Assessing low vision care and the utilisation of optical low vision aids among patients with visual impairment in Taiwan.

PURPOSE: The aim of this study was to examine the quality of assessment and the utilisation of optical low vision aids (OLVAs) among people with visual impairment (VI) in Taiwan. METHODS: The study included 577 participants between 4 and 100 years of age (314 males and 263 females). All participants had been certified by the Ministry of the Interior of Taiwan, indicating that they had undergone a thorough and comprehensive low vision assessment, including evaluation of visual acuity (VA), contrast sensitivity, colour vision, visual fields and glare disability. Furthermore, all participants who consented to refraction had received prescriptions for OLVAs. RESULT: All participants were prescribed one or more OLVAs such as eyeglasses, tinted lenses, magnifiers, closed-circuit television magnifiers, telescopes, or screen magnifiers. Among the 577 individuals, 515 received correction for refractive errors, providing the best-corrected VA (BCVA). The improvement in VA was significant at both distance and near, improving from 1.29 ± 0.55 to 1.01 ± 0.52 logMAR (p < 0.001) and from 1.29 ± 0.56 to 1.01 ± 0.52 logMAR (p < 0.001), respectively. Eyeglasses were the primary OLVAs chosen by 333 participants (64.7%), while 53.3%-80.3% of participants combined eyeglasses with other OLVAs to enhance their visual performance. CONCLUSIONS: The most commonly used and effective OLVA was eyeglasses. Skilfully utilising appropriate refractive and VA measurements is crucial for determining the most suitable and beneficial OLVA for individuals with VI.

Correlating Ocular Physiology and Visual Function with Mild Cognitive Loss in Senior Citizens in Taiwan.

Purpose: The transition of Taiwan from an aging to a super-aging society has come with a cost as more elderly now suffer from cognitive impairment. The main purpose of our study was to investigate if early detection can be developed so that timely intervention can be instituted. We analyzed the correlation of cognitive function with ocular physiology and visual functions between senior citizens aged 60 years or older in Taiwan. Methods: Thirty-six healthy subjects were recruited for the study. Addenbrooke's cognitive examination III (ACE-III), binocular functions (including objective and subjective refraction, distance and near dissociated phoria, stereopsis, contrast sensitivity, adult developmental eye movement (ADEM), and ocular physiology (by using optical coherence tomography, OCT, and macular pigment measurement, MPS) were performed, and the data were analyzed via independent t-test, chi-square test, Pearson correlation, linear regression, and ROC (receiver operating characteristic) curve. Results: Data analysis showed that (1) patients with poor eye movement had a strong correlation with the total score and all dimensions of cognitive functions, (2) the thickness of the macula had a strong correlation with attention and memory, and (3) patients with poor eye movement and poor stereopsis in combination with thinner inferior macula appeared to have lower cognitive abilities. Discussion and Conclusions: Cognitive dysfunction is not readily identified during the early stage of cognitive decline. The use of simple and inexpensive ADEM or stereopsis test and comparing the OCT results that are popular in optometry clinics for reference can be diagnostic in identifying patients with mild cognitive impairments. With the combined use of macular pigment density or retinal thickness measurements, it was possible to effectively predict the early degradation of cognition.

Association among pterygium, cataracts, and cumulative ocular ultraviolet exposure: A cross-sectional study in Han people in China and Taiwan.

PURPOSE: Pterygium is an ocular surface disorder mainly caused by ultraviolet (UV) light exposure. This study explored the relationships between six cataract types with pterygium and UV exposure. METHODS: We have previously studied cataracts in residents of three regions in China and Taiwan with different UV intensities. From that study, we identified 1,547 subjects with information on the presence or absence of pterygium. Pterygium severity was graded by corneal progress rate. Cataracts were graded by classification systems as three main types (cortical, nuclear, posterior subcapsular) and three subtypes (retrodots, waterclefts, fiber folds) with high prevalence in middle-aged and elderly people. We calculated the cumulative ocular UV exposure (COUV) based on subject data and National Aeronautics and Space Administration data on UV intensities and used logistic regression to calculate odds ratios for the associations of COUV, cataract, and pterygium. RESULTS: We found an overall pterygium prevalence of 23.3%, with significant variation among the three regions. Four cataract types (cortical, nuclear, posterior subcapsular, and retrodots) were significantly associated with the presence of pterygium. CONCLUSIONS: There was a significant association between COUV and pterygium, indicating that COUV is associated with the risk of pterygium development and that pterygium is useful as an index of UV exposure. Furthermore, the type of cataract in eyes with pterygium may indicate the level of UV exposure.

Visual Function and Visual Perception among Senior Citizens with Mild Cognitive Impairment in Taiwan.

Purpose: With the benefits of advanced medical technology, Taiwan has gradually changed from an aged society to a super-aged society. According to previous studies, the prevalence rate of mild cognitive impairment (MCI) over the age of 60 is 15% to 20%. Therefore, the main purpose of our study was to analyze the correlation of cognitive function with visual function (specifically, binocular vision and visual perception) in Taiwanese volunteers aged 60 years or older. Methods: Thirty-six healthy participants who were not taking psychiatric medications and who had not been diagnosed with any retinal or optic nerve diseases were enrolled. Addenbrooke's cognitive examination III (ACE-III), binocular visual function, and visual perception evaluation were performed, and the data analyzed statistically by t-test, χ2, linear regression, and MANOVA. Results: Cognitive function was closely correlated with visual function and visual perception; the horizontal adjustment time of binocular eye movement, stereopsis, the motor-free visual perception test-4 (MVPT-4), and peripheral awareness actually displayed higher explanatory power in predicting cognitive function. In addition, various interactive parameters between visual function and visual perception were found to affect specific aspects of ACE-III. Discussion: Our study revealed that there was a close correlation of cognitive function with visual function; as such, it may be possible to predict visual function deficits in patients with mild cognitive impairment.

Myopization factors affecting urban elementary school students in Taiwan.

PURPOSE: To investigate factors that may contribute to the myopization of urban elementary school students in Taiwan. METHODS: Grades 1 to 6 students of the same racial background (n = 1894; mean age, 6.3-11.3 years) in three schools, located in Tamsui, Taichung, and Tainan, were refracted to obtain the best corrected visual acuity. The refractive power needed for best corrected visual acuity was used for subsequent statistical analysis. On behalf of their children, parents also completed a questionnaire on six categories of potential myopization variables. Correlation between these variables and the increase or decrease in the refractive error was assessed. The predictive value of each variable was also calculated based on linear regression analysis. RESULTS: The overall mean refractive error in grades 1 to 6 was -0.37, -0.68, -1.33, -1.60, -1.90, and -2.51 D, respectively. The prevalence of myopia (-1.00 D or more minus) showed a significant difference between grades 2 and 3 and, again, between grades 5 and 6. In addition, 20 potential modulating factors were evaluated; 65.9% of the change in the refractive error could be explained by four: (1) lag in optimal correction, defined as a -1.00-D deficit between new refractive error and current optical correction; (2) outdoor spectacle wear; (3) spectacles for different working distances; and (4) hours spent on reading and writing on weekdays. In contrast, outdoor time and the intake frequency of 36 food items both held very low predictive values of 0.2% and 2.5%, respectively. CONCLUSIONS: Each variable associated with the refractive error has a different predictive value, either positive or negative. Ultimately, the interplay of these variables decides the outcome of the pattern and the degree of school myopia.

Characterising visual deficits in children of an urban elementary school in Taiwan.

PURPOSE: The aim was to screen children from Grades 1 to 6 in an urban elementary school in Central Taiwan for visual deficits and associated parameters and, as an extension, to examine the acceptance of cycloplegic therapy as well as the lag in optimal vision correction. METHODS: Of 900 students in one school, 731 participated in the study, with parental consent. Data from 694 students, who had also completed a vision correction history were analysed. In addition to body height and weight, the screening included vision, non-cycloplegic autorefraction and distance retinoscopy, axial length and functional testing. RESULTS: There was a decrease in students with vision of 1.0 or better from 55.8 per cent in Grade 1 to 20.0 per cent in Grade 6. The decreases between Grades 2 and 3 and Grades 5 and 6 were significant. These trends were in general agreement with those based on refractive error and axial length. The students had abnormal functional findings including: stereoscopic vision, 9.2 per cent; cover tests, 14.1 per cent; pupillary responses, 13.8 per cent; and less commonly in extraocular muscular functions (3.0 per cent) and colour vision (5.2 per cent). A full 40 per cent of students received cycloplegic therapy with 25 per cent dropping out for various reasons. These cases were generally associated with lower vision and higher myopia. A lag between subnormal vision and optical correction was also observed with 55.1 per cent apparently not optimally corrected. Other parameters, including body height, weight and body mass index were not correlated with vision or refractive error. CONCLUSIONS: Age-dependent increase in the prevalence of myopia appears to continue despite the common practice of topical cycloplegic therapy in Taiwan. Timely correction of the refractive error is also lacking. While maintaining a visual acuity of 1.0 or better for all students at all times is not possible, this lag might be shortened by more frequent screening and/or direct provision of optical aids.

DNA damage induced by shikonin in the presence of Cu(II) ions: potential mechanism of its activity to apoptotic cell death.

Shikonin (ß-alkannin), a naphthazarin derivative, has shown a variety of abilities such as anti-inflammatory, antitumoral, cytotoxic, and antimicrobial activities. In the presence of Cu(II), shikonin caused breakage of supercoiled plasmid pBR322 DNA. Other metal ions tested [Mg(II), Ca(II), and Ni(II)] were ineffective and only Fe(II) has the same ability in the DNA breakage reaction. The involvement of active oxygen in the reaction was established by the inhibition of DNA breakage by superoxide dismutase, catalase, thiourea, sodium azide, potassium iodide, and sodium benzoate. Cu(I) was shown to be an essential intermediate using the Cu(I)-specific sequestering reagent neocuproine. Shikonin induced HeLa cell apoptosis involved in the mechanism of increasing intracellular reactive oxygen species (ROS). It was suggested that shikonin generated ROS as a pro-oxidant in the presence of Cu(II), and ROS resulted in DNA damage and apoptotic cell death in cells.

Disopropyl {[(2S,3S)-2-amino-3-methyl-penta-namido](phen-yl)meth-yl}phosphinate.

There are two independent mol-ecules in the asymmetric unit of the title compound, C(19)H(33)N(2)O(4)P. In the crystal, the two independent mol-ecules are linked via N-H⋯O=P hydrogen bonds, forming dimers.

A new compound, brefeldin A formylate, from Penicillium sp. strain HLKG-44.

A novel compound named as brefeldin A formylate (1), together with two known compounds, brefeldin A (2) and ergosterol (3), was isolated from the Penicillium sp. strain HLKG-44, which was isolated from polluted environment in Fujian Province. Their structures were identified based on the spectral and X-ray crystallographic analyses. The compound 1, brefeldin A formylate, exhibited moderate cytotoxic activity against the human lung cancer cell line A549 with IC(50) value of 18.9 microg/ml by the MTT assay protocol.

[Important genetic etiology of infertile Chinese males: chromosome abnormality and deletion of DAZ gene copy in the AZFc region of Y chromosome].

OBJECTIVE: To investigate the correlation of male infertility with abnormality of chromosomal quantity and construction and with the deletion of DAZ gene copy in the AZFc region of Y chromosome. METHODS: Included in the study were 247 azoospermic and 206 severe oligozoospermic patients, as well as 210 fertile men as controls. Multi-PCR and PCR-RFLP were used to analyze the deletion of DAZ gene copies in the AZFc region of Y chromosome. Chromosomal quantity and construction were detected by G-band in the 453 patients. RESULTS: In the azoospermic and severe oligozoospermic patients, the incidences of chromosomal abnormality were 12.6% and 8.3%; the rates of complete DAZ deletion were 7.7% and 11.2%, and the rates of DAZ1/DAZ2 deletion were 7.3% and 4.9% respectively, but no deletion was detected in the controls. CONCLUSION: There is a high frequency of chromosomal abnormality and DAZ gene copy deletion in patients with azoospermia and oligospermia, which suggests that chromosomal abnormality and partial and complete deletion of DAZ gene copy might be important genetic causes of Chinese male infertility.

[Construction and expression of recombinant plasmid with prostate-specific membrane antigen promoter and enhancer regulating uracil phosphoribosyltransferase gene].

OBJECTIVE: To construct the recombinant expression plasmid pPSMA(EP)-UPRT including UPRT gene that is regulated by PSMA(enhancer/promoter). METHODS: By use of PCR, UPRT gene was amplified from E. coli JM109 genome. Then UPRT gene was cloned into the recombinant expression plasmid pPSMA(enhancer/promoter)-EGFP that is driven by prostate-specific membrane antigen promoter and enhancer. RESULTS: It was found that EGFP was digested by two restriction enzymes from the recombinant expression plasmid pPSMA(enhancer/promoter)-EGFP, and UPRT gene was linked with the recombinant expression plasmid by T4 DNA ligase. We succeeded in constructing the recombinant expression plasmid pPSMA(enhancer/promoter)-UPRT. The recombinant plasmid sequences were verified, and the expression in vitro was measured by MTT. CONCLUSION: The recombinant expression plasmid pPSMA(enhancer/promoter)-UPRT is regulated targetly by prostate-specific membrane antigen promoter and enhancer. It is, of importance to us in studying the UPRT/5-FU for gene therapy of prostate cancer, especially suicide gene therapy (CD/5-FC system).

Racial differences of lens transparency properties with aging and prevalence of age-related cataract applying a WHO classification system.

PURPOSE: To investigate racial differences of lens transparency properties and the prevalence of lens opacification by age. METHODS: Lenses of randomly selected Asian (1,038 Japanese and 517 Singaporeans) and Caucasian (1,045 Icelanders) subjects were evaluated for their lens transparency property (LTP). The prevalence of lens opacification was determined with a newly proposed WHO cataract classification system. RESULTS: LTP increased with aging for all nationalities. Light scattering intensity was significantly higher in the Singaporeans followed by the Icelandic subjects. The prevalence of cortical opacification in Singaporeans was significantly higher than those of the other nationalities up to the age of 60, and the prevalence in Asians was significantly higher than that in Caucasians aged 60-69. Cortical opacification was more prevalent than the other types for both Japanese and Icelanders in their 50s, 60s and 70s. Regarding the central optical zone, the prevalence in the Singaporeans was significantly higher than in the other two groups in their 50s and 60s. The prevalence of nuclear opacification in Singaporeans was markedly higher than those of the two other groups for all ages. Subcapsular cataract was the least prevalent type for all age groups and nationalities; however, the highest prevalence was observed in Singaporeans. CONCLUSIONS: Lens transparency decreased with age in the Singaporeans more markedly than in the other two groups. The high prevalence of nuclear opacification in Singaporeans is considered to be due to environmental rather than race-specific factors.

Localization of cortical cataract in subjects of diverse races and latitude.

PURPOSE: To compare the characteristics of early cortical cataract localization in three groups in cataract epidemiologic surveys performed in Reykjavík, Melbourne, and Singapore. METHODS: Individuals who had right eyes with an area of cortical opacity less than 20% of the pupil when dilated 7 mm or more were selected as subjects. This included 197 subjects from the Reykjavík Eye Study, 231 from the Vitamin E, Cataract, and Age-Related Maculopathy (VECAT) study in Melbourne, and 92 from the Singapore-Japan Cooperative Cataract Study, all showing early-stage cataract in pupils dilated to 7 mm or more. Scheimpflug and retroilluminated photographs were used to locate opacities. Localization of cortical cataract was determined by dividing the retroillumination image into seven concentric circles with diameters of 1 through 7 mm, and eight sections of 45 degrees radial octants. The positive rate of opacification was then calculated for each quadrant. RESULTS: The highest positive rate of opacification was observed in the lower nasal quadrant in all groups. The relative risk of the prevalence of cortical opacity in the lower nasal oblique hemisphere to the upper temporal oblique hemisphere was the highest in the Singaporean subjects followed by those of Melbourne and then of Reykjavík. CONCLUSIONS: The prevalence of cortical cataract was higher in the lower nasal quadrant than in the other quadrants for all subjects of diverse race in three climatically different locations. This higher prevalence was most pronounced in subjects living at low latitude. These results support the view that solar UV exposure is a possible risk factor for development of human cortical cataract.

[Clinical study of sildenafil in the treatment of premature ejaculation complicated by erectile dysfunction].

OBJECTIVES: To evaluate the efficacy and safety of sildenafil citrate in the treatment of premature ejaculation (PE) complicated by erectile dysfunction (ED). METHODS: Forty-five patients of PE complicated by ED received flexible doses of sildenafil from 50 to 100 mg for 1 to 3 months. Intravaginal ejaculatory latency time (IELT) and sexual satisfaction ratio (SSR) of partner were recorded to evaluate the effect of PE treatment, as well as the general efficacy and satisfaction of ED treatment. And the difference of IIEF-5 before and after the treatment were compared. RESULTS: Twenty-seven patients had their PE improved and the effective rate was 60%. Forty patients reported the improvement in erection and the percentage of erectile improvement was 88.88%. All the 27 patients with improvement of PE achieved effective erection through the administration of 50 mg sildenafil and the satisfaction rate reached 81.48%. On the other hand, only 1 case (5.56%) reported satisfaction over the treatment in the 18 patients who did not obtain improvement of PE. Between the PE improvement group and non-improvement group, there were significant differences (P < 0.001) shown in IIEF-5 scores before and after the treatment. Mild or moderate side effects were reported in 9 patients(20%), who recovered without any treatment. CONCLUSIONS: To premature ejaculation patients with ED, sildenafil can safely and effectively improve their erectile function, the satisfaction over the ED treatment outcome means that their PE symptoms could be alleviated.

Prevalence of primary cornea guttata and morphology of corneal endothelium in aging Japanese and Singaporean subjects.

The purpose of the present study was to examine, in the aging people, racial and gender differences in the morphology of corneal endothelium as well as the incidence of cornea guttata in two Asian subject groups, one in Singapore and the other in Japan. Four hundred and sixty-five Chinese Singaporeans and 299 Japanese subjects (residents of Monzen-machi, Ishikawa Prefecture) aged 50 years and older were recruited for the study. Corneal endothelial abnormalities were diagnosed with slit-lamp biomicroscopy and specular microscopy. Primary cornea guttata appeared as beaten metal appearance in slit-lamp images and dark regions in specular images. In addition to cornea guttata, corneal endothelial morphology was also analysed with specular microscopy. The mean cell density was 2,808/mm(2) in the Japanese subjects which was significantly higher than the 2,718/mm(2) seen in the Singaporeans (p < 0.001). The incidence of cornea guttata was significantly higher in the Singaporeans than in the Japanese individuals and also higher in women than in men of both racial groups. These differences support not only a racial and a gender factor but also a possible environmental influence.

Water diffusion in the rabbit lens in vivo.

PURPOSE: To examine water diffusion in the crystalline lens and sugar cataracts in the rabbits in vivo. MATERIALS AND METHODS: Water self-diffusion in the lens cortices of alloxan-diabetic and galactosemic rabbits was examined with magnetic resonance imaging (MRI). The animals were positioned in a 4.7-tesla animal system in conjunction with a 1-inch surface coil for the eye. Diffusion-weighted MRI was conducted using a pulsed-gradient spin-echo sequence with a gradient strength of 0-6 Gs/cm in the primary and secondary coordinates. Other MRI parameters included TR (repetition time)/TE (echo time) = 2,000/10 ms, a field of view of 4 cm, and a 256 x 128 matrix. RESULTS: There appeared an increase in water relaxation resulting in an increase of % (equatorial cortex depth)/(lens long axis) from 18 in the lenses of normal rabbits to 30.4 and 39.9 in the lenses of galactosemic and diabetic rabbits, respectively. In addition, water diffusion changed in the lens of the diabetic rabbit with an increasing intracellular fluidity along the long axis of the cortical fibers, for example, the diffusion coefficient changed from a normal of 0.48 to 0.96 x 10(-5) cm2 s-1 in the lens of the diabetic rabbit. These results showed altered water mobility due to subcellular disturbances occurring before any apparent lens opacities. Further, there also was an increase in the water diffusivity in the aqueous humor from a normal of 1.77 to 2.67 x 10(-5) cm2 s-1 in the galactosemic rabbit eye suggesting an increase in either free water proportion or thermal convection. CONCLUSIONS: Resistance to water self-diffusion appeared to relate to lens fiber orientation and intracellular protein order. Diffusion imaging therefore can be used to examine water self-diffusion to detect early osmotic alteration of lens fibers.

High prevalence of nuclear cataract in the population of tropical and subtropical areas.

The authors have conducted cataract epidemiological studies in four climatically and racially different places and compared the data. The survey places were Noto and Amami in Japan, Reykjavik in Iceland, and Singapore. The evaluation and grading of lens opacities were done using graphic analysis of Scheimpflug and retro-illumination images. The prevalence of nuclear opacity was extremely high in the Singapore group, followed by Amami. The main type of lens opacity was nuclear in the Singapore group and cortical in the Noto and Icelandic groups. The characteristic lens opacity in Amami was in between the above two groups. No significant difference was seen in the prevalence of nuclear opacity between males and females in any of the groups. Although the common factors of the living conditions in the subjects with a high prevalence of nuclear opacity appear to be high UV exposure and high ambient temperature, future investigations should be made to disclose the possible cause.