The Body Fat-Cognition Relationship in Healthy Older Individuals: Does Gynoid vs Android Distribution Matter?

OBJECTIVE: To examine the relationship between regional and whole body fat accumulation and core cognitive executive functions. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: 78 healthy men and women aged between 65 and 75 years recruited through consumer's database. MEASUREMENTS: DXA measured percentage total body fat, android, gynoid distribution and android/gynoid ratio; inhibition and working memory updating through Random Number Generation test and cognitive flexibility by Trail Making test. First-order partial correlations between regional body fat and cognitive executive function were computed partialling out the effects of whole body fat. Moderation analysis was performed to verify the effect of gender on the body fat-cognition relationship. RESULTS: Results showed a differentiated pattern of fat-cognition relationship depending on fat localization and type of cognitive function. Statistically significant relationships were observed between working memory updating and: android fat (r = -0.232; p = 0.042), gynoid fat (r = 0.333; p = 0.003) and android/gynoid ratio (r = -0.272; p = 0.017). Separating genders, the only significant relationship was observed in females between working memory updating and gynoid fat (r = 0.280; p = 0.045). In spite of gender differences in both working memory updating and gynoid body fat levels, moderation analysis did not show an effect of gender on the relationship between gynoid fat and working memory updating. CONCLUSIONS: Results suggest a protective effect of gynoid body fat and a deleterious effect of android body fat. Although excessive body fat increases the risk of developing CDV, metabolic and cognitive problems, maintaining a certain proportion of gynoid fat may help prevent cognitive decline, particularly in older women. Guidelines for optimal body composition maintenance for the elderly should not target indiscriminate weight loss, but weight maintenance through body fat/lean mass control based on non-pharmacological tools such as physical exercise, known to have protective effects against CVD risk factors and age-related cognitive deterioration.

Effects of Physical-Cognitive Dual Task Training on Executive Function and Gait Performance in Older Adults: A Randomized Controlled Trial.

Physical and cognitive training seem to counteract age-related decline in physical and mental function. Recently, the possibility of integrating cognitive demands into physical training has attracted attention. The purpose of this study was to evaluate the effects of twelve weeks of designed physical-cognitive training on executive cognitive function and gait performance in older adults. Thirty-six healthy, active individuals aged 72.30 ± 5.84 years were assigned to two types of physical training with major focus on physical single task (ST) training (n = 16) and physical-cognitive dual task (DT) training (n = 20), respectively. They were tested before and after the intervention for executive function (inhibition, working memory) through Random Number Generation and for gait (walking with/without negotiating hurdles) under both single and dual task (ST, DT) conditions. Gait performance improved in both groups, while inhibitory performance decreased after exercise training with ST focus but tended to increase after training with physical-cognitive DT focus. Changes in inhibition performance were correlated with changes in DT walking performance with group differences as a function of motor task complexity (with/without hurdling). The study supports the effectiveness of group exercise classes for older individuals to improve gait performance, with physical-cognitive DT training selectively counteracting the age-related decline in a core executive function essential for daily living.

Evaluation of retinal nerve fiber layer and ganglion cell complex thickness after ocular blunt trauma.

PURPOSE: To evaluate circumpapillary retinal nerve fiber layer (cpRNFL) and ganglion cell complex (GCC) after ocular blunt trauma. METHODS: Best-corrected visual acuity (BCVA), cpRNFL and GCC were evaluated by RTVue-100 OCT in all consecutive patients with previous monocular blunt trauma seen between January 2012 and December 2012. RESULTS: Twenty-two patients (11 females, 11 males, mean age 43.9 ± 14.2 years) were included in the study. Patients were seen after a mean of 8.42 ± 13.3 (range, 0.08-55.3) years from ocular blunt trauma. BCVA was normal in 11 cases and was less than 0.4 LogMAR in all cases. In 9/22 patients (40.9%), cpRNFL and GCC were reduced, whereas in one case an isolated reduction of GCC with normal cpRNFL was present. In patients with reduction of cpRNFL and GCC, mean BCVA was 0.17 ± 0.17 LogMAR. In 6/9 patients (66.6%) with cpRNFL and GCC reduction, BCVA was ≤ 0.1 LogMAR. CONCLUSION: cpRNFL and GCC reduction may be present after ocular blunt trauma and may be associated with preserved visual acuity.

Functional changes after treatment of optic pathway paediatric low-grade gliomas.

OBJECTIVE: To evaluate the functional changes after treatment of paediatric optic pathway gliomas (OPGs). METHODS: All patients with monofocal OPG seen from January 2004 to January 2011 were included. Best corrected visual acuity (BCVA, LogMAR), contrast sensitivity (Hiding-Heidi low-contrast 'face' test (HH) and Pelli-Robson (PR) contrast sensitivity test), and the Color Test (Ishihara plate) were obtained. RESULTS: Twenty-one patients (10 boys and 11 girls with a mean age of 5.5 ± 4.4 years at diagnosis) were included in the study. Neurofibromatosis was present in four cases. Eighteen patients (85.7%) were treated with initial surgery and three patients (14.3%) with initial chemotherapy. BCVA was 0.67 ± 0.8 LogMAR at baseline and 0.62 ± 0.9 LogMAR at last visit (P=0.41). The Color test was not significantly changed at last visit (P=0.62). Contrast sensitivity with the HH test was 9.1 ± 11.1% at baseline and 3.8 ± 6.4% at last visit (P=0.03). Contrast sensitivity with PR chart was 1.33 ± 0.9 log at baseline and 1.05 ± 0.7 log at last visit (P=0.005). A reduction in contrast sensitivity at both tests was significantly greater in patients who relapsed than in patients who did not relapse (P=0.001). CONCLUSION: After the treatment of paediatric optic pathway low-grade gliomas, a reduction in contrast sensitivity during follow-up was observed and may be correlated with tumour relapses.

[Corneal neovascularization: epidemiological, physiopathological, and clinical features]. / Néovascularisation cornéenne : aspects épidémiologiques, physiopathologiques et cliniques.

Corneal neovascularization is defined as the presence of vessels within the normally avascular corneal stroma. This physiopathological process is the consequence of local hyper-expression of pro-angiogenic factors in response to tissue damage. These new vessels (neovessels), initially immature and poorly developed, predispose the cornea to lipid exudation, inflammation, and scarring. Additionally, the influx of vascular cells into the stroma induces a loss of the cornea's immune privilege, resulting in a higher rate of graft rejection. In this literature review, we touch on epidemiological, physiopathological, and clinical aspects of corneal neovascularization, as well as secondary complications.

[Efficacy of intravitreal injections of ranibizumab compared to visudyne phototherapy in myopic choroidal neovascularization associated with high myopia]. / Comparaison du traitement par injections intravitréennes de ranibizumab à la photothérapie dynamique dans la néovascularisation choroïdienne compliquant la myopie forte.

INTRODUCTION: Myopic choroidal neovascularization (CNV) is the first cause of CNV in young patients. The aim of this study was to compare the efficacy of intravitreal injections (IVT) of ranibizumab with photodynamic therapy (PDT) in this indication. PATIENTS AND METHODS: Retrospective comparative study analyzing the visual acuity (VA) outcomes of CNV myopic patients treated with either IVT or PDT. RESULTS: Twenty-seven eyes of 25 patients were treated with PDT (group 1) and 18 eyes of 17 patients were treated with IVT of ranibizumab (group 2). Demographic data were similar in the two groups. The median initial VA was 20/80 for group 1 and 20/160 for group 2 (P=0.37). At 1 year, the median VA was 20/80 for group 1 (P=0.32) and 20/63 for group 2 (P=0.04). A significant improvement in VA was observed in 23.1% and in 27.3% of cases in groups 1 and 2, respectively (P=0.53). A significant VA worsening was observed in 34.6% of cases in group 1 and in 9.1% of cases in group 2 (P=0.21). CONCLUSION: IVT of ranibizumab compared to PDT treatment showed greater efficacy in this study.

[Multiple evanescent white dot syndrome and multiple sclerosis]. / Syndrome des taches blanches évanescentes et sclérose en plaques.

PURPOSE: To describe a patient who fulfilled the criteria for both clinically definite multiple evanescent white dot syndrome (MEWDS) and multiple sclerosis. METHODS: We performed a complete ophthalmologic and neurological examination in a 30-year-old woman who was referred to our department for blurred vision in her left eye (LE) with photopsia. RESULTS: Following a complete ophthalmologic examination, the patient was diagnosed with MEWDS and coincident multiple sclerosis. She underwent therapy with intravenous methylprednisolone (1000 mg/day) for three days, followed by oral prednisone (1 mg/kg per day) for 15 days. Most of the symptoms and signs apparently regressed within one month, despite a still abnormal OCT macular scan, probably due to atrophic post-inflammatory changes in the outer and photoreceptor layers (rods and cones). CONCLUSION: This report, showing the clinical features of MEWDS associated with multiple sclerosis, strongly suggests common neuropathological and inflammatory mechanisms between MS and white dot syndromes.

[A chart for low visual acuities: experience in a center for low vision and rehabilitation]. / Intérêt de mesurer les acuités visuelles très basses dans un centre de réadaptation pour déficients visuels.

INTRODUCTION: Commonly used visual test charts can be used to measure 1-m minimal visual acuities (VA) of 20/1000 (Snellen chart) and 1/40 (Early Treatment of Diabetic Retinopathy Study [ETDRS] charts). METHODS: In a prospective study, we considered all patients who visited in a Low Vision and Rehabilitation Center between September 2007 and January 2009. Distance best corrected VA (DBCVA) was evaluated with the ETDRS LogMAR 4-m chart and a customized ETDRS 1-m chart, while near best corrected VA (NBCVA) was measured with the LogMAR conversion of the Parinaud 30-cm chart. RESULTS: One hundred and sixteen eyes (58 patients; 34 males and 24 females with a mean age of 69+/-19.4 [19-94] years) were included in the study. Mean DBCVA was 0.97+/-0.58 LogMAR, mean NBCVA was 0.28+/-0.2 LogMAR. In 52 eyes (44.8%), distance VA was less than 1/20 (DBCVA 1.86+/-0.5 LogMAR, NBCVA 0.08+/-0.05 LogMAR). Among the 58 best seeing eyes, DBCVA was 0.87+/-0.6 LogMAR, while NBCVA was 0.34+/-0.2 LogMAR. In 18 of 58 cases (31%), distance VA was less than 1/20 (DBCVA 1.86+/-0.59 and NBCVA 1.51+/-0.42). CONCLUSION: In a center for low vision and visual rehabilitation, a customized chart was necessary in 31% of cases for evaluation of VA. A fine measurement of low VA is useful for baseline assessment and for evaluation of changes during rehabilitation.

Intravitreal bevacizumab vs intravitreal triamcinolone combined with macular laser grid for diffuse diabetic macular oedema.

OBJECTIVE: To evaluate the 12-month clinical outcome of patients with persistent non-ischaemic diffuse diabetic macular oedema (DME) treated with intravitreal bevacizumab (IVB) or with intravitreal injection of triamcinolone combined with macular laser grid (IVTA-MLG) from September 2005 to February 2008. METHODS: Retrospective interventional comparative study. Best-corrected visual acuity (BCVA, ETDRS LogMAR scale) and foveal thickness (FT) at optical coherence tomography (OCT) were obtained at baseline and during 12 months after first treatment. Re-treatment was based on clinical or OCT-based evidence of persistent macular oedema or deterioration in visual acuity. RESULTS: Forty-three eyes (32 patients) with DME were treated with IVB. Ninety-six eyes (52 patients) with DME were treated with combined laser grid treatment and intravitreal triamcinolone. At baseline, mean BCVA and FT were 0.92+/-0.34 LogMAR and 372+/-22 microm in the IVTA-MLG group, and 1.07+/-0.49 LogMAR and 423+/-33 microm in the IVB group, respectively. At 1- and 3-month visits, BCVA and FT had significantly improved in both groups. After 6 and 12 months, the IVB group experienced a statistically significant improvement in visual acuity (0.83+/-0.21 LogMAR, P<0.001 at 6 months; BCVA 0.86+/-0.24 LogMAR, P<0.001 at 12 months) and FT (248+/-18 microm, P<0.001 at 6 months; 262+/-28 microm, P=0.001 at 12 months) when compared with baseline, whereas the IVTA-MLG group did not show statistically significant improvement in vision and FT. An increase in intraocular pressure (IOP) was present in 10 of 96 (10.4%) eyes treated with IVTA-MLG, and in two cases it was resistant to topical treatment. No significant side effects were reported in the IVB group. CONCLUSIONS: At 6 and 12 months after first treatment for chronic DME IVB provided significant improvement of BCVA and FT, whereas improvement after IVTA-MLG was not significant. Increased IOP occurred in 10.4% of patients who received IVTA, with two patients requiring trabeculectomy.

Comparison of time domain Stratus OCT and spectral domain SLO/OCT for assessment of macular thickness and volume.

PURPOSE: To compare retinal thickness and volume measurements obtained with Stratus time domain optical coherence tomography (OCT) and spectral domain scanning laser ophthalmoscope OCT (SD-SLO/OCT). METHODS: In a cross-sectional study, 52 eyes with a normal macula, 30 eyes with retinal oedema, and 10 eyes with a myopia higher than 6 D have been evaluated with both time domain OCT (TD-OCT, Stratus OCT, Carl Zeiss Meditec, USA) and SD-SLO/OCT (OTI, Toronto, Canada). Retinal thickness and volume measurements in the nine areas of the 6-mm ETDRS ring were compared. Artefacts were defined as the discordance between the automatically detected anterior and posterior retinal boundaries and the boundaries detected by the examiner. RESULTS: Artefacts were more frequent with TD-OCT (35 vs26%). Mean retinal thickness was significantly higher with SD-SLO/OCT by 30.1 microm (+/-25.8) (P=0.003) in presence of the artefacts and by 39.2 microm (+/-25.8) (P=0.003) after their exclusion. The correlation between the two retinal thickness data sets before exclusion of the artefacts (r=0.59, P<0.001) increased after their removal (r=0.84, P<0.001). A strong correlation was present between the two retinal volume data sets before (r=0.94, P<0.001) and after exclusion of the artefacts (r=0.96, P<0.001). CONCLUSIONS: SD-SLO/OCT produced fewer artefacts than Stratus TD-OCT. This could be attributed to the greater resolution and acquisition speed of SD-SLO/OCT. The macular retinal thickness values measured with SD-SLO/OCT were significantly higher than those measured with Stratus TD-OCT. Retinal volumes measured with Stratus TD-OCT and SD-SLO/OCT were strongly correlated.

[Optical coherence tomography and fundus-related perimetry in spontaneous closure of a traumatic macular hole]. / Fermeture spontanée d'un trou maculaire post-traumatique évaluée par tomographie par cohérence optique et micropérimétrie.

We describe the spontaneous closure of a traumatic macular hole as evaluated with optical coherence tomography (OCT) and fundus-related perimetry. A 36-year-old man was examined by fundus biomicroscopy, ultrasonography, fundus-related perimetry, and OCT a few hours after injury to his left eye and during the following 18 months. At first examination, OCT showed a full-thickness macular hole, while fundus-related perimetry showed reduction of mean macular sensitivity, with an eccentric and unstable fixation. After 1 month, OCT scans showed complete closure of the macular hole, while fundus-related perimetry revealed a new eccentric but stable fixation (new preferred-retinal-locus). OCT and fundus-related perimetry seem to be useful tools to evaluate traumatic macular holes during follow-up.

[Microperimetry in age-related macular degeneration]. / La micro-périmétrie dans la dégénérescence maculaire liée à l'âge.

INTRODUCTION: Patients with age-related macular degeneration (AMD) usually present fixation and sensitivity abnormalities. The relationships between fundus lesions and functional abnormalities were evaluated with microperimetry. PATIENTS AND METHODS: A complete ophthalmologic examination, including best corrected visual acuity (BCVA) and fundus-related perimetry (MP-1 Micro-Perimeter, Nidek Technologies, Padova, Italy) was performed in 80 eyes of 80 consecutive patients (43 females, 37 males) with AMD and in 20 matched healthy control subjects (11 females, nine males). RESULTS: The patients' age ranged from 55 to 85 years and BCVA ranged from 20/20 to 20/400. In patients with early AMD, fixation was foveal and stable, with presence of a relative or absolute scotoma in correspondence with the abnormal retinal areas. In eyes with dry AMD, an absolute scotoma corresponding to the atrophic retinal areas was found. In eyes with neovascular AMD, an absolute scotoma in correspondence with the neovascular areas was noted. All groups evaluated presented a strong correlation between visual acuity and fixation stability (p<0.01). CONCLUSION: Microperimetry is a noninvasive examination that provides new and useful information to better characterize AMD and to diagnose and evaluate the progression of AMD.

[Transpupillary thermotherapy of choroidal melanomas]. / La thermothérapie transpupillaire des mélanomes choroïdiens.

PURPOSE: To evaluate the effectiveness of transpupillary thermotherapy (TTT) as a single treatment of choroidal melanomas. METHODS: We studied a series of 50 cases of choroidal melanoma treated with TTT and evaluated them with standardized A-scan and B-scan echography before and after treatment (1 week, 1, 3, and 6 months after treatment, then every 6 months). RESULTS: There were 22 males and 28 females with a mean age of 57 years (range, 22-78). The mean thickness of the lesion was 2.7 +/- 0.6 mm (range, 1.63-3.72). The mean follow-up was 38 months (range, 21-41). In almost all the eyes treated with TTT, substantial regression of tumoral microcirculation was observed after 1 week associated with a 70%-80% reduction in tumor thickness after 6 months (stabilized during follow-up). In one case of juxtapapillary melanoma with a thickness of 3.72 mm, another TTT application was necessary for local relapse. Visual acuity (VA) decreased to 20/30 in two cases (4%) and to 20/200 in four cases (8%) after the development of a cystoid macular edema. These latter patients were treated with two intravitreal injections (range, 1-3) of triamcinolone acetonide, and after a follow-up of 25 months (range, 21-29) VA improved to 20/20 in the first two cases, while two of the four other cases improved to 20/40 and two to 20/30. CONCLUSION: Transpupillary thermotherapy has visual results similar to those obtained with irradiation for the treatment of choroidal melanomas. Nevertheless, considering the high rate of recurrence at 5 and 10 years after transpupillary thermotherapy alone, most authors think that transpupillary thermotherapy is useful when associated irradiation for the treatment of choroidal melanomas, but its precise indications need to be defined.

Impression cytology with scanning electron microscopy: a new method in the study of conjunctival microvilli.

PURPOSE: Recent studies used impression cytology with scanning electron microscopy (SEM) to study the conjunctival surface of bovine eyes and normal human eyes. The purpose of this study was to evaluate the use impression cytology and SEM (ICSEM) in patients affected by tear film abnormalities. METHODS: Forty-five patients were divided into three groups according to mild, moderate or severe subjective sensation of dry eye. Fifteen asymptomatic subjects served as control group. In all patients the tear film was evaluated with break-up time (BUT), Schirmer's, and Ferning test, whereas conjunctival epithelium was evaluated with impression cytology and optic microscopy (ICOM), and ICSEM. The Spearman rank correlation test was used to compare the outcome of these examinations with the subjective sensation of dry eye in each group, and to identify correlations among the five tests. RESULTS: ICSEM findings highly correlated with subjective dry eye sensation (Spearman correlation coefficient, 796; P<0.01). ICSEM revealed incipient epithelial damage (reduction or absence of microvilli) before the appearance of alterations of nucleus and cytoplasm of epithelial cells revealed by optic microscopy. The number of microvilli was correlated with the degree of tear film abnormalities and subjective sensation of dry eye (Spearman correlation coefficient, 796; P<0.01). CONCLUSION: ICSEM was very effective in detecting the reduction in the number of microvilli. Therefore, it could represent an effective method to detect alterations in the conjunctival epithelium resulting from tear film damage even before the epithelial damage occurs and is detected by optic microscopy.

Evaluation of peripapillary detachment in pathologic myopia with en face optical coherence tomography.

BACKGROUND: A newly recognized lesion in pathologic myopia is peripapillary detachment of the retinal pigment epithelium (RPE) and retina. Recently introduced en face optical coherence tomography (OCT) provides not only cross-sectional but also coronal scans of the retina, and allows lateral extent visualization and thickness measurement of lesions. METHODS: Three patients presenting bilateral peripapillary yellow-orange lobulated area in high myopia have been evaluated with fluorescein angiography (FA), indocyanine green angiography (ICGA), en face OCT (OCT/SLO; Ophthalmic Technologies Inc, Toronto, Canada), and Humphrey visual field analyzer. RESULTS: In all eyes, en face OCT has shown the presence of a peripapillary sub-RPE nonreflective area. The lateral extent of this area was clearly detectable and the measurement of its thickness was obtained. We detected a cleft in the RPE at one edge of the cavitation in two eyes, vascular tractions and vitreoretinal tractions in two eyes, a macular hole with posterior retinal detachment, and small areas of RPE detachment nonconnected with the peripapillary detachment in one eye. In the four eyes presenting a proper central fixation, glaucomatous visual field defects were evident. CONCLUSION: En face OCT has allowed to evaluate the thickness and the lateral extent of the peripapillary detachment. Therefore, its use could be important in determining the size and grading of these lesions at first visit, and to detect minimal changes of width and thickness during follow-up as an alternative to fluorescein angiography.

Visualization of vitreomacular tractions with en face optical coherence tomography.

BACKGROUND: In vitreomacular traction syndrome, an incomplete vitreous detachment with persistent vitreous traction on the macula is present. This condition may determine formation of epiretinal membranes, macular puckering, macular oedema, and traction macular detachment. Recently introduced en face optical coherence tomography (OCT) provides not only longitudinal B-scan but also coronal C-scan images of the retina. METHODS: Fifteen eyes of 11 non-diabetic patients presenting vitreomacular traction syndrome have been evaluated with en face OCT (OTI, Toronto, Ontario, Canada). RESULTS: In 12 eyes, cystoid macular oedema was detectable at fundus examination and was associated with a broad-based adherence of the posterior hyaloid to the macula. In three eyes, foveal detachment appeared to be associated with focal foveal vitreoretinal traction. In all eyes, the lateral extent of the hyaloidal tractions on the macula was clearly detectable at coronal C-scan. They appeared as sigmoid hyper-reflective bands in the hyporeflective vitreous chamber. Overlay of C-scans on red-free confocal images allowed the visualization of the edges of the adherences in relation to the structures of the posterior pole. CONCLUSIONS: The C-scan images allowed clear visualization of the total extension of the posterior vitreomacular adherences and their relationships with the vascular arcades, the optic disc, and the fovea.

[Iridoschisis and angle-closure glaucoma: a case report]. / Iridoschisis et glaucome par fermeture de l'angle: à propos d'un cas.

INTRODUCTION: Iridoschisis is a rare condition where a localized area of iris stroma is cleaved in two, with the anterior atrophic portion disintegrating into fibrils. It is frequently associated with angle closure glaucoma and with cataract. CASE REPORT: A 70-year-old male presented with reduction of visual acuity in the left eye. Visual acuity was 20/25 OD and 20/70 OS. He had suffered acute angle-closure glaucoma in the right eye 10 years before, treated with laser iridotomy and topical antiglaucomatous therapy. Intraocular pressure was 12 mmHg OD and 46 mmHg OS. Slit lamp biomicroscopic examination revealed bilateral shallow anterior chamber, iris atrophy, and leaf degeneration of the iris stroma. A-scan and B-scan standardized echography in both eyes showed shortening of the anterior chamber, a thickened and more anteriorly located lens, the presence of a few hyperechogeneous flocculated masses floating in the vitreous, and optic disc excavation. CONCLUSION: The mechanism by which iridoschisis causes angle closure is unclear. A pupillary block could be favored by the thickening and anteriorization of the lens and the ciliary processes. Both the presence of strings of iris stroma occluding the trabecula and pupillary block could cause an elevation in intraocular pressure.