Epidemiology of the optic nerve grey crescent in the Reykjavik Eye Study.

AIM: To establish the epidemiology of the grey crescent in a white population within the age range most susceptible to glaucoma. METHODS: Bruce Shields was first to use this term to describe a localised, physiological pigmentation of the optic nerve neuroretinal rim tissue that is distinct from peripapillary pigmentation. An experienced glaucomatologist (KFD) evaluated stereofundus photographs of the participants of the Reykjavik Eye Study (RES)-a random sample from the national population census including people 50 years and older. 1012 right eyes could be evaluated for grey crescent. RESULTS: The prevalence of grey crescent in the right eyes was 22.0% (95% CI 10 to 25). It was more commonly found in women (27.0%: 95% CI 23 to 30) than in men (17.0%: 95% CI 14 to 21), and was most often located temporally (36.9%), 360 degrees (15.9%), or nasally (15.4%). The spherical equivalent was +1.30 dioptres (D) for those with and +0.80 D for those without grey crescent (p = 0.002), respectively. Vertical optic disc diameters were 0.203 v 0.195 units (p<0.001). There was no difference in the prevalence of grey crescent in glaucomatous or non-glaucomatous eyes (OR = 1.05, 95% CI 0.49 to 2.26). The prevalence of a grey crescent was inversely related to the prevalence of peripapillary atrophy (p = 0.001). CONCLUSIONS: The grey crescent needs to be recognised as a physiological variant in order to avoid falsely labelling eyes as having glaucomatous optic nerve damage.

Prevalence of open-angle glaucoma in Iceland: Reykjavik Eye Study.

PURPOSE: To establish the age- and sex-specific prevalence of open-angle glaucoma (OAG) subsuming pseudoexfoliation (PEX) in the city of Reykjavik. METHODS: Participants 50 years of age and older who were part of the Reykjavik Eye Study and classified as having glaucoma were divided into three categories:Category 1: two or more of the following based on optic nerve stereophotograph reading: vertical cup to disc ratio (VCDR) 97.5th percentile (>0.7), focal glaucomatous disc change, C/D asymmetry of 97.5th percentile difference between eyes (>0.2) as well as glaucomatous visual field defect (GVFD). Category 2: 99.5th percentile of VCDR (>0.8) and 99.5% percentile difference between eyes (>/=0.3), without a GVFD. Category 3: VA<3/60 and IOP>99.5th percentile or VA <3/60 and evidence of filtering surgery. For a glaucoma suspect, one of the following was present: VCDR>99.5th percentile (>0.8), focal glaucomatous disc change, C/D asymmetry of 99.5th percentile (> or =0.3), GVFD only, IOP> or =23 mmHg (97.5 percentile). PEX was diagnosed by the presence of a central shield and/or a peripheral band on the anterior lens capsule. RESULTS: Of 42 persons (22 males and 20 females) with OAG, 13 (31.0%) had PEX. The minimum prevalence of OAG was 4.0% (42/1045) (95% CI 2.8-5.2) for those 50 years and older and 10.3% (95% CI 8.5-12.2) for PEX. The prevalence of OAG increases with age (OR=1.10/year, 95% CI 1.07-1.13, P=0.000) and the same applies for the prevalence of PEX, OR=1.10 (95% CI 1.07-1.12, P=0.000). CONCLUSION: There is a 10% annual increase for both OAG and PEX in persons 50 years and older.

Modification of the Xenopus electroretinogram by actions of glycine in the proximal retina.

The electroretinogram (ERG) was recorded from the Xenopus retina, to examine the effects of glycine and strychnine on these responses and to determine the origins of these changes. Glycine at concentrations between 0.1 and 10 mM reduced the b- and d-waves of the ERG in a dose-dependent manner, while strychnine increased their amplitude. 2-Amino-4-phosphonobutyric acid (APB) reduced the b-wave and blocked the effect of glycine, but not strychnine, on the d-wave. When the d-wave had first been blocked by kynurenic acid (KYN) or reduced by (+/-)cis-2,3-piperidine dicarboxylic acid (PDA) the b-wave was enhanced by glycine, but not by strychnine. N-methyl-DL-aspartate (NMDLA), which alters responses in the proximal retina only, blocked the effects of glycine and strychnine on the ERG. This suggests that the glycinergic effects on the ERG are at least partly mediated by processes in the proximal retina. The results further support the suggestion that inhibitory neurotransmitters in the proximal retina may modulate both the b- and d-waves of the Xenopus ERG.

Laser treatment and the mechanism of edema reduction in branch retinal vein occlusion.

PURPOSE: To test a hypothesis on the physiological mechanism of the disappearance of macular edema after laser treatment. The hypothesis is based on the effect grid laser treatment has on retinal oxygenation and hemodynamics. It predicts that laser-induced reduction of macular edema is associated with shortening and narrowing of retinal vessels in patients with branch retinal vein occlusion (BRVO). METHODS: The study included 12 subjects, treated with argon laser photocoagulation for BRVO and macular edema. Fundus photographs taken at the time of diagnosis and again after laser treatment, were digitized, and diameter and segment length of retinal vessels was measured using NIH-Image program. RESULTS: Macular edema disappeared or was dramatically reduced in all cases after laser treatment. The diameter of occluded venules constricted to 0.81+/-0.02 (mean +/- SD, P = 0.019) of the prelaser diameter and adjacent arterioles constricted to 0.78+/-0.01 (P = 0.008). The laser treatment also led to shortening of the affected vessels. The final segment length of the occluded venules was 0.95+/-0.17 (P = 0.005) of the length before treatment. The corresponding value for the adjacent arterioles is 0.95+/-0.14 (P = 0.008). Control arterioles and venules in the same fundus did not change in either length or width. CONCLUSIONS: These results do not reject the authors' hypothesis that the disappearance of macular edema in BRVO can be explained by the effect the laser photocoagulation has on retinal oxygenation. Increased oxygenation causes vessel constriction and shortening and lower intravascular pressure, which reduces edema formation according to Starling's law.

[Age and sex specific prevalence of lens opacifications in Iceland.].

OBJECTIVES: Cataract is one of the most common causes for blindness in the world, though not in Iceland due to availability of cataract surgery. The aim of this study was to establish the age and sex specific prevalence of lens opacification and its severity in Iceland. MATERIAL AND METHODS: One thousand seven hundred citizens of Reykjavik 50 years and older were randomly selected from the national population census and offered to participate in an extensive eye study. The lenses were examined on the slitlamp microscope by two experienced ophthalmologists. Three types of lens opacification were considered separately namely cortical, nuclear and posterior subcapsular and graded according to severity using the World Health Organisation protocol. Of those randomized 68.2% of persons aged 50-79 attended and 35.8% of those 80 years and older. A total of 1045 persons; 461 males and 584 females, were examined. RESULTS: The percentage of persons with clear lenses decreased rapidly with increasing age. Of subjects age 50-59 years 45% had clear lenses, 24% of those 60-69 years and 6% of persons 70-79 year old. No subject 80 years or older was found to have a clear lens. Concurrent with this increase in the prevalence, there was an increase in severity of lens opacification. Opacification of the cortex was most common or 67%. There was a strong correlation between opacification in one eye and opacification in the contralateral eye or 84%. Conciusions: Lens opacification is an age-related phenomenon. Early cortical opacification is common after the age of 50 years and vision-disturbing cataract is common in persons older than 70 years. In coming years considerable increase in cataract surgery may be expected because of increase in the population 70 years and older.

The role of GABA in modulating the Xenopus electroretinogram.

We have recorded the electroretinogram (ERG) from the superfused eyecup of the Xenopus retina in order to assess the effects of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), and its agonists and antagonists, on individual ERG components. We found that GABA (0.5-10 mM) reduced the amplitudes of both the b- and d-waves of the Xenopus ERG. The GABA uptake blocker nipecotic acid (1 mM) had similar effects on b- and d-waves. GABA at 5 mM and 10 mM also caused an increase in the a-wave. The GABA antagonist picrotoxin (0.1-2 mM) and the GABA/a antagonist bicuculline (0.2 mM) both increased the amplitude of the b- and d-waves of the ERG. The GABA/b agonist baclofen (0.3 mM) reduced the amplitude of the ERG b-wave, enhanced the amplitude of the a-wave, and slightly reduced the amplitude and increased the peak time of the d-wave. The GABA/b antagonists phaclofen and saclofen had no reliable effects on the Xenopus ERG. Glutamate analogs known to affect specific types of retinal neurons were applied to modify the retinal circuitry and then the effects of GABA and its antagonists were examined under these modified conditions. 2-amino-4-phosphonobutyric acid (APB) increased the d-wave, and blocked the b-wave and the effect of GABA on the ERG, but not the antagonist-induced increase in the d-wave. KYN blocked the antagonist-induced increase in the b-wave, while GABA increases the amplitude of the b-wave if the d-wave has been removed by prior superfusion with kynurenic acid (KYN). N-methyl-DL-aspartate (NMDLA), which acts only in the proximal retina, reduced the amplitude of the ERG and blocked the effect of GABA and the antagonist-induced increase in ERG b- and d-waves amplitude. These results suggest that GABAergic mechanisms related to both A and B receptor types can influence the amplitude and light sensitivity of all the components of the Xenopus ERG. Since GABA is found in greatest abundance in the proximal retina, and B type of receptors are present almost exclusively there, the data suggests that most of the effects of GABA agonists and antagonists observed are dependent on proximal retinal mechanisms, and that there are separate mechanisms in the proximal retina related to the b- and the d-waves.

[Oscillatory potentials in the retina: the effects of GABA agonists.].

We have recorded the electroretinogram from 19 superfused eyecups of the Xeiiopus retina in order to assess the effects of agonists of the inhibitory neurotransmitter gamma-aminobutyric acid (GA notBA), on both oscillatory potentials and the b-wave. We found that in seven eyecups the GABA uptake blocker nipecotic acid (0.1-5 mM) reduced the amplitudes of the oscillatory potentials, without having an effect on the b-wave unless it was applied in larger doses. The GABAB agonist baclofen (0.05-3 mM) reduced the amplitude of the ERG b-wave selectively in seven eyecups tested, without any effect on the amplitude of the oscillatory potentials. The GABAA agonist aminovaleric acid (0.05-3 mM) on the other hand, selectively reduced the oscillatory potentials in five, but had no reliable effects on the Xenopus b-wave. These results suggest that GABAergic mechanisms related to both A and B receptor types induce different influence on the amplitude of the oscillatory potentials and the b-wave.