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One of the most common sensory impairments of elderly people is hearing loss. Glaucoma is one of the leading causes of blindness worldwide. Hearing and vision loss typically increase with older age. There is scientific evidence that the coincidence of hearing and vision loss is more frequent than expected by the prevalence of individual disorders. With regards to demographic changes and an aging population, in future, it is probable that the incidence of combined hearing and vision impairments will increase, representing a particular challenge not only for doctors and nurses but also a high burden for the private environment of the patients. Therefore, it is of particular importance to diagnose and to treat hearing and vision loss (dual sensory loss) as early as possible. The treatment of hearing disorders and glaucoma as well as possibly underlying systemic diseases such as circulatory disturbances is as important as responsible rehabilitation measures and the supply of hearing and low vision aids. During the last years, knowledge about the molecular biological background of hearing loss and glaucoma has continuously increased but it is currently still at the level of laboratory and animal experiments. Therefore, it remains to be seen whether and to what extent a real therapy for the underlying genetic, immunological and in particular mitochondrial disorders may be accessible in the future., (© Georg Thieme Verlag KG Stuttgart · New York.)

One of the most common sensory impairments of elderly people is hearing loss. Glaucoma is one of the leading causes of blindness worldwide. Hearing and vision loss typically increase with older age. There is scientific evidence that the coincidence of hearing and vision loss is more frequent than expected by the prevalence of individual disorders. With regards to demographic changes and an aging population, in future, it is probable that the incidence of combined hearing and vision impairments will increase, representing a particular challenge not only for doctors and nurses but also a high burden for the private environment of the patients. Therefore, it is of particular importance to diagnose and to treat hearing and vision loss (dual sensory loss) as early as possible. The treatment of hearing disorders and glaucoma as well as possibly underlying systemic diseases such as circulatory disturbances is as important as responsible rehabilitation measures and the supply of hearing and low vision aids. During the last years, knowledge about the molecular biological background of hearing loss and glaucoma has continuously increased but it is currently still at the level of laboratory and animal experiments. Therefore, it remains to be seen whether and to what extent a real therapy for the underlying genetic, immunological and in particular mitochondrial disorders may be accessible in the future., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Glaucomatous optic neuropathy is characterized by a progressive loss of retinal ganglion cells (RGCs). The defects in the peripapillary retinal nerve fiber layer (RNFL) have been reported to be the earliest sign of glaucoma. We determined the agreement between RNFL thickness assessments from spectral-domain OCT (Spectarlis HRA + OCT; Heidelberg Engeneering, Heidelberg, Germany), scanning laser polarimetry (SLP) with variable cornea compensation (GDxVCC; Carl Zeiss Meditec, Dublin, CA, USA), and SLP with enhanced cornea compensation (GDxECC; Carl Zeiss Meditec, Dublin, CA, USA) in glaucomatous patients. Furthermore, we investigate the influence of typical scan score (TSS) on the results of GDx assessments., Methods: The enrolled subjects were devided into different groups by modified HODAPP visual field criteria. The peripapillary RNFL thickness was assessed with the three devices . ANOVA test, Pearson and Spearman correlation coefficient, and Bland-Altman plots were used to analyse the RNFL thickness assessments., Results: Ninety-two eyes from 92 glaucomatous subjects were analysed. These were divided into four groups: preperimetric glaucoma (n = 26), mild glaucoma (n = 18), moderate glaucoma (n = 21), and severe glaucoma (n = 27). For Spectralis-OCT, the average RNFL thickness (mean ± SD) was 99.25 ± 26.31 μm, 80.52 ± 16.63 μm, 71.59 ± 21.15 μm, and 63.85 ± 20.86 μm for preperimetric, mild, moderate, and severe glaucoma respectively. For GDxVCC, the corresponding assessments were 52.63 ± 8.18 μm, 52.95 ± 10.20 μm, 46.77 ± 10.62 μm, and 49.70 ± 13.34 μm. For GDxECC, the assessments were 49.35 ± 6.52 μm, 45.92 ± 7.21 μm, 42.19 ± 8.00 μm, and 39.53 ± 8.45 μm. All Spectralis-GDxVCC and Spectralis-GDxECC differences were statistically significant by ANOVA test. The differences between GDxVCC and GDxECC were statistically significant only for severe glaucoma. There was a highly significant correlation between Spectralis-OCT and GDxECC, as well as Spectralis-OCT and GDxVCC, in assessing the RNFL thickness. The best instrument agreement was found between GDxECC and Spectralis-OCT. The RNFL thickness assessed with Spectralis-OCT and GDxECC showed a better correlation to visual field defects than GDxVCC. Evaluating GDx assessments with typical retardation pattern GDxVCC and GDxECC showed very similar RNFL thickness results., Conclusions: RNFL thickness assessments between GDxVCC, GDxECC, and Spectralis-OCT cannot be directly compared. The assessments are generally higher with Spectralis-OCT than with GDxVCC and GDxECC, because of differences in method of the devices. The atypical retardation pattern has a major impact on the RNFL thickness results of GDx devices. This must be taken into account when evaluating the assessed RNFL thickness results.

The term glaucoma is used as a melting pot of many different diseases which have in common that the retinal ganglion cells and their axons are damaged. Untreated, apoptosis can be induced causing ganglion cell death which subsequently leads to typical glaucomatous damage at the optic nerve head, scotomas of the visual fields, and in the worst case scenario to blindness. It is well known that patients with glaucoma can suffer a 20 to 50 % loss of retinal ganglion cells before a defect becomes evident in standard white on white perimetry. To prevent glaucomatous damage, it is important to detect changes of the retinal ganglion cells and their nerve fibre layer as early as possible and to monitor their follow-up as closely as possible in order to find an adequate treatment of glaucoma, and to control its efficiency. In the past few years, scanning laser polarimetry by means of GDx technology (Carl Zeiss Meditec, Dublin, USA) could be established as a new method to measure the retinal nerve fibre layer not only qualitatively but even quantitatively. Presently, the GDx plays an important role in actual glaucoma diagnostics on account of its high resolution, the comfort for both patient and user, and its highly reproducible measurements. Especially in difficult evaluable optic nerve heads (e. g., micro- and macrodiscs), tilted discs, and optic disc anomalies (e. g., optic nerve drusen) modern nerve fibre diagnostics by means of GDx technology is a helpful enrichment in clinical routine., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Recently, in patients with normal tension glaucoma (NTG) elevated levels of antiphosphatidylserine antibodies (APSA), a subgroup of antiphospholipid antibodies (APLA) were found. Progressive sensorineural hearing loss (PSHL) is associated with autoimmune diseases and also the presence of APLA., Methods: To investigate a possible association between NTG and PSHL, 34 patients (age range 31-81 years) with NTG were evaluated for evidence of audiovestibular disorders. Besides ophthalmological standard examinations (slit lamp, IOP, funduscopy, perimetry) scanning laser tomography and polarimetry were performed. From all patients' audiograms, stapedial thresholds and otoacoustic emissions were obtained. The serological testing of patients and controls (40 healthy blood donors older than 50 years) concerned IgG and IgM levels of antibodies against phosphatidylserine (APSA) and beta2 glycoprotein., Results: 23 of 34 NTG patients had hearing loss (PSHL n = 11; presbyacusis n = 12). The NTG patients had significantly higher APSA levels than controls. Elevated APSA concentrations were significantly more frequent in patients with NTG and hearing loss compared with NTG patients with normacusis., Conclusions: These findings show that NTG and hearing loss have a high coincidence. The elevated APSA levels may indicate an association with similar systemic autoimmune processes.

Purpose: To describe the influence of cataract surgery with implantation of different intraocular lenses on scanning laser tomography (SLT) and scanning laser polarimetry (SLP) and to measure the birefringent properties of intraocular lenses in a laboratory setting., Design: Prospective cohort study., Methods: The influence of phacoemulsification cataract surgery with intraocular lens implantation (56 polymethylmethacrylate [PMMA; 31 Pharmacia/Upjohn 811 B and 25 Domilens Flex 60]; 25 hydroxyethylmethacrylate/methylmethacrylate (HEMA/MMA) [Technomed, Memory Lens]; 32 silicone [Allergan Si40]; 25 acrylic [Storz Hydroview]) on SLP and SLT measurements was evaluated preoperatively and 3 to 4 weeks postoperatively in 138 eyes of otherwise healthy patients. Lens opacities were classified according to the Lens Opacities Classification System III (LOCS III). Imaging was performed with TopSS and GDx (Laser Diagnostic Technologies, San Diego, California, USA) for SLT and SLP, respectively. Additionally, birefringent properties of intraocular lenses were measured in a laboratory setting., Results: Our results show that imaging with SLT and SLP is possible with lens opacity-induced visual acuity reductions down to 0.2 and 0.16, respectively. There were no significant differences in the topographic parameters assessed before and after cataract surgery with SLT. However, standard deviations between three within-session single measurements were smaller postoperatively. Nerve fiber layer patterns were similar before and after cataract surgery with SLP, whereas certain total nerve fiber layer thickness values were significantly higher postoperatively. As a consequence, "the number" is significantly lower in the Domilens Flex 60 group (P =.01) and in the Storz Hydroview group (P =.02), and with a tendency also in the other groups as well. Measurements with a high-resolution optical bench revealed no birefringent properties of the implanted lenses., Conclusions: Our results indicate that after cataract surgery with intraocular lens implantation some SLP values are altered significantly, whereas SLT parameters are not influenced. These findings are of clinical interest, especially in the follow-up of glaucoma patients.

Background: In the pathogenesis of glaucoma, besides an elevated intraocular pressure (IOP), cardiovascular risk factors, such as arterial hypotension and hypertension, vasospasms, autoregulatory defects, atherosclerosis, and diabetes mellitus are of increasing importance, especially in normal tension glaucoma. Recently, there have been several reports of an additional risk factor: obstructive sleep apnea syndrome., Methods: Literature review (Medline) and case report., Results: The authors report on a 8 1/2 years follow-up of a 60-year-old patient with normal tension glaucoma. Despite successful pharmacological and surgical lowering of intraocular pressure a progressive glaucomatous damage with optic nerve atrophy and increasing visual field defects occurred. As a result of intensive investigations of possible cardiovascular risk factors, an obstructive sleep apnea syndrome was diagnosed. Since the beginning of therapy with nCPAP (nasal continuous positive airway pressure) more than 3 1/2 years ago, no further progression of glaucomatous optic nerve damage or visual field defects have been observed., Conclusions: In clinical practice, obstructive sleep apnea syndrome often is underdiagnosed. In patients suffering from glaucoma and obstructive sleep apnea syndrome, intraocular pressure lowering therapy may not be enough, whereas an additional nCPAP-therapy potentially could prevent the beginning/progression of glaucomatous optic nerve damage.

Background: Glaucomatous optic neuropathy is characterized by a progressive loss of retinal ganglion cells (RGCs). The defects in the peripapillary retinal nerve fiber layer (RNFL) have been reported to be the earliest sign of glaucoma. We determined the agreement between RNFL thickness assessments from spectral-domain OCT (Spectarlis HRA + OCT; Heidelberg Engeneering, Heidelberg, Germany), scanning laser polarimetry (SLP) with variable cornea compensation (GDxVCC; Carl Zeiss Meditec, Dublin, CA, USA), and SLP with enhanced cornea compensation (GDxECC; Carl Zeiss Meditec, Dublin, CA, USA) in glaucomatous patients. Furthermore, we investigate the influence of typical scan score (TSS) on the results of GDx assessments. Methods: The enrolled subjects were devided into different groups by modified HODAPP visual field criteria. The peripapillary RNFL thickness was assessed with the three devices . ANOVA test, Pearson and Spearman correlation coefficient, and Bland-Altman plots were used to analyse the RNFL thickness assessments. Results: Ninety-two eyes from 92 glaucomatous subjects were analysed. These were divided into four groups: preperimetric glaucoma ( n = 26), mild glaucoma ( n = 18), moderate glaucoma ( n = 21), and severe glaucoma ( n = 27). For Spectralis-OCT, the average RNFL thickness (mean ± SD) was 99.25 ± 26.31 μm, 80.52 ± 16.63 μm, 71.59 ± 21.15 μm, and 63.85 ± 20.86 μm for preperimetric, mild, moderate, and severe glaucoma respectively. For GDxVCC, the corresponding assessments were 52.63 ± 8.18 μm, 52.95 ± 10.20 μm, 46.77 ± 10.62 μm, and 49.70 ± 13.34 μm. For GDxECC, the assessments were 49.35 ± 6.52 μm, 45.92 ± 7.21 μm, 42.19 ± 8.00 μm, and 39.53 ± 8.45 μm. All Spectralis-GDxVCC and Spectralis-GDxECC differences were statistically significant by ANOVA test. The differences between GDxVCC and GDxECC were statistically significant only for severe glaucoma. There was a highly significant correlation between Spectralis-OCT and GDxECC, as well as Spectralis-OCT and GDxVCC, in assessing the RNFL thickness. The best instrument agreement was found between GDxECC and Spectralis-OCT. The RNFL thickness assessed with Spectralis-OCT and GDxECC showed a better correlation to visual field defects than GDxVCC. Evaluating GDx assessments with typical retardation pattern GDxVCC and GDxECC showed very similar RNFL thickness results. Conclusions: RNFL thickness assessments between GDxVCC, GDxECC, and Spectralis-OCT cannot be directly compared. The assessments are generally higher with Spectralis-OCT than with GDxVCC and GDxECC, because of differences in method of the devices. The atypical retardation pattern has a major impact on the RNFL thickness results of GDx devices. This must be taken into account when evaluating the assessed RNFL thickness results. [ABSTRACT FROM AUTHOR]

Purpose : To investigate the primate episcleral vasculature and its innervation with respect to morphological specializations. Methods : Serial sections of the anterior episclera of 8 monkey eyes and 20 human eyes were investigated enzyme- and immunohistochemically using antibodies against smooth-muscle a -actin (SMA), neurofilament, synaptophysin, substance P (SP), calcitonin gene-related peptide (CGRP), vesicular acetylcholine transporter (VACHT), vasoactive intestinal polypeptide (VIP), neuropeptide Y (NPY), tyrosine hydroxylase (TH), vesicular monoamine transporter II (VMAT II), as well as the NADPH-diaphorase reaction. Arteriovenous anastomoses (AVA) were quantified. Results : All episcleral vessels including veins showed intense staining for SMA. Capillary loops were only seen in the limbal arcades, not in the episclera itself. Instead, AVA connected the episcleral arteries with the veins, which formed an interlacing vascular network. In the monkey episclera, 4–6/mm 2 AVA were found; in the human episclera, 0.5–1/mm 2 . Numerous nerve endings staining for NADPHd (NADPHdiaphorase) and TH surrounded all episcleral vessels including anastomoses and veins. NPY, VIP, and VACHT-immunoreactive (IR) nerve terminals were less numerous. CGRP and SP-IR terminals were seen both at the vessels and in the intervascular connective tissue. Conclusions : The episcleral vasculature shows a specialized morphology with absence of capillaries, numerous arteriovenous anastomoses, a muscle-rich venous network, and intense innervation by vasodilative and vasoconstrictive nerves. This might allow regulation of blood flow and volume in the episcleral vessels and Voigt's capillaries for thermoregulation and modulation of episcleral venous pressure and thereby outflow facility. [ABSTRACT FROM AUTHOR]

Recently discovered endogenous opioid peptides such as nociceptin are known to modulate neurotransmitter release of primary afferent neurons (especially substance P, SP) and they have also been demonstrated in peripheral nerve fibres. The aim of this study was to investigate the opioid peptidergic innervation of the anterior eye segment and to compare it with the innervation pattern of SP in order to shed light on the functional relationship between these peptides. Anterior eye segments of 20 rat eyes were cut in a tangential plane and the sections stained with antibodies against SP, nociceptin, nocistatin, endomorphin 1 and 2, leu-enkephalin and met-enkephalin. Sections of the spinal cord or brain were used as positive controls. Numerous SP-immunoreactive nerve fibres were found in the conjunctiva, cornea, episclera, trabecular meshwork, iris and ciliary body. A weak staining for met-enkephalin and leu-enkephalin could only be found in the iris and anteriormost ciliary body. Nerve fibres immunoreactive for nociceptin, nocistatin, and endomorphin 1 or 2 could not be detected in any part of the anterior eye segment. It is tempting to speculate that the opioid peptidergic innervation of the anterior ciliary body may play a role in the modulation of intraocular inflammation. [ABSTRACT FROM AUTHOR]