Peripapillary Retinal Nerve Fiber Layer Thickness and the Evolution of Cognitive Performance in an Elderly Population.

Retinal nerve fiber layer (RNFL) thickness is reduced in Alzheimer's patients. However, whether it is associated with early evolution of cognitive function is unknown. Within 427 participants from the Three-City-Alienor longitudinal population-based cohort, we explored the relationship between peripapillary RNFL thicknesses and the evolution of cognitive performance. RNFL was assessed at baseline by spectral domain optical coherence tomography; cognitive performances were assessed at baseline and at 2 years, with the Mini-Mental State Examination, the Isaacs' set test, and the Free and Cued Selective Reminding Test (FCSRT). Multivariate linear mixed models were performed. The RNFL was not associated with initial cognitive performance. Nevertheless, a thicker RNFL was significantly associated with a better cognitive evolution over time in the free delayed recall (p = 0.0037) and free + cued delayed recall (p = 0.0043) scores of the FCSRT, particularly in the temporal, superotemporal, and inferotemporal segments. No associations were found with other cognitive tests. The RNFL was associated with changes in scores that assess episodic memory. RNFL thickness could reflect a higher risk of developing cognitive impairment over time.

Optic Radiations Microstructural Changes in Glaucoma and Association With Severity: A Study Using 3Tesla-Magnetic Resonance Diffusion Tensor Imaging.

Purpose: To compare microstructural changes along the optical radiations and brain structure volumes between glaucoma and control subjects using in vivo magnetic resonance imaging and to analyze their association with severity of the disease. Methods: A total of 50 open-angle glaucoma subjects and 50 healthy age- and sex-matched controls underwent detailed ophthalmologic examinations (including visual field testing [VF], funduscopy, and spectral-domain optical coherence tomography) as well as diffusion tensor imaging (DTI) using 3.0-Tesla magnetic resonance imaging. Fractional anisotropy (FA), mean diffusivity, radial diffusivity (RD), and axial diffusivity (AD) were quantified semiautomatically along the optical radiations. DTI parameters and volumes of specific brain structures were compared between cases and controls using conditional logistic regression. Association between DTI metrics and the severity of the disease was studied using linear mixed regression analyses. Results: In glaucoma subjects, optic radiations FA was significantly lower (0.57 vs. 0.59; P = 0.02) and RD was significantly higher (52.78 10-5 mm2/s vs. 49.74 10-5 mm2/s; P = 0.03) than in controls. Optic radiations FA was significantly correlated with homolateral functional and structural damage of glaucoma (mean deviation of VF [P = 0.03], retinal nerve fiber layer thickness [P = 0.03], vertical cup to disc ratio [P = 0.0007]). Volume and DTI parameters of other brain structures (including hippocampus) were not significantly different between glaucoma patients and controls. Conclusions: We evidenced microstructural modifications along visual pathways of glaucoma patients and these alterations were correlated with disease severity. The association of glaucoma with other neurodegenerative alterations would need further exploration and a prospective follow-up of our cohort of subjects. (ClinicalTrials.gov number, NCT01621841).

Evolution Profiles of Different Corneal Parameters in Progressive Keratoconus.

PURPOSE: To analyze the evolution profiles of several corneal topographic and tomographic parameters in progressive keratoconus and compare them with the kinetics of evolution of anterior keratometry. METHODS: One hundred nine eyes of 55 patients were prospectively enrolled and followed up every 3 months for at least 1 year. Forty-five corneal parameters were measured at each visit using a combined Placido-based and dual Scheimpflug imaging system. Percentage of progression between each visit was calculated for each parameter and comparisons were tested between the different variables. RESULTS: At 1 year, 11% (12/109) of eyes progressed with an increase in maximum anterior keratometry of 1 D or more. Among these eyes, the posterior maximum keratometry and vertical corneal coma had a significantly higher percentage of progression (P < 0.05) than the maximum anterior keratometry, 5.9%, 27%, and 3.2%, respectively, and occurred significantly earlier than the modifications of the anterior keratometry, at the third-, sixth-, and 12th-month visits, for vertical corneal coma, posterior keratometry, and anterior keratometry respectively. CONCLUSIONS: Modifications of the posterior surface and corneal vertical coma occurred earlier and were detectable before changes in the anterior keratometry readings in eyes with progressive keratoconus. These parameters may be relevant warning signs when monitoring progressive keratoconus.

Anterior capsule contraction treated by femtosecond laser capsulotomy.

PURPOSE: To describe a new method to treat severe anterior capsule contraction using a femtosecond laser anterior capsulotomy. METHODS: Case report. RESULTS: A 48-year-old woman with a history of myotonic dystrophy experienced a severe contraction of the anterior capsule following an uneventful phacoemulsification cataract surgery with a hydrophilic acrylic intraocular lens implanted in the capsular bag. A femtosecond laser anterior capsulotomy was performed using a non-applanating fluid-filled interface. The spectral-domain optical coherence tomography imaging system associated with the laser enabled precise centration and location of the capsulotomy with a posterior cut located between the anterior surface of the intraocular lens and the anterior capsule inner surface. The free-floating capsulotomy was easily removed after the laser procedure, and 8 days postoperatively visual acuity recovered and myopic shift regressed with an intraocular lens centered in the capsular bag. CONCLUSIONS: Femtosecond laser assisted by a high-resolution imaging system appears to be a safe and efficient treatment for severe anterior capsule contraction.

Wavefront analysis after wavefront-guided myopic LASIK using a new generation aberrometer.

PURPOSE: To evaluate the short-term aberrometric outcomes of wavefront-guided LASIK for the correction of low to moderate myopia and myopic astigmatism using a new generation aberrometer (iDesign System; Abbott Medical Optics, Inc., Santa Ana, CA). METHODS: Charts of 92 eyes of 46 patients successively treated by wavefront-guided LASIK for myopia and/or myopic astigmatism were retrospectively reviewed at 3 months postoperatively. Aberrometric analysis of the wavefront errors was performed for a 6-mm pupil diameter to investigate the surgical induction of the total higher-order aberrations (HOAs), spherical aberrations Z41, and coma-like aberrations Z3 . Additionally, correlations between the magnitude of aberrations induced with the level of achieved correction and the preoperative amount of aberrations were tested. RESULTS: A minimal but statistically significant induction in all of the aberrations tested was observed at 3 months postoperatively (P < .01), with an increase (calculated for a 6-mm pupil) of +0.12 + 0.2, +0.06 + 0.1, and 0.05 + 0.1 pm in the root mean square (RMS) total HOA, RMS spherical aberration Z41, and RMS coma Z31, respectively. The postoperative change in aberrations was poorly correlated with both the level of achieved myopic correction for all of the aberrations tested (r < 0.3; P < .001) and the preoperative level of spherical aberrations (r = 0.3; P < .05) and coma (r = 0.46; P < .05). CONCLUSIONS: Wavefront-guided LASIK using the new generation Hartmann-Shack aberrometer allows a minimal induction of HOAs regardless of the level of myopic correction achieved or the preoperative magnitude of aberrations.