Vitreous Detachment

What is vitreous detachment?

Most of the eye's interior is filled with vitreous, a gel-like substance that helps the eye maintain a round shape. There are millions of fine fibers intertwined within the vitreous that are attached to the surface of the retina, the eye's light-sensitive tissue. As we age, the vitreous slowly shrinks, and these fine fibers pull on the retinal surface. Usually the fibers break, allowing the vitreous to separate and shrink from the retina. This is avitreous detachment.
In most cases, a vitreous detachment, also known as a posterior vitreous detachment, is not sight-threatening and requires no treatment.

Risk Factors

Who is at risk for vitreous detachment?

A vitreous detachment is a common condition that usually affects people over age 50, and is very common after age 80. People who are nearsighted are also at increased risk. Those who have a vitreous detachment in one eye are likely to have one in the other, although it may not happen until years later.

Symptoms and Detection

What are the symptoms of vitreous detachment?

As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina that you may notice as floaters, which appear as little "cobwebs" or specks that seem to float about in your field of vision. If you try to look at these shadows they appear to quickly dart out of the way.
One symptom of a vitreous detachment is a small but sudden increase in the number of new floaters. This increase in floaters may be accompanied by flashes of light (lightning streaks) in your peripheral, or side, vision. In most cases, either you will not notice a vitreous detachment, or you will find it merely annoying because of the increase in floaters.

How is vitreous detachment detected?

The only way to diagnose the cause of the problem is by a comprehensive dilated eye examination. If the vitreous detachment has led to a macular hole or detached retina, early treatment can help prevent loss of vision.

Treatment

How does vitreous detachment affect vision?

Although a vitreous detachment does not threaten sight, once in a while some of the vitreous fibers pull so hard on the retina that they create amacular hole to or lead to a retinal detachment. Both of these conditions are sight-threatening and should be treated immediately.
If left untreated, a macular hole or detached retina can lead to permanent vision loss in the affected eye. Those who experience a sudden increase in floaters or an increase in flashes of light in peripheral vision should have an eye care professional examine their eyes as soon as possible.
Article republished from http://www.nei.nih.gov/health/vitreous/vitreous.asp#a

Laser's Precision and Simplicity Could Revolutionize Cataract Surgery

 

Two new studies add to the growing body of evidence that a new approach to Cataract surgery may be safer and more efficient than today's standard procedure. The new approach, using a special femtosecond laser, is FDA-approved, but not yet widely available in the United States. It's one of the hottest topics this week at the 115th Annual Meeting of the American Academy of Ophthalmology.

Research reported Oct. 23 by William W. Culbertson, MD, of the Bascom Palmer Eye Institute at the University of Miami School of Medicine, and by Mark Packer, MD, of Oregon Health and Sciences University, confirms several advantages of laser Cataract surgery.

Laser Lens Fragmentation Boost Safety by Reducing Need for Ultrasound

Dr. Culbertson's team studied how pre-treating Cataracts with the femtosecond laser affected the level of ultrasound energy needed to soften the Cataracts. This emulsification is performed so that the Cataracts can be easily suctioned out. Surgeons want to use the lowest possible level of ultrasound energy, since in a small percentage of patients it is associated with slower recovery of good vision after surgery and/or problems with the cornea, which is the clear outer layer of the eye. Ideally, in appropriate cases, ultrasound use would be eliminated altogether.

In Dr. Culbertson's prospective, randomized study, 29 patients had laser Cataract surgery with a femtosecond laser in one eye and the standard Cataract procedure, called phacoemulsification, in the other. Laser surgery included: a laser capsulotomy, which is a circular incision in the lens capsule, followed by laser lens fragmentation, then ultrasound emulsification and aspiration. Lens fragmentation involved using the laser to split the lens into sections and then soften it by etching cross-hatch patterns on its surface. Standard surgery included a manual incision, followed by ultrasound emulsification and aspiration. After Cataract removal by either method, intraocular lenses were inserted into eyes to replace the natural lens and provide appropriate vision correction for each patient.

The use of ultrasound energy use was reduced by 45 percent in the laser pre-treated eyes compared with the eyes that received the standard cataract surgery procedure. Also, surgical manipulation of the eye was reduced by 45 percent in eyes that received laser pre-treatment as compared to manual standard surgery. This study involved the most common types of cataracts, those graded 1- 4. Dr. Culbertson notes that these findings may not apply to higher grade cataracts.

"In clinical practice, surgeons would expect safer, faster cataract surgery when laser pre-treatment is performed before cataract removal," said Dr. Culbertson. "The combination of precision and simplification that is possible with the femtosecond laser represents a major advance for this surgery."

Laser Lens Fragmentation Protects Corneal Endothelial Cells

Dr. Packer's team at the Oregon Health and Sciences University in Portland, Oregon, assessed the safety of laser cataract surgery in terms of loss of corneal endothelial cells, as measured after cataract surgery. Measuring endothelial cell loss is one of the most important ways to assess the safety of new cataract surgery techniques and technology. These cells preserve the cornea's clarity, and since they don't regenerate, they must last a lifetime. Dr. Packer's study found that when laser lens fragmentation was used in 225 eyes, there was no loss of endothelial cells, while the 63 eyes that received standard treatment had cell loss of one to seven percent.

"Our finding, that laser lens fragmentation appears to protect corneal endothelial cells, represents a significant benefit of this new surgery," said Dr. Packer. "This procedure is safer than standard cataract treatment and is likely to mean better vision and fewer eye health concerns for cataract patients, over the long term."

Earlier studies of femtosecond laser cataract surgery found other benefits. The laser allows the surgeon to make smaller, more precise incisions and to perform improved capsulotomies, which is the removal of part of the lens capsule that make intraocular lens (IOL) placement more secure. This reduces the chance that an IOL will later become displaced. Also, laser cataract surgery appears to improve results in patients who opt for advanced technology IOLs, plus corrective corneal incisions, to achieve good all-distance vision.

Femtosecond lasers have been used by ophthalmologists for years in refractive surgery such as LASIK, in-corneal transplants, and in other procedures. In 2009, a new type of femtosecond laser that could reach deep enough into the eye to be used in cataract removal was approved by the FDA. In addition to Dr. Culbertson's and Dr. Packer's presentations, key sessions on the topic at the Academy's 2011 Annual Meeting include a special session in the Sunday afternoon program, Spotlight on Femtosecond-Assisted Cataract Surgery: The Tough Questions, Femtosecond Laser Cataract Surgery: the Future,a video presentation,and two new instruction courses.

http://www.sciencedaily.com/releases/2011/10/111023135653.htm

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The above story is reprinted from materials provided by American Academy of Ophthalmology.

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Detecting Glaucoma Before It Blinds

 

Early detection and diagnosis of open angle Glaucoma important so that treatment can be used in the early stages of the disease developing to prevent or avoid further vision loss. Writing in a forthcoming issue of the International Journal of Medical Engineering and Informatics, researchers in the US have analyzed and ranked the various risk factors for open angle Glaucoma so that patients can be screened at an earlier stage if they are more likely to develop the condition.

Glaucoma is one of the main leading causes of blindness; it is a progressive and irreversible disease. Of the various forms of Glaucoma, open angle Glaucoma (OAG) is the most common and can cause the most damage. Unfortunately, unless a patient is undergoing regular screening from about the age of 40 years because of a family history, it is otherwise difficult to detect until substantial and irreversible vision loss has occurred. Glaucoma is the third leading cause of blindness worldwide and the second leading cause of blindness in the USA.

Now, Duo Zhou and colleagues at the University of Medicine and Dentistry of New Jersey, Newark, have used statistical collinearity analysis to evaluate risk factors for OAG, and logistic regression models to identify a minimum set of such risk factors for prognosis and diagnosis of the disease. Their study was based on more than 400 patients with subtle or severe vision problems who attended hospital. It reveals the relative risk of being a smoker, age, visual "field test" results, presence of a localized notch or thinning of the neuroretinal rim identified during standard eye examination, cup to disk ratio (a measure of restriction of the optic nerve at the back of the eye) and other factors.

The data are complex and separating out predictors from diagnostic factors was difficult, the team admits. However, they suggest that family history, medical history, current medications, geographic location, visual field test and ocular examination must all be considered in diagnosis and prognosis for OAG. They have excluded certain factors from the OAG prognosis: gender, race, family history of Glaucoma, diabetes mellitus, hypercholesterolemia, thyroid disease, migraine, Reynaud's disease and myopia as these have no direct effect on OAG development.

As revealed in the analyses, the odds of developing OAG will be increased by 91% with an increase in the Cup-to-Disc ratio of 0.1. Risk increases by 3% annually by age but decreases by 31% for every dB increase of mean deviation of Humphrey visual field. The odds of developing OAG will be 4.36 higher for patients with abnormal Humphrey visual filed overall test, 7.19 higher in patients with localized notch or thinning of the neuroretinal rim. Interestingly, patients with a smoking history seem to be less likely to develop OAG as compared to those with smoking history; although there are many smokers with OAG. Oddly, because of the location of the study, the team can also say that patients living in Atlantic/Quebec will be 73% less likely to develop OAG compared to their fellow Canadians in Ontario.

http://www.sciencedaily.com/releases/2011/10/111006094823.htm

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The above story is reprinted from materials provided by Inderscience Publishers, via EurekAlert!, a service of AAAS.

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Contact Lenses Provide Extended Pain Relief to Laser Eye Surgery Patients

ContactContact Lenses Provide Extended Pain Relief to Laser Eye Surgery Patients

Scientists are reporting development of ContactContact lenses that could provide a continuous supply of anesthetic medication to the eyes of patients who undergo laser eye surgery -- an advance that could relieve patients of the burden of repeatedly placing drops of medicine into their eyes every few hours for several days.Their report appears in ACS' journal Langmuir

.

Anuj Chauhan and colleagues explain that more than 1 million laser eye correction procedures are performed each year in the U.S. The surgery enables most patients to see clearly without eye glasses or ContactContact lenses. The procedure known as LASIK is the most common type of laser eye surgery, but complications can develop if the patient undergoes trauma or is hit very hard at any time after the procedure. Photorefractive keratectomy (PRK) doesn't have this complication, and that's why it is preferred for athletes and those in the military. A downside to PRK, however, is a longer period of pain after surgery. To ease their pain, PRK patients place drops of several medications, including anesthetics, into their eyes every few hours, which can interfere with daily life and increase the risk of drug overdose. PRK patients receive a special "bandage ContactContact lens" after surgery to help the outer layer of the eye heal.

The researchers tested whether anesthetics loaded onto this type of lens could release the drugs over time automatically. They found that adding vitamin E to the lenses extended the time of release of three commonly used anesthetics from just under two hours to up to an entire day -- or a few days in some instances. The vitamin E acts as a barrier, keeping the anesthetics on the eye, right where they are needed. The researchers say that, in the future, these lenses could serve as bandage ContactContact lenses after PRK surgery while also delivering necessary pain medications.

The authors acknowledge funding from the University of Florida.

http://www.sciencedaily.com/releases/2012/01/120118112001.htm

The above story is reprinted from materials provided by American Chemical Society.

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New Light Shed On How Retina's Hardware Is Used in Color Vision

Biologists at New York University and the University of Würzburg have identified, in greater detail, how the Retina's cellular hardware is used in color preference. The findings, published in the latest issue of the Proceedings of the National Academy of Sciences (PNAS), enhance our understanding of how eyes and the brain process color.

Light can serve as an attractive or repulsive landmark for orientation -- we identify an object or a light source at a certain location in visual space, then approach it or retreat from it. This process, called phototaxis, was the focus of the PNAS study.

Conducted by biologists at New York University's Center for Developmental Genetics and the Department of Genetics and Neurobiology at the University of Würzburg in Germany, the research specifically examined the photoreceptor cells in the Retinas of the fruit fly Drosophila. Drosophila is a powerful model for studying the color vision process as it is amenable to very specific genetic manipulations, allowing researchers to analyze how its visual system functions when different elements of its Retina are affected.

The visual systems of most species contain photoreceptors with distinct spectral sensitivities that allow animals to distinguish lights by their spectral composition (i.e., color). In Drosophila, six of these (R1-R6) are responsible for motion detection and are sensitive to the brightness or dimness of a broad spectrum of light. Two others (R7 and R8) are used for color vision by comparing ultraviolet light (UV), detected by R7, with green or blue light detected by two types of R8. The NYU and University of Würzburg biologists investigated how photoreceptor types contribute to phototaxis by blocking the function of either R7 or R8, or a combination of a range of photoreceptors (R1-R6, R7 and/or R8).

In the study, they constructed two sets of "Y-shaped mazes" with two different types of light at the ends of each: UV and blue in one and blue and green in the other. Under this arrangement, the fly would show a preference for certain type of light (UV vs. blue in one maze; blue vs. green in the other) by moving toward it. The researchers could then link specific preferences to the make-up of each fly's visual system.

In a "UV vs. blue" choice, flies with only R1-R6 and flies with only R7/R8 photoreceptors preferred the blue to the UV light. This finding suggested that these two sets of photoreceptors (R1-R6 and R7/R8) function separately in phototaxis as flies with only one of these sets showed similar preferences. In addition, flies without a functioning R7 photoreceptor preferred the blue to the UV light, whereas flies without R8 preferred UV. In the "blue vs. green" maze, flies without a functioning blue R8 photoreceptor preferred green, whereas those with a defective for green R8 photoreceptor preferred blue. This shows that each subclass of photoreceptors [R1-R6, R7, R8 (blue), R8 (green)] is used by the fly to distinguish colors and setup its innate color preference. In a previous work, the same authors had shown that motion detection only involves R1-R6 and not R7 and R8, suggesting that there are two independent channels in the fly visual system -- one for motion and one for color.

"This simple insect can achieve sophisticated color discrimination and detect a broader spectrum of colors than we can, especially in the UV," said NYU biologist Claude Desplan, one of the study's authors. "It is a great model system to understand how the Retina and the brain process visual information.

The research was supported by a grant from the National Institutes of Health.

http://www.sciencedaily.com/releases/2010/03/100308151051.htm

The above story is reprinted from materials provided by New York University, via EurekAlert!, a service of AAAS.

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New Glaucoma Test Allows Earlier, More Accurate Detection

Cumbersome Glaucoma tests that require a visit to the ophthalmologist could soon be history thanks to a home test developed by a UA engineer.

Phoenix ophthalmologist Dr. Gholan Peyman demonstrates a prototype Glaucoma test instrument that's noninvasive and simpler to use than current procedures. It can also be used in situations that are difficult or impossible with current tests. (Credit: Image courtesy of University of Arizona College of Engineering)

The self-test instrument has been designed in Eniko Enikov's lab at the UA College of Engineering. Gone are the eye drops and need for a sterilized sensor. In their place is an easy-to-use probe that gently rubs the eyelid and can be used at home.

"You simply close your eye and rub the eyelid like you might casually rub your eye," said Enikov, a professor of aerospace and mechanical engineering. "The instrument detects the stiffness and, therefore, infers the intraocular pressure." Enikov also heads the Advanced Micro and Nanosystems Laboratory.

While the probe is simple to use, the technology behind it is complex, involving a system of micro-force sensors, specially designed microchips, and math-based procedures programmed into its memory.

Enikov began working on the probe four years ago in collaboration with Dr. Gholan Peyman, a Phoenix ophthalmologist. "We went through several years of refinement and modifications to arrive at the current design," Enikov noted.

The National Science Foundation has funded the work, and Enikov and Peyman now are seeking investors to help fund final development and commercialization of the product.

In addition to screening for Glaucoma, an eye disease that can lead to blindness if left untreated, the device corrects some problems with the current procedure, and can be used to measure drainage of intraocular fluid.

"Eye pressure varies over a 24-hour cycle," Enikov said. "So it could be low at the doctor's office and three hours later it might be high. With only a single test, the doctor might miss the problem. Having the ability to take more frequent tests can lead to earlier detection in some cases."

Once the diagnosis is made, several treatments are available. The question then is: How effective are they? Patients could use the probe at home to trace how much the pressure decreases after using eye drop medications, for instance.

"One of the reasons pressure builds up in the eye is because fluid doesn't drain properly," Enikov noted. "Currently, there are no methods available to test drainage."

Current tests require applying pressure directly to the cornea, but only very light pressure is safe to use, and it doesn't cause the fluid to drain.

"Our technique allows us to apply slightly greater pressure, but it's still not uncomfortable," he said. "It's equivalent to rubbing your eye for a brief period to find out if the pressure changes. If it does, we know by how much and if there is a proper outflow of intraocular fluid."

Sometimes, a surgical shunt is used to help fluid drain from the eye. "The problem with Glaucoma shunts is they can plug up over time," Enikov noted. "Or if they're not properly installed, they may drain too quickly. So you would want to know how well the shunt is working and if it is properly installed. Our device could help answer those questions."

In another scenario, certain patients cannot be tested for Glaucoma using currently available procedures. "If a patient had cataract surgery or some other surgery through the cornea, the cornea sometimes thickens," Enikov said. "The cornea's structure is different, but our test remains accurate because it's not applied to the cornea."

Instead, it presses the entire eyeball, much as you might press a balloon to determine its stiffness.

"The innovation with our device is that it's noninvasive, simpler to use and applies to a variety of situations that are either difficult to address or impossible to test using the current procedures," Enikov said. "That's why we're so excited about this probe. It has great potential to improve medical care, and significant commercial possibilities, as well."

http://www.sciencedaily.com/releases/2011/01/110104101331.htm

The above story is reprinted from materials provided by University of Arizona College of Engineering. The original article was written by Ed Stiles.

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The Pupils Are the Windows to the Mind

The eyes are the window into the soul -- or at least the mind, according to a new paper published in Perspectives on Psychological Science, a journal of the Association for Psychological Science. Measuring the diameter of the Pupil, the part of the eye that changes size to let in more light, can show what a person is paying attention to. Pupillometry, as it's called, has been used in social psychology, clinical psychology, humans, animals, children, infants -- and it should be used even more, the authors say.

The Pupil is best known for changing size in reaction to light. In a dark room, your Pupils open wide to let in more light; as soon as you step outside into the sunlight, the Pupils shrink to pinpricks. This keeps the retina at the back of the eye from being overwhelmed by bright light. Something similar happens in response to psychological stimuli, says Bruno Laeng of the University of Oslo, who cowrote the paper with Sylvain Sirois of Université du Québec à Trois-Rivières and Gustaf Gredebäck of Uppsala University in Sweden. When someone sees something they want to pay closer attention to, the Pupil enlarges. It's not clear why this happens, Laeng says. "One idea is that, by essentially enlarging the field of the visual input, it's beneficial to visual exploration," he says.

However it works, psychological scientists can use the fact that people's Pupils widen when they see something they're interested in.

Laeng has used Pupil size to study people who had damage to the hippocampus, which usually causes very severe amnesia. Normally, if you show one of these patients a series of pictures, then take a short break, then show them another series of pictures, they don't know which ones they've seen before and which ones are new. But Laeng measured patients' Pupils while they did this test and found that the patients did actually respond differently to the pictures they had seen before. "In a way, this is good news, because it shows that some of the brains of these patients, unknown to themselves, is actually capable of making the distinction," he says.

Pupil measurement might also be useful for studying babies. Tiny infants can't tell you what they're paying attention to. "Developmental psychologists have used all kinds of methods to get this information without using language," Laeng says. Seeing what babies are interested in can give clues to what they're able to recognize -- different shapes or sounds, for example. A researcher might show a child two images side by side and see which one they look at for longer. Measuring the size of a baby's Pupils could do the same without needing a comparison.

The technology already exists for measuring Pupils -- many modern psychology studies use eye-tracking technology, for example, to see what a subject is looking at, and Laeng and his coauthors hope to convince other psychological scientists to use this method.

http://www.sciencedaily.com/releases/2012/01/120127162800.htm

The above story is reprinted from materials provided by Association for Psychological Science.