UV Effect on Human Anterior Lens Capsule Macro-Molecular Composition Studied by Synchrotron-Based FTIR Micro-Spectroscopy.

Ultraviolet (UV) irradiation is an important risk factor in cataractogenesis. Lens epithelial cells (LECs), which are a highly metabolically active part of the lens, play an important role in UV-induced cataractogenesis. The purpose of this study was to characterize cell compounds such as nucleic acids, proteins, and lipids in human UV C-irradiated anterior lens capsules (LCs) with LECs, as well as to compare them with the control, non-irradiated LCs of patients without cataract, by using synchrotron radiation-based Fourier transform infrared (SR-FTIR) micro-spectroscopy. In order to understand the effect of the UV C on the LC bio-macromolecules in a context of cataractogenesis, we used the SR-FTIR micro-spectroscopy setup installed on the beamline MIRAS at the Spanish synchrotron light source ALBA, where measurements were set to achieve a single-cell resolution with high spectral stability and high photon flux. UV C irradiation of LCs resulted in a significant effect on protein conformation with protein formation of intramolecular parallel ß-sheet structure, lower phosphate and carboxyl bands in fatty acids and amino acids, and oxidative stress markers with significant increase of lipid peroxidation and diminishment of the asymmetric CH3 band.

Ultraviolet B Radiation Stimulates the Interaction between Nuclear Factor of Activated T Cells 5 (NFAT5) and Nuclear Factor-Kappa B (NF-κB) in Human Lens Epithelial Cells.

PURPOSE: Nuclear factor-kappa B (NF-κB) has been proposed as a therapeutic target for the treatment of cataracts. The authors investigated the relationship between nuclear factor of activated T cells 5 (NFAT5) and NF-κB in ultraviolet B (UVB)-irradiated human lens epithelial (HLE) cells. METHODS: Human lens epithelial B-3 (HLE-B3) cells were exposed to UVB light at a dose of 10 mJ/cm2 and then incubated for 24 h. Cell viability was assessed by using the Cell Counting Kit-8 (CCK-8) assay. Gene expression level of NFAT5 was determined using real-time quantitative polymerase chain reaction (qPCR). Protein expression levels of NFAT5, NF-κB p65, and α-smooth muscle actin (α-SMA) and the association of NFAT5 with the NF-κB p65 subunit were measured by Western blot analysis and a co-immunoprecipitation assay, respectively. The cellular distribution of NFAT5 and NF-κB p65 was examined by triple immunofluorescence staining. RESULTS: At 24 h after UVB exposure, cell viability significantly decreased in a dose-dependent manner, and UVB light (15 and 20 mJ/cm2) significantly increased the ROS generation. UVB irradiation increased NFAT5 mRNA and protein levels and increased phosphorylation of NF-κB in HLE-B3 cells. α-SMA protein levels were increased in the irradiated cells. In addition, NFAT5 and NF-κB translocated from the cytoplasm to the nucleus, and binding between the p65 subunit and NFAT5 was increased. CONCLUSIONS: Exposure to UVB radiation induces nuclear translocation and stimulates binding between NFAT5 and NF-κB proteins in HLE-B3 cells. These interactions may form part of the biochemical mechanism of cataractogenesis in UVB-irradiated HLECs.

Increase in lens capsule stiffness caused by vital dyes.

PURPOSE: To assess potential changes in lens capsule mechanical properties after staining with brilliant blue, indocyanine green (ICG), and trypan blue. SETTING: Department of Ophthalmology and Applied Physics and Center for NanoScience, Ludwig-Maximilians-University, Munich, Germany. DESIGN: Experimental study. METHODS: Fifteen unstained lens capsules were dissected into 7 wedge-shaped parts. Three fragments were stained with brilliant blue 0.025%, ICG 0.05%, and trypan blue 0.06%, respectively, for 1 minute. Another 3 specimens were additionally illuminated using a standard light source. The seventh part served as an untreated control. All specimens were analyzed using atomic force microscopy (AFM) in contact mode with a scan rate of 0.6 Hz. Two scan regions of 10 µm × 10 µm were chosen, and stiffness was determined using AFM in a force spectroscopy mode. The force curves were performed with a data rate of 5000 Hz. RESULTS: Staining of the samples resulted in an increase in tissue stiffness (brilliant blue: P<.001; ICG: P<.01; trypan blue: P<.05). Additional illumination after staining further increased tissue stiffness, but not significantly. Mean increase in the relative elasticity values were 1.61 ± 0.15 (SD) for brilliant blue, 2.04 ± 0.21 for brilliant blue with illumination, 1.63 ± 0.22 for ICG, 2.01 ± 0.22 for ICG with illumination, 1.23 ± 0.11 for trypan blue, and 1.39 ± 0.11 for trypan blue with illumination. In relation to unstained tissue, the relative elasticity of the stained tissue increased 1.2-fold after illumination. CONCLUSION: Staining significantly increased the mechanical properties of the human lens capsule. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

NASA study of cataract in astronauts (NASCA). Report 1: Cross-sectional study of the relationship of exposure to space radiation and risk of lens opacity.

The NASA Study of Cataract in Astronauts (NASCA) is a 5-year longitudinal study of the effect of space radiation exposure on the severity/progression of nuclear, cortical and posterior subcapsular (PSC) lens opacities. Here we report on baseline data that will be used over the course of the longitudinal study. Participants include 171 consenting astronauts who flew at least one mission in space and a comparison group made up of three components: (a) 53 astronauts who had not flown in space, (b) 95 military aircrew personnel, and (c) 99 non-aircrew ground-based comparison subjects. Continuous measures of nuclear, cortical and PSC lens opacities were derived from Nidek EAS 1000 digitized images. Age, demographics, general health, nutritional intake and solar ocular exposure were measured at baseline. Astronauts who flew at least one mission were matched to comparison subjects using propensity scores based on demographic characteristics and medical history stratified by gender and smoking (ever/never). The cross-sectional data for matched subjects were analyzed by fitting customized non-normal regression models to examine the effect of space radiation on each measure of opacity. The variability and median of cortical cataracts were significantly higher for exposed astronauts than for nonexposed astronauts and comparison subjects with similar ages (P=0.015). Galactic cosmic space radiation (GCR) may be linked to increased PSC area (P=0.056) and the number of PSC centers (P=0.095). Within the astronaut group, PSC size was greater in subjects with higher space radiation doses (P=0.016). No association was found between space radiation and nuclear cataracts. Cross-sectional data analysis revealed a small deleterious effect of space radiation for cortical cataracts and possibly for PSC cataracts. These results suggest increased cataract risks at smaller radiation doses than have been reported previously.

Photothermal effects in connective tissues mediated by laser-activated gold nanorods.

We report a study on the application of laser-activated nanoparticles in the direct welding of connective tissues, which may become a valuable technology in biomedicine. We use colloidal gold nanorods as new near-infrared chromophores to mediate functional photothermal effects in the eye lens capsules. Samples obtained ex vivo from porcine eyes are treated to simulate heterotransplants with 810-nm diode laser radiation in association with a stain of gold nanorods of aspect ratio approximately 4. This stain is applied at the interface between a patch of capsule from a donor eye and the capsule of a recipient eye. Then, by administration of laser pulses of 40 msec and approximately 100-140 J/cm(2), we achieved the local denaturation of the endogenous collagen filaments, which reveals that the treated area reached temperatures above 50 degrees C. The thermal damage is confined within 50-70 mum in a radial distance from the irradiated area.

Spontaneous resolution of a traumatic cataract caused by an intralenticular foreign body.

A 49-year-old man presented with an intralenticular metal foreign body incurred while he was sawing wood. The metal chard had violated the lens capsule and was lodged in the cortex of the lens. It was removed using a lens-preservation technique during open-globe repair. Subsequently, a dense posterior cortical cataract developed, which spontaneously resolved over the ensuing months. The cataract had a cruciate configuration with wave-like disruption of the stromal lamellae. To our knowledge, this is the first case of spontaneous resolution of a cataract after capsule violation by an intralenticular foreign body. The unique appearance of the cataract and its unusual resolution led to a new theory of lens injury by shockwave.

Low-intensity ultraviolet A irradiation of the lens capsule to remove lens epithelial cells during cataract surgery. Effectiveness and safety.

PURPOSE: To assess the effectiveness and safety of low-intensity ultraviolet A (UVA) irradiation in removing lens epithelial cells (LECs) during cataract surgery and compare them with those of mechanical polishing and no treatment. SETTING: Eyecove Ophthalmology Clinics, Pune, India. METHODS: This prospective randomized double-masked study consisted of preoperative screening of 36 patients, of which 30 met the inclusion criteria and were recruited. The patients had routine cataract surgery. A bean-shaped capsulorhexis was performed. After the nucleus and cortex were removed, the capsular bag was irradiated from inside with low-intensity UVA in 1 group. A second group had mechanical polishing, and a third group was not treated. A small flap of the anterior capsule was removed in each patient. The flap was stained and mounted in a Fuchs-Rosenthal chamber. For estimation of effectiveness, the area of capsule covered with epithelial cells was estimated by examination under a light microscope. One day postoperatively, an examination was performed to assess the safety of each technique. RESULTS: The area of the capsule from which the LECs were removed was significantly larger in the UVA-irradiation group than in the mechanical-polishing group (P = .001) and the no-treatment group (P = .001). There was no significant difference between the mechanical-polishing and no-treatment groups (P>.05). The area of the capsule flap that was covered with LECs was significantly less in the UVA-irradiation group than in the mechanical-polishing group (P = .017) and the no-treatment group (P = .001). The mechanical-polishing group and no-treatment group were not significantly different from each other (P>.05). Corneal edema was significantly less in the UVA-irradiation group than in the mechanical-polishing group (P<.001) and no-treatment group (P = .012). No patient in the UVA-irradiation group had postoperative lid edema; 8 patients in each of the other 2 groups had lid edema. The difference was statistically significant (P<.0001). Pupil size was significantly larger in the UVA-irradiation group than in the mechanical-polishing group and no-treatment group; the difference was significant (both P = .0001). There was no significant difference in pupil size in the mechanical-polishing group and no-treatment group. No significant difference was observed between the 3 groups in visual acuity, conjunctival edema, anterior chamber flare, and intraocular pressure. CONCLUSION: Ultraviolet A irradiation of the capsular bag was effective and safe in removing LECs from the anterior capsule during cataract surgery.

Cataracts among Chernobyl clean-up workers: implications regarding permissible eye exposures.

The eyes of a prospective cohort of 8,607 Chernobyl clean-up workers (liquidators) were assessed for cataract at 12 and 14 years after exposure. The prevalence of strictly age-related cataracts was low, as expected (only 3.9% had nuclear cataracts at either examination), since 90% of the cohort was younger than 55 years of age at first examination. However, posterior subcapsular or cortical cataracts characteristic of radiation exposure were present in 25% of the subjects. The data for Stage 1 cataracts, and specifically for posterior subcapsular cataracts, revealed a significant dose response. When various cataract end points were analyzed for dose thresholds, the confidence intervals all excluded values greater than 700 mGy. Linear-quadratic dose-response models yielded mostly linear associations, with weak evidence of upward curvature. The findings do not support the ICRP 60 risk guideline assumption of a 5-Gy threshold for "detectable opacities" from protracted exposures but rather point to a dose-effect threshold of under 1 Gy. Thus, given that cataract is the dose-limiting ocular pathology in current eye risk guidelines, revision of the allowable exposure of the human visual system to ionizing radiation should be considered.

[The influence of ionizing radiation on the development of posterior capsule opacification in vitro]. / Der Einfluss ionisierender Strahlen auf die Entwicklung der Sekundärkatarakt in vitro.

BACKGROUND AND PURPOSE: Histologically, the posterior capsule opacification (PCO) corresponds to regenerative tissue of transformed lens epithelial cells (LECs) with extracellular matrix production. In this study, the influence of ionizing radiation on proliferating LECs and the development of PCO was investigated in vitro. MATERIAL AND METHODS: Each four and 14 pork lenses, respectively, were irradiated with 6 MeV electrons with single doses of 8, 10, 12, and 20 Gy. 1-2 h after irradiation the lens was removed by capsulorrhexis and hydrodissection. After fixation of the capsular bag in a special device the proliferation of residual LECs was examined daily. The experiment was considered to be finished when the capsular bag was completely opacified by confluent cell proliferates. RESULTS: Single dose irradiation with electrons in a dose range from 8 to 12 Gy significantly protracted the development of PCO with complete inhibition of PCO after application of 20 Gy. CONCLUSION: To inhibit PCO in vitro, a single dose of 20 Gy is necessary. The actual in vitro model allows an optimal investigation of PCO formation under different external influences and is therefore very suitable for radiobiological questions.

Thermal stability of UV-irradiated collagen in bovine lens capsules and in bovine cornea.

The thermal stability of UVB irradiated collagen in bovine lens capsules and in bovine cornea has been investigated by differential scanning calorimetry (DSC). During UVB irradiation the lens capsules and cornea were immersed in water to keep the collagen in a fully hydrated condition at all times. UV irradiation induced changes in collagen which caused both stabilization and destabilization of the collagen structure. The helix-coil transition for non-irradiated collagen in cornea occurred near 66 degrees C, instead for the irradiated one for 3h it occurred at 69 degrees C. After irradiating for longer times (20-96h) the helix-coil transition peak occurred at much lower temperatures. The peak was very broad and suggested that collagen was reduced by UV to different polypeptides of different molecular weight and different lower thermal stabilities. The irradiation of lens capsules with UVB light in vitro resulted in changes in the thermal properties of type-IV collagen consistent with increased cross-linking. DSC of lens capsules showed two major peaks at melting temperatures at 54 degrees C Tm1 and 78 degrees C Tm2, which can be attributed to the denaturation of the triple helix and 7S domains, respectively. UVB irradiation of lens capsules in vitro for 6 h caused an increase in Tm1 from 54 to 57 degrees C. The higher temperature required to denature the type-IV collagen after irradiation in vitro suggested an increase of intermolecular cross-linking.

Biomechanical changes in the anterior lens capsule after trypan blue staining.

PURPOSE: To examine the effect of trypan blue staining on the biomechanical behavior of the porcine anterior lens capsule. SETTING: Department of Ophthalmology, Technical University of Dresden, Dresden, Germany. METHODS: Fifty-five anterior lens capsules from porcine cadaver eyes were used. Two parallel 8.0 mm x 4.0 mm large capsule strips were prepared from each capsule. After trypan blue staining for various time intervals combined with exposure to white light (6000 lux) or with no light exposure, biomechanical stress-strain measurements were performed using an automated material tester. Untreated specimens and specimens treated with glutaraldehyde 0.1% were used as controls. The absorption spectrum of trypan blue 0.1% solution and the emission spectrum of the light source were measured. RESULTS: After treatment with light and trypan blue, at 25% strain, there was a statistically significant increase in stress of up to 70.1% and in elastic stiffness of 47% and a decrease in the ultimate mechanical strain of up to 13%. There were no biomechanical changes in capsules with trypan blue staining in the absence of light or after a short illumination time of 30 seconds, indicating a light-dependent process. After 30 minutes of glutaraldehyde 0.1% treatment, there was an increase in stress of 321.6% at 25% strain and a decrease in the ultimate strain of 47.6%. The emission spectrum of the light source included the absorption peak for trypan blue at 580 nm. CONCLUSIONS: Trypan blue staining of the lens capsule combined with light irradiation for at least 1 minute led to an increase in elastic stiffness at 25% strain and a reduction in the ultimate extensibility. This effect is probably due to the photosensitizing action of trypan blue, leading to light-induced collagen crosslinking of the capsule collagen similar to age-related crosslinking. Nucleus expression might be impeded by the increased capsule stiffness. Continuous curvilinear capsulorhexis is facilitated.

The effects of sub-solar levels of UV-A and UV-B on rabbit corneal and lens epithelial cells.

The purpose of this work was to establish whether exposing cultured rabbit corneal and lens epithelial cells to ultraviolet radiation equivalent to several hours under the sun would damage the cells. Confluent rabbit corneal epithelial cells were irradiated with broadband UV-A or UV-B, and confluent lens epithelial cells were irradiated with broadband UV-A. The maximum dose of UV-A was 6.3 J cm(-2) and that of UV-B was 0.60 J cm(-2). Damage to corneal epithelial cell was studied using the terminal deoxynucleotidyl transferase mediated dUTP-X nick end labeling (TUNEL) assay and damage to lens epithelial cell was studied using the single cell gel electrophoresis (comet) assay and trypan blue exclusion assay. Lipid peroxidation was assayed using the thiobarbituric acid reaction. Both UV-B and UV-A induced cell death in corneal epithelial cells with different latent periods. UV-A damage included cell death, decreased viability and increased lipid peroxidation of lens epithelial cell. In addition, UV irradiation of the corneal and lens epithelial cells decreased the activity of catalase to thirty to fifty percent of its original value, while the activities of glutathione peroxidase and superoxide dismutase did not decrease within experimental error. Thus, even sub-solar UV radiation can cause irreversible damage to corneal and lens epithelial cells.

Influence of indocyanine green staining on the biomechanical properties of porcine anterior lens capsule.

PURPOSE: Indocyanine green (ICG) has recently been introduced in cataract surgery to stain the anterior lens capsule for better visualization of the capsulorhexis. The aim of the current in vitro study was to examine the effect of ICG staining on the biomechanical strength of the anterior porcine lens capsule. METHODS: Two parallel, 8 mm anterior lens capsule strips were prepared from each of 65 porcine postmortem eyes. ICG staining combined with white light exposure of 0.5, 1, 3, and 30 min duration was conducted. Unstained, nonilluminated and 0.1% glutaraldehyde-treated specimens were used as controls. Biomechanical stress-strain measurements were performed using an automated material tester. The absorption spectrum of the 0.5% ICG solution and the emission spectrum of the light source were controlled. RESULTS: After ICG staining combined with at least 3 min light exposure, a significant increase of stress (31%) at 25% strain and a significant decrease (7%) in ultimate strain was found. Without light exposure, there was no such effect, suggesting a light-dependent process. After 30 min of 0.1% glutaraldehyde treatment, there was a similar increase in stress (322%) at 25% strain and a decrease (47.6%) in ultimate strain. CONCLUSIONS: ICG staining of the lens capsule causes a significant increase in elastic stiffness and a reduction in ultimate extensibility, thereby facilitating a smooth continuous capsulorhexis. The effect is due to a photosensitizing effect of ICG, leading to collagen cross-linking.

Measurement of oxygen production by in vitro human and animal lenses with an oxygen electrode.

PURPOSE: This paper describes an advantageous method of measuring the activity of the enzyme catalase, which has an important antioxidative role in the lens. This method allows the measurement of catalase in whole lenses. METHODS: Exposure to UVA (99% UV-A) radiation was used to stress animal and human (Eye Bank) lenses in vitro. The ability of lens catalase to convert H2O2 into O2 was measured directly, using an oxygen electrode and meter. This method is very specific, as catalase is the only enzyme that converts H2O2 to O2. RESULTS: Catalase in the lenses of humans, rabbits, and squirrels catalyzed the production of O2 from H2O2 very efficiently. The anterior equatorial regions of these lenses were the most active O2 producing areas. More than 95% of lens catalase activity was found in the capsule-epithelium layer. Exposure to UVA radiation, up to approximately 100 J/cm2 in 18 h, strongly inhibited O2 production from 0.77 mM H2O2 by the lenses. Catalase activity decreased with increasing age. Mixed cataractous human lenses produced O2 from H2O2 at only 60% of the rate of normal lenses of similar ages. Nuclear cataracts produced O2 at only 75% of the rate of normal lenses. Alpha-tocopherol (10(-5) M) protected lens catalase activity strongly. Alpha-tocopherol is known to accumulate in and protect against cell membrane peroxidation, and against singlet oxygen formation. These oxidative mechanisms appear to contribute to catalase photoinactivation. CONCLUSIONS: The method described indicated that catalase is a crucial antioxidative enzyme in the normal lens. Its inactivation could upset the oxidation-reduction balance in the lens and stimulate lens opacification.

Effects of UV-B radiation on a hereditary suture cataract in mice.

UV-B (290-320 um, lambda max = 305 nm) radiation and the Cat2ns (suture cataract) mutation in mice affect both the anterior lens epithelium and the formation of the suture. A low dose of UV-B radiation (2.2 Jcm-2) induces similar anterior subcapsular and cortical lens opacities in wild type as in heterozygous mutant mice. The UV-B treatment of the mutant lenses, however, leads to an increase in the number of epithelial cell layers in the anterior central part as compared to the wild type indicating a more severe form of the cataract formation in mutants. In addition, mutants demonstrate a predisposition for a rupture of the posterior lens capsule, because from 2.9 Jcm-2 and higher, this phenomenon could always be observed in the UV-B treated mutants, but never in the treated wild type mice. The protein biochemical analyses were performed by gel electrophoresis and isoelectric focusing of extracts of total lenses or from defined areas of the lens (lens slice technique). These covered the patterns of those proteins already synthesized before irradiation, which in irradiated lenses in no case evidenced a difference to the untreated control, neither in the wild type nor in the mutants. In contrast, by analysing specifically those proteins, which are synthesised after irradiation, in both treated groups a protein with a molecular mass of about 31 kDa becomes discernable in both treated groups. In addition, the cataractous lenses demonstrate a significantly enhanced overall synthesis of water-soluble proteins after irradiation, which might promote the rupture of the posterior capsule at the posterior pole. The present study offers for the first time the possibility to discriminate between endogeneous (genetic) effects and exogeneous (environmental) effects in cataractogenesis and to study their interactive effects. The first set of experiments demonstrated a clear intensification of the hereditary cataract by the UV-B treatment. The study supports the hypothesis that environmental stress (like UV-B radiation) enhanced the severity of genetically triggered eye disease.

Prevalence of lens changes in Ukrainian children residing around Chernobyl.

The objective of this study is to determine the prevalence and characteristics of lens changes in the eyes of a pediatric population, 5-17 y old, living in the permanent control zone around the Chernobyl nuclear reactor and to compare these findings with those from an unexposed control population. A total of 1,787 children are reported on (996 exposed and 791 unexposed). Over three-quarters of the subjects examined in this study show a form of minor change, termed focal lens defect, in the cortical and/or nuclear portions of the lens of the eye. The exposed group shows a small (3.6%), but statistically significant excess (p = 0.0005) of subclinical posterior subcapsular lens changes similar in form to changes identified in atomic bomb survivors. These posterior subcapsular changes tend to occur in boys 12-17 y old and in exposed children who report consuming locally grown mushrooms on a regular basis.

Modulating radiation cataractogenesis by hormonally manipulating lenticular growth kinetics.

There is considerable evidence that the lens epithelium is the primary site of injury leading to the development of cataracts following radiation exposure. That the damaged cells of the epithelium are the progenitors of the aberrantly differentiating fibers associated with the cataract is indisputable. So too is the observation that post-radiation proliferative activity in the lens epithelium is required for cataracts to develop. The natural hormonal regulation of lens epithelial mitotic activity in the frog offers the opportunity to alter the cell cycle of the lens epithelium in vivo, thus enabling the direct examination of the role of lenticular mitosis in the cytopathomechanism of radiation-induced cataracts. The cell cycle of the lens epithelium of northern leopard frogs was manipulated by hypophysectomy (to halt mitotic activity) and pituitary hormone administration (to stimulate baseline mitosis and reverse hypophysectomy-induced mitotic suppression). Animals were hypophysectomized, irradiated and injected with pituitary hormone replacement. Irradiated animals, irradiated animals + hormone replacement and irradiated hypophysectomized animals served as controls. Cataract development was evaluated by slit-lamp biomicroscopy and correlated with histologic determinations of mitotic index and meridional row disorganization on lens epithelial whole mounts. In another study, hypophysectomized-irradiated animals received varying concentrations of replacement hormone in an attempt to quantitatively modulate lens epithelial mitotic activity and determine the effect on cataractogenesis. It was found that irradiated-hypophysectomized (mitosis halted) frogs failed to develop opacities, while those with hormonal replacement (mitosis reinstated) developed cataracts.(ABSTRACT TRUNCATED AT 250 WORDS)

Light absorption characteristics of the lens capsule.

Spectrophotometric measurement of the absorption characteristics of the lens capsule was carried out on 20 cases of so-called complicated or senile cataract operated through intracapsular cataract extraction (ICCE). The lens capsule almost completely transmitted visible radiation (between 400 and 750 nm) and near-ultraviolet (UV) radiation (between 300 and 400 nm). In the UV portion below 300 nm, the lens capsule showed one absorption peak at 280 nm and rapid increase of absorbance below 240 nm. These results reveal that the capsule of the cataractous lens retains a high degree of transparency, but its function as a UV filter is negligible.

Potential acuity meter for predicting visual acuity after Nd:YAG posterior capsulotomy.

We studied 30 patients with opacifications of the posterior capsule to determine if the potential acuity meter (PAM) could accurately predict final visual outcome after Nd:YAG discussion. The final visual acuity was within one line of the PAM prediction in 22 of 30 patients (73%), better by two or more lines in seven patients (23%), and worse in one patient (4%) by two lines. Although in thicker capsules the final acuity was occasionally better than the PAM prediction, the rates of false negative and false positive predictions were very low. Mild cystoid macular edema (3 patients), age-related macular degeneration (3 patients), intraocular lens status, and level of initial acuity did not diminish PAM accuracy. The PAM effectively predicts final visual acuity after YAG posterior capsulotomy, when used in a patient, unhurried manner.