < 0.001 for OU], body height [in men, P = 0.007 for OD, P = 0.04 for OS; in women P < 0.001 for OU], and body mass index (P < 0.001 for OD, P = 0.001 for OS). In men only, the CCT correlated with the body weight [P = 0.024 (OD), P = 0.048 (OS)] and smoking [P = 0.006 (OD), P < 0.001 (OS)]. No correlations were found between the CCT and dyslipidemia, diabetes, or hypertension. Conclusions: The CCT was associated with male gender, body height, and body mass index in an adult white cohort. It correlated with body weight and nicotine abuse in men only. No associations were found between the CCT and dyslipidemia, diabetes, or hypertension.

[Secondary glaucoma in hyphema, hypopyon, iris prominence and iris hyperemia].

Eine 76-jährige Patientin stellte sich mit schmerzhaftem Sekundärglaukom des rechten Auges vor. Anamnestisch war ein hochmalignes B-Zell-Non-Hodgkin-Lymphom (NHL) der Leiste bekannt, das sich nach erfolgter Chemotherapie in kompletter Remission befand. Zwei Tage vor Aufnahme betrug der Quick-Wert unter Cumarinderivattherapie 7%. Ferner litt die Patientin an einer arteriellen Hypertonie, Herzinsuffizienz und einem Diabetes mellitus Typ II.

[Is a cataract avoidable? Current status with special emphasis on the pathophysiology of oxidative lens damage, nutritional factors, and the ARED study].

ZusammenfassungDer Nutzen einer langjährigen Einnahme antioxidativer Nahrungsergänzungsmittel zur Verzögerung oder Verhinderung altersbedingter Augenleiden wie Katarakt oder Makuladegeneration wird kontrovers diskutiert. Durch Auswertung aktueller Literatur zu den Themen oxidativer Linsenschädigungen und nutritiver Einflussfaktoren sollen Erkenntnisse über den Nutzen und das Risiko solch einer Supplementation gewonnen werden. Der Schwerpunkt dieser Übersichtsarbeit liegt auf den epidemiologischen Längsschnittstudien, da die Identifizierung beeinflussbarer Risikofaktoren eine immense ökonomische Bedeutung erlangen könnte.Die Ergebnisse der ARED-Studie,die keinen protektiven Effekt einer Zufuhr der Antioxidanzien Vitamin C,Vitamin E,Beta-Carotin und Zink auf die Entwicklung einer Katarakt feststellen konnte, stehen teilweise im Widerspruch zu vorausgegangenen epidemiologischen Untersuchungen,die zumindest für bestimmte Kataraktformen einen protektiven Effekt antioxidativer Nahrungssupplemente nachweisen.Obwohl aufgrund experimenteller und epidemiologischer Studien die Einnahme von Antioxidanzien zur Kataraktprophylaxe naheliegt, ist eine generelle Empfehlung der Zufuhr noch verfrüht oder vielleicht sogar falsch, da bis heute ein zwingender Wirksamkeitsnachweis aussteht.Der Wert einer Kataraktprophylaxe wird kritisch diskutiert.AbstractThe benefit of long-term nutrient intake to reduce the risk of age-related ocular disease such as cataract or macular degeneration is subject to controversy.Conclusions about the benefits and risks of antioxidant supplements can be expected after reviewing the current literature concerning oxidative-induced lens damage and nutritional effects. Identification of influenceable risk factors for senile cataracts could achieve immense economical relevance.In contrast to former longitudinal epidemiological studies, the AREDS report failed to verify protective properties of highly concentrated vitamin supplements on cataract formation. Although there are enough epidemiological indications for reducing the risk of cataracts by the intake of antioxidants, a general recommendation for the use of supplements is untimely or even wrong until stringent evidence of efficacy is provided.The usefulness of cataract prevention is discussed.

Sekundärglaukom bei Hyphäma, Hypopyon, Irisprominenz und Irishyperämie

Eine 76-jährige Patientin stellte sich mit schmerzhaftem Sekundärglaukom des rechten Auges vor. Anamnestisch war ein hochmalignes B-Zell-Non-Hodgkin-Lymphom (NHL) der Leiste bekannt, das sich nach erfolgter Chemotherapie in kompletter Remission befand. Zwei Tage vor Aufnahme betrug der Quick-Wert unter Cumarinderivattherapie 7%. Ferner litt die Patientin an einer arteriellen Hypertonie, Herzinsuffizienz und einem Diabetes mellitus Typ II.