Wojciech Lubiński

Ophthalmological Features of Parkinson Disease

Background The aim of this study was to determine the type and frequency of ophthalmologic changes occurring in patients with Parkinson disease (PD). Material/Methods One hundred consecutive patients (196 eyes) with idiopathic PD and a control group consisting of 100 healthy patients (196 eyes) matched for age and sex underwent a complete ophthalmological examination of both eyes, including assessment of patient medical history, dry eye questionare, and visual hallucinations questionnaire, distance and near best corrected visual acuity (DBCVA, NBCVA), color vision, distance photopic contrast sensitivity, near point of convergence, slit lamp examination of the eye anterior segment, tear film osmolarity and breakup time, aqueous tear production, and intraocular pressure, as well as fundus examination and evaluation of the perimacular retinal thickness (RT) and peripapillary retinal nerve fiber layer (RNFL) thickness. Results In the eyes of PD patients DBCVA, NBCVA, contrast sensitivity, and color discrimination were significantly reduced. We also detected increased frequency of convergence insufficiency, seborrhoic blepharitis, meibomian gland disease (MGD), dry eye syndrome, nuclear and posterior subcapsular cataract, and glaucoma (p<0.05). However, intraocular pressure (IOP) was significantly lower in the PD group compared to controls. The frequency of visual hallucinations, age-related macular degeneration (ARMD), and other ophthalmological diseases, as well as RT and RNFL thickness, did not significantly differ between investigated groups. Conclusions Clinicians need to be aware of the association between PD and ophthalmological changes. Restoration of good-quality vision has a great impact on PD patients’ quality of life, reduction of costs of treatment and care, and rehabilitation.

Speed of Visual Sensorimotor Processes and Conductivity of Visual Pathway in Volleyball Players

Speed of Visual Sensorimotor Processes and Conductivity of Visual Pathway in Volleyball Players Volleyball is a dynamic game which requires a high level of visual skills. The first aim of this study was to investigate the several aspects of reaction times (RT) to visual stimuli in volleyball players (12) compared to non-athletic subjects (12). By using the tests included in the Vienna Test System (Schuhfried, Austria), simple reaction time (SRT), choice reaction time (CRT) and peripheral reaction time (PRT) were examined. The second aim of this study was to assess the neurophysiological basis of early visual sensory processing in both examined groups. We measured two sets of pattern-reversal visual evoked potentials (VEPs) during monocular central field stimulation (Reti Scan, Roland Consult, Germany). The latencies of waves N75, P100 and N135 were determined. We observed significantly shorter (p<0.05) total reaction time to stimuli appearing in the central and peripheral field of vision in the volleyball players compared to non-athletes. With regard to SRT and CRT the main differences between the groups appeared in pre-motor reaction times. Volleyball players had shorter VEPs P100 wave latencies (p<0.05) than the non-athlete group. The results indicate faster signal transmission in visual pathways in athletes than in non-athletes. This fact can be attributed to the effect of rapid visual-activity-demanding sports on the central nervous system.

Clinical outcomes after cataract surgery with implantation of the Tecnis ZMB00 multifocal intraocular lens

Background The aim of this study was to evaluate visual performance, contrast sensitivity, and patient satisfaction in patients undergoing cataract surgery with bilateral implantation of the Tecnis ZMB00 diffractive multifocal IOL (intraocular lens). Material/Methods This was a prospective study of 40 eyes of 20 patients with an age range from 48 to 67 years and undergoing cataract surgery with implantation of the diffractive 1-piece IOL Tecnis ZMB00 (Abbott Medical Optics) in 1 eye and 3 weeks later in the other eye. The following parameters were evaluated at 3 and 6 months after the operation: binocular uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), uncorrected binocular photopic and mesopic distance and photopic near contrast sensitivity (CSV-1000), subjective symptoms, and patient satisfaction (VF-14). Results No significant change was observed in logMAR UDVA between 3 and 6 months postoperatively (−0.11±0.14 vs. −0.10±0.13, p>0.05). In contrast, UNVA (0.06±0.12 vs. −0.02±0.12, p=0.004) and UIVA (0.12±0.15 vs. 0.07±0.11, p=0.005) in this period improved significantly. At 3 and 6 months after surgery, 85% of patients no longer needed to wear corrective lenses. Contrast sensitivity under different conditions was within normal age-matched limits, with significant improvements for some spatial frequencies at 3 and 6 months after surgery (p<0.04). Mean overall patient satisfaction was 9.39±1.06 and 9.19±1.20 (scale from 1 to 10, with 10 being the best score) at 3 and 6 months, respectively. Low level of halo perception was reported in 75% of patients. Conclusions The Tecnis ZMB00 IOL provides an effective restoration of the distance, intermediate, and near visual function, allowing patients to be totally free of need to wear corrective lenses and providing high levels of patient satisfaction.

Stem Cells are mobilized from the bone marrow into the peripheral circulation in response to retinal pigment epithelium damage--a pathophysiological attempt to induce endogenous regeneration.

Purpose: Stem cell regeneration of damaged tissue has recently been reported in many different organs. Here, we investigated the mobilization of different stem/progenitor cell (SPC) populations into the peripheral blood (PB), their subsequent homing to the injured retina (IR) and contribution to its regeneration in a retinal pigment epithelium (RPE) damage model induced by sodium iodate (NaIO3). Methods: Mobilization of SPCs was evaluated by flow cytometry. SPCs distribution in IR was assessed using bone marrow (BM)-derived GFP+Lin− cells transplanted intravenously into NaIO3-treated C57Bl/6 mice. The quantity of the chemokine SDF-1 in PB and IR was measured by ELISA and qRT-PCR, respectively. Apoptosis (TUNEL assay), cell proliferation (PCNA analysis) as well as functional retinal activity (electroretinogram) were examined at several time points after NaIO3 administration. Results: Mobilization of SPCs along with the highest cell proliferation and massive apoptosis within IR were observed on the third day after NaIO3 administration. Similarly, donor GFP+Lin− cells were detected in the retina as soon as day 4 after NaIO3 injection. Plasma levels of SDF-1 did not differ significantly in mice exposed to NaIO3 compared to healthy controls, however mRNA for SDF-1 was overexpressed locally in IR. Functional retinal recovery was not achieved. Conclusion: Our study provides evidence that BM SPCs egress into PB and home to the injured retina, but are not capable of restoring its function. These results indicate that if the range of retinal destruction is profound, endogenous regeneration is ineffective and may ultimately require adjuvant therapeutic transplantation of specific SPCs subpopulations.

The effect of progressively increased physical efforts on visual evoked potentials in volleyball players and non-athletes

Abstract We assessed the effect of physical effort with increasing intensity on neural activity in the visual pathway in volleyball players (n = 10) and non-athletes (n = 10). Participants performed three 10-min tests of increasing intensity on a cycle ergometer. Each participant was assigned individual workloads below the lactate threshold (40% [Vdot]O2max), at the lactate threshold (65–75% [Vdot]O2max), and above the lactate threshold (80% [Vdot]O2max). Four recordings of visual evoked potentials were made: pre-exercise and immediately after each of the three subsequent tests. We assessed neural activity of the visual pathway by examining the amplitude and latency of the N75, P100, and N135 components of the visual evoked potentials waveform. Pre-exercise P100 wave latency was shorter (P < 0.05) in volleyball players than in non-athletes. In non-athletes, the latency of P100 following the first and second effort (40% and 65–75% [Vdot]O2max) was reduced compared with pre-exercise (P < 0.01). However, P100 latency increased and P100 amplitude decreased after the third test (80% [Vdot]O2max) in non-athletes. In contrast, no significant changes in the latency or amplitude of visual evoked potentials were observed in the athletes in the three tests. Neural conductivity in the visual pathway after exercise might be at least partially dependent on the individuals personal training adaptation status.

PARS PLANA VITRECTOMY IN ADVANCED CASES OF VON HIPPEL-LINDAU EYE DISEASE.

Purpose: To investigate spectrum of patients with Von Hippel–Lindau disease (VHL) that required pars plana vitrectomy and evaluate anatomical and functional outcomes of surgery. Methods: Twenty-three patients who underwent surgery for advanced VHL eye disease were assessed by genetic tests, diagnostic tests for systemic lesions, and clinical eye examination. The vitrectomized eyes were divided into two groups: with or without retinotomy (group R vs. NR). Functional and anatomical outcome was analyzed and compared between the groups. Results: All patients had central nervous system hemangioblastomas and 57% had other systemic tumors. Point germline mutations, large partial deletions, and complete vhl gene deletions were found in 64%, 27%, and 9% of patients, accordingly. Destruction of hemangioblastomas by retinotomy, laser, or cryotherapy and anatomical attachment of the retina were achieved in all eyes. Preoperative mean distance best-corrected visual acuity was logarithm of the minimum angle of resolution 2.66 (20/9,140) in group R and 1.76 (20/1,150) in group NR (P < 0.05). At 6 months postoperatively, distance best-corrected visual acuity improved in 20 eyes (83%). After over 24 months postoperatively, distance best-corrected visual acuity remained better than preoperatively in 36% in the R group and in 70% in the NR group of eyes. During 24 months postoperatively in 17 eyes, new retinal capillary hemangiomas developed. The mean number of new retinal capillary hemangiomas per eye was higher in group R than in group NR (3.14 vs. 0.70; P < 0.01). In group R, number of new retinal capillary hemangioblastoma was higher in retinal segments where retinotomy was performed (n = 29) than in other areas (n = 13) (P < 0.01). Conclusion: Advanced VHL eye disease correlates with occurrence of central nervous system and systemic lesions. Spectrum of vhl gene mutation in the patients corresponds to that of the general VHL population. Pars plana vitrectomy in advanced VHL eye disease can improve or preserve visual function, but postoperative progression of ocular VHL disease can be accelerated in cases where retinotomy is performed.

Does athletic training in volleyball modulate the components of visual evoked potentials? A preliminary investigation

Abstract This longitudinal study investigated visual evoked potentials (VEPs) in 11 young female volleyball players who participated in extensive training for 2 years. The control group consisted of 7 age-matched female students who were not involved in any regular sports activity. Recordings of VEPs were performed twice: baseline recording (i.e., before training began) and after 2 years of systematic, volleyball-specific athletic training. The effect of athletic training on visual signal conductivity was assessed by recording the latency of N75, P100 and N135 components of the VEPs waveform. Extensive experience with volleyball training reduced signal conductivity time through visual pathway. Specifically, the latency of P100 was reduced on average by 2.2 ms during binocular viewing. Moreover, athletes had reduced N75 latency (difference of 3.3 ms) for visual stimuli that generated greater response from peripheral retina. These results indicate that sport training can affect very early sensory processing in athletes.

A 43-year-old man with reduced visual acuity and normal fundus: occult macular dystrophy—case report

Purpose Occult macular dystrophy (OMD) is an unusual, inherited macular dystrophy characterized by a slowly progressive decline of visual acuity with normal fundus and fluorescein angiography (FA). The authors present a 43-year-old man who was diagnosed as having OMD because of the results of electrophysiological, psychophysical, optical coherence tomography (OCT) tests. Methods Routine ophthalmological evaluation, FA, visual field tests, electroretinographic examinations (EOG, ERG, PERG and mfERG recordings according to ISCEV standards) and foveal thickness measurements (OCT) were performed. Results Funduscopic examinations, FA, full field ERG as well as PERG results were all normal. In both eyes, the abnormalities were observed in static perimetry (relative central scotomas), mfERG (significant reduction of P1 amplitude in the central retinas) and OCT (significantly thinner foveal thickness). Conclusions A new case with OMD is added to preceding reports. The mfERG and OCT tests are important in detection of OMD patients. It can help in differential diagnosis of amblyopia, optic nerve diseases and non-organic visual disorders.

Clinical Outcomes after Uncomplicated Cataract Surgery with Implantation of the Tecnis Toric Intraocular Lens

Purpose. To evaluate the clinical outcomes after uncomplicated cataract surgery with implantation of an aspheric toric intraocular lens (IOL) during a 6-month follow-up. Methods. Prospective study including 27 consecutive eyes of 18 patients (mean age: 66.1 ± 11.4 years) with a visually significant cataract and corneal astigmatism ≥ 0.75 D and undergoing uncomplicated cataract surgery with implantation of the Tecnis ZCT toric IOL (Abbott Medical Optics). Visual, refractive, and keratometric outcomes as well as IOL rotation were evaluated during a 6-month follow-up. At the end of the follow-up, patient satisfaction and perception of optical/visual disturbances were also evaluated using a subjective questionnaire. Results. At 6 months after surgery, mean LogMAR uncorrected (UDVA) and corrected distance visual acuity (CDVA) were 0.19 ± 0.12 and 0.14 ± 0.10, respectively. Postoperative UDVA of 20/40 or better was achieved in 92.6% of eyes. Mean refractive cylinder decreased significantly from −3.73 ± 1.96 to −1.42 ± 0.88 D (p < 0.001), while keratometric cylinder did not change significantly (p = 0.44). Mean absolute IOL rotation was 1.1 ± 2.4°, with values of more than 5° in only 2 eyes (6.9%). Mean patient satisfaction score was 9.70 ± 0.46, using a scale from 0 (not at all satisfied) to 10 (very satisfied). No postoperative optical/visual disturbances were reported. Conclusion. Cataract surgery with implantation of the Tecnis toric IOL is an effective method of refractive correction in eyes with corneal astigmatism due to the good IOL positional stability, providing high levels of patients satisfaction.

The Effects of Sports Vision Training on Binocular Vision Function in Female University Athletes.

Abstract Binocular vision is the most important visual cue for spatial orientation in many sports. In this study, we investigated how binocular vision was influenced by an eye training program that may be used to improve individual’s oculomotor function. The experiment involved twenty-four female student athletes from team ball sports (soccer, basketball, handball). After an initial testing session, 12 participants were randomly allocated to the experimental group. Optometric investigation which included synoptophore testing and a test of dissociated horizontal phoria based on the Maddox method was performed three times: before the experiment, after eight weeks of eye training (3 times a week for 20 minutes), and four weeks after the experiment was terminated. Eye exercise methodology was based on orthoptic, sport and psychological aspects of performance. The phoria screening examination showed that exophoria was the most frequent disorder of binocular vision. Low fusional vergence range was also observed. Following the training period, 3 of the 6 oculomotor variables improved. The greatest effect was observed in near dissociated phoria (χ²=14.56, p=0.001 for the right eye; χ²=14.757, p=0.001 for the left eye) and fusional convergence (χ²=8.522, p=0.014). The results of the retention test conducted four weeks after the experiment confirmed the effectiveness of the vision training program. The results of the study suggest that binocular functions are trainable and can be improved by means of appropriate visual training