Effectiveness of a smartphone application for testing near visual acuity.

PURPOSE: The purpose of this study was to evaluate the discrepancy between the near visual acuity (VA) measurements using the EyeHandBook smartphone application and the conventional method of using the near vision card. METHODS: Using similar environmental/examinational conditions, near VA measurements were obtained and compared using the near vision card and the EyeHandBook app for IPhone 5 from 100 subjects. The obtained data were changed to LogMAR format and the relationship between the two techniques was analyzed by paired sample t-test and scatterplot. RESULTS: With a P-value of<0.0001, our results indicate that the EyeHandBook application running on IPhone 5 overestimates the near VA compared with the conventional near vision card by an average of 0.11 LogMAR unless the measurement done by the near vision card was 20/20. CONCLUSIONS: Owing to vast utilization of portable high-definition screens in VA measurements, eye-care providers have to be mindful of the potential disparity in VA measurement between different platforms, which in our study was likely secondary to the high contrast and brightness levels of the smartphone's high-definition screen when compared with the near vision card.

Oxidant and antioxidant modulation of chloride channels expressed in human retinal pigment epithelium.

Retinal pigment epithelium (RPE) possesses regulated chloride channels that are crucial for transepithelial fluid and ion transport. At present, little is known about the molecular nature of chloride channels in human adult RPE (haRPE) or the effects of oxidative stress on membrane conductance properties. In the present study, we assessed ClC channel and cystic fibrosis transmembrane conductance regulator (CFTR) expression and membrane chloride conductance properties in haRPE cells. ClC-5, ClC-3, ClC-2, and CFTR mRNA expression was confirmed with RT-PCR analysis, and protein expression was detected with Western blot analysis and immunofluorescence microscopy. Whole cell recordings of primary cultures of haRPE showed an outwardly rectifying chloride current that was inhibited by the oxidant H(2)O(2). The inhibitory effects of H(2)O(2) were reduced in cultured human RPE cells that were incubated with precursors of glutathione synthesis or that were stably transfected to overexpress glutathione S-transferase. These findings indicate a possible role for ClC channels in haRPE cells and suggest possible redox modulation of human RPE chloride conductances.

Hydrogen peroxide stimulates apoptosis in cultured human retinal pigment epithelial cells.

PURPOSE: To determine whether hydrogen peroxide (H2O2), a physiological mediator of oxidative stress induces apoptosis in retinal pigment epithelial (RPE) cells. METHODS: To demonstrate that oxidatively stressed retinal pigment epithelial cells undergo apoptosis consequential to mitochondrial dysfunction, biochemical parameters of apoptosis were determined in cultured cells after treatment with 50-200 mM H2O2 for different times. Caspase-3 protease activity was determined from hydrolysis of DEVD-rho-nitroanilide. Expression of the anti-apoptotic protein, bcl-2 and the pro-apoptotic proteins p53 and p21 were analyzed by western blotting. RESULTS: Caspase-3 activity significantly increased in cells exposed to H2O2. Also, the expression of bcl-2 in cells treated with 200 microM H2O2 was diminished, whereas expression of p53 and p21waf-1 was increased compared to the controls. CONCLUSIONS: Exposure of retinal pigment epithelial cells to concentrations of H2O2 that cause in vitro mitochondrial DNA damage also promotes apoptosis.

Rod outer segments mediate mitochondrial DNA damage and apoptosis in human retinal pigment epithelium.

PURPOSE: To investigate the interrelationships between DNA damage, mitochondrial activity, and apoptosis in retinal pigment epithelial cells (RPE) after exposure to rod outer segments (ROS). METHODS: After incubation of cultured human RPE with ROS, mitochondrial redox function was evaluated from MTT reduction. Mitochondrial (mt) and nuclear (n) DNA damage were determined by quantitative polymerase chain reactions (QPCR). Apoptotic RPE cells were detected by binding of annexin V to phosphatidyl serine (PS) using fluorescence microscopy. The expression of the pro-apoptotic proteins, p53 and p21(waf-1), and DNA repair enzymes, apurinic/apyrimidinic endonuclease (APE(ref-1)) and DNA polymerase beta (beta-pol) were quantitatively determined by Western blotting analysis. RESULTS: Mitochondrial function decreased by 20 +/- 5% and annexin V immunofluorscent binding was enhanced after exposure of cells to physiological levels of ROS (3.8 x 10(6)cm(-2)) for 4 h. MtDNA was preferentially damaged after exposure to ROS with increased lesion frequencies of 1.49 +/- 0.37 and 2.2 +/- 0.14 per 10 kb base pairs (bp), respectively after 5 and 7 h contact, compared to untreated controls (zero class damage). APE(ref-1)expression increased more than 340% above controls after exposure to ROS for 7 and 24 h. The expression of beta-pol in cultures increased 110% above controls after 24 h contact with the ROS. The expression of p53 and p21 in cells increased 100 and 38% above controls after 24 h exposure to the ROS. CONCLUSIONS: Exposure of ROS to ROS induced mtDNA damage and dysfunction and activated nDNA repair pathways, which did not prevent apoptosis.

Chloride channel expression in cultured human fetal RPE cells: response to oxidative stress.

PURPOSE: The human fetal cell line RPE 28 SV4 has been useful for studies of oxidative stress and apoptosis in retinal pigmented epithelium. This cell model is now assessed in functional investigations of chloride channel activity. The study aims to determine the presence of specific chloride channels, including CFTR and ClC channels, to identify the properties of membrane chloride currents and to assess their modulation by hydrogen peroxide, cAMP, and other agents. METHODS: Channel expression was determined using RT-PCR and cDNA cloning and biochemical and immunocytochemical methods. Membrane currents were analyzed using whole-cell, patch-clamp techniques. RESULTS: RT-PCR results confirmed the presence of ClC-5 mRNA, and a full-length clone encoding ClC-3 was isolated from a cDNA library for RPE 28 SV4 cells. Specific staining for CFTR and several ClC channels was detected by immunocytochemistry. Whole-cell chloride currents (under conditions of symmetrical chloride concentrations) averaged 16.9 +/- 3.4 pA/pF (at +100 mV; n = 8), showed outward rectification, and had an anion permeability sequence of Cl(-) > I(-) > cyclamate. Currents were stimulated by cAMP cocktail (250 microM cAMP, 100 microM IBMX, and 25 microM forskolin) and were inhibited by 1 mM DIDS. The oxidative agent hydrogen peroxide (100 microM) decreased the current by 34% +/- 10% (n = 4). CONCLUSIONS. These findings suggest that RPE 28 SV4 cells possess regulated chloride channels including CFTR and members of the ClC chloride channel family. The inhibition of chloride currents by H(2)O(2) suggests that this cell line may be advantageous for studies of chloride channel modulation by oxidative stress.

Dietary curcumin prevents ocular toxicity of naphthalene in rats.

Administration of naphthalene is known to cause cataract formation in rats and rabbits and naphthalene-initiated cataract is frequently used as a model for studies on senile cataract in humans. Oxidative stress has been implicated in the mechanism of naphthalene-induced cataract. Curcumin, a constituent of turmeric, a spice used in Indian curry dishes, is an effective antioxidant and is known to induce the enzymes of glutathione-linked detoxification pathways in rats. During the present studies, we have examined whether low levels of dietary curcumin could prevent naphthalene-induced opacification of rat lens. The presence of apoptotic cells in lens epithelial cells was also examined by catalytically incorporating labeled nucleotide to DNA with either Klenow fragment of DNA polymerase or by terminal deoxynucleotidyl transferase (TdT), which forms polymeric tail using the principle of TUNEL assay. The results of these studies demonstrated that the rats treated with naphthalene and kept on a diet supplemented with only 0.005% (w/w) curcumin had significantly less opacification of lenses as compared to that observed in rats treated only with naphthalene. Our studies also demonstrate, for the first time, that naphthalene-initiated cataract in lens is accompanied and perhaps preceded by apoptosis of lens epithelial cells and that curcumin attenuates this apoptotic effect of naphthalene.

Induction of glutathione S-transferase hGST 5.8 is an early response to oxidative stress in RPE cells.

PURPOSE: To delineate the role of the glutathione S-transferase (GST) isozyme hGST 5.8 in protection mechanisms against oxidative stress, the effect of low-level transient exposure of H2O2 to retinal pigmented epithelial (RPE) cells on hGST 5.8 and other enzymes involved in defense against oxidative stress was examined. METHODS: Cultured human RPE cells were exposed to 50 microM H2O2 for 20 minutes. Subsequently, the cells were washed and resuspended in the culture media. The cells were pelleted and lysed, and the levels of lipid peroxidation products including thiobarbituric acid-reactive substances (TBARS), glutathione (GSH), glutathione peroxidase (GPX), glucose 6-phosphate dehydrogenase, glutathione reductase, GST, catalase (CAT), and superoxide dismutase (SOD) were determined and compared with levels in control cells. Total GSTs were purified by GSH-affinity chromatography, and the isozymes were separated by isoelectric focusing, characterized, and quantitated. hGST 5.8 was quantitated by an immunologic method as well as by determining activity toward its preferred substrate, 4-hydroxynonenal (4-HNE). Kinetic constants of hGST 5.8 purified from H2O2-treated cells were also determined and compared with those of control cells. RESULTS: Exposure of RPE cells to 50 microM H2O2 for 20 minutes showed a significant increase in TBARS (1.8-fold) and gamma-glutamyl cysteine synthetase (gamma-GCS) activity (1.6-fold). A significant increase (1.2-fold) was also observed in GPX activity toward cumene hydroperoxide, but CAT and SOD activities remained unchanged. There was no significant increase in GST activity toward 1-chloro-2, 4-dinitrobenzene but GST activity toward 4-HNE was increased by 1.4- to 1.8-fold. The increase in GST activity toward 4-HNE was associated with a 2.8-fold increase in protein of the isozyme hGST 5.8, which uses 4-HNE as the preferred substrate. CONCLUSIONS: Results of these studies show that the induction of hGST 5.8, which is involved in the detoxification of the lipid peroxidation products 4-HNE and hydroperoxides, may be an early adaptive response of RPE cells exposed to low levels of transient oxidative stress. It is suggested that this isozyme may be crucial for protecting the RPE from low levels of chronic oxidative stress. Observed increases in GPX and gamma-GCS activities are consistent with this idea, because GPX activity is also expressed by hGST 5.8, and gamma-GCS is the rate-limiting enzyme in biosynthesis of GSH, the substrate for hGST 5.8.

Hydrogen peroxide causes significant mitochondrial DNA damage in human RPE cells.

Retinal pigment epithelial cell dysfunction mediated by reactive oxygen intermediates has been suggested as a possible cause of age-related macular degeneration. To test the hypothesis that retinal pigment cells are susceptible to genetic damage mediated by reactive oxygen intermediates, retinal pigment epithelial cells were treated with 50 micrometers-200 micrometers of hydrogen peroxide in vitro. Damage to mitochondrial DNA and three nuclear loci were assessed using quantitative polymerase chain reaction. Hydrogen peroxide treatment of retinal pigment epithelial cells resulted in significantly increased mitochondrial DNA damage. Significant mitochondrial DNA damage occurred rapidly and was not completely repaired within 3 hr post-treatment. By contrast, no DNA damage was observed in three different nuclear loci (beta-globin gene cluster, hprt, and beta- polymerase genes). Hydrogen peroxide treatment of retinal pigment epithelial cells also resulted in decreased mitochondrial redox function compared to controls, consistent with increased mitochondrial DNA damage. Consequently, retinal pigment epithelial cell mitochondrial DNA appears susceptible to hydrogen peroxide mediated damage in vitro, and thus, may serve as a catalyst in the initial events leading to retinal pigment epithelial cell dysfunction in vivo.

Clinical features of progressive bifocal chorioretinal atrophy: a retinal dystrophy linked to chromosome 6q.

PURPOSE: The gene for progressive bifocal chorioretinal atrophy (PBCRA) has been linked to chromosome 6q, near the genomic assignment for North Carolina macular dystrophy. A study was undertaken to define the clinical features of a large PBCRA pedigree and to determine whether PBCRA and North Carolina macular dystrophy are phenotypically distinct entities. METHODS: Fifteen affected individuals from 1 large family were examined clinically, which included angiography and electrophysiologic studies. RESULTS: The PBCRA is an autosomal dominant chorioretinal dystrophy of early onset characterized by large atrophic macular and nasal retinal lesions, nystagmus, myopia, poor vision, and slow progression. A large atrophic macular lesion and nasal subretinal deposits are evident soon after birth. An atrophic area nasal to the optic nerve head appears in the second decade, which enlarges progressively. Electro-oculographic and electroretinographic studies indicated marked, diffuse abnormalities of rod and cone function. Fluorescein and indocyanine green angiography showed a large circumscribed area of macular choroidal atrophy with staining of deposits in the peripheral retina. In addition to previously documented features, nasal retinal abnormalities from a few weeks of age, marked photopsia in a number of patients, and retinal detachments in three eyes are reported as new features of the disease. CONCLUSIONS: An extended description of PBCRA is presented highlighting that the phenotype is distinct from North Carolina macular dystrophy, although some phenotypic similarities exist between the two conditions. These disorders may be the result of different mutations on the same gene or nearby genes.

Localization of the gene for progressive bifocal chorioretinal atrophy (PBCRA) to chromosome 6q.

Progressive bifocal chorioretinal atrophy (PBCRA) is a rare, autosomal dominant congenital chorioretinal dystrophy. We have performed genetic linkage analysis on a five-generation British pedigree. Two-point linkage analysis showed significant linkage with nine microsatellite marker loci mapping to chromosome 6q. Multipoint analysis gave a maximum lod score of 11.8 (theta = 0.05) between D6S249 and D6S283. This region overlaps with that to which the gene for North Carolina macular dystrophy (MCDR1) has been assigned. However, given the range of differences in phenotype between these two retinal disorders, it is likely that different mutation mechanisms are responsible for each disease.

Release of endogenous dopamine from the superfused rabbit retina in vitro: effect of light stimulation.

Light exposure activates dopamine (DA)-releasing neurons in the retina. Previous studies have employed indirect means (i.e. accumulation of DA metabolites in vivo4.11, or [3H]DA release from preloaded retina in vitro2) to estimate light-stimulated retinal DA release. We describe a new technique, based on superfusion of retinal pieces in vitro, which allows direct measurement of endogenous DA release. Dark-adapted pieces of retina from male albino rabbits were individually superfused in vitro with a physiologic buffer containing nomifensine (30 microM) (a DA reuptake blocker), and exposed to steady white light (300 microW/cm2) for 15 min. Retinal DA release into the superfusate was significantly greater (60%) during photic stimulation than during dark-exposure.

Spinal cord noradrenergic neurons are activated in hypotension.

Although norepinephrine-containing nerve terminals in the spinal cord synapse in the vicinity of sympathetic preganglionic cells, their effect on sympathetic outflow has remained unclear. Since survival during hypotension necessitates sustaining maximal sympathetic activity, we used experimental hypotension as a physiological stimulus to determine whether such activity is associated with an increase or a decrease in spinal cord norepinephrine turnover. Male Sprague-Dawley rats (500 g) were anesthetized with chloralose and urethane and their left carotid arteries were cannulated for blood pressure measurements and blood removal. Control animals remained normotensive during the 1-h study period; hypotensive animals were bled to a 50 mm Hg systolic pressure. Catecholamine release, as indicated by methoxyhydroxyphenylethyleneglycol sulfate (MHPG-SO4) concentrations, was greater in spinal cords of hypotensive rats than in normotensive controls. Apparent catecholamine synthesis also increased: norepinephrine concentrations did not change even though those of MHPG-SO4 doubled and the accumulation of dihydroxyphenylalanine (in other animals pretreated with NSD 1015) also doubled. These studies show that catecholamine-containing neurons in the spinal cord are stimulated in hypotension, and suggest that they may function physiologically to increase sympathetic outflow and thus blood pressure.