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Este artículo se ha publicado de forma definitiva en: http://www.scielo.br/pdf/abo/v82n1/0004-2749-abo-82-01-0056.pdf Purpose: The porcine eye is frequently used as a research model. This paper analyzes the effect of different storage methods on the transparency of pig crystalline lens. Methods: A spectral transmission curve (from 220 to 780 nm) for the crystalline lens was determined experimentally after storage in different conditions: saline solution, formalin, castor oil, and freezing at -80°C. The total transmission in the visible spectrum, which was used as an index of transparency, was calculated from these curves. For comparative purposes, fresh lenses were evaluated and used as controls. Results: Storing the porcine crystalline lens in saline solution or castor oil resulted in a transparency loss of approximately 10% after 24 h and storage in formalin resulted in a loss of nearly 30%. Storage by freezing at -80°C for 4 weeks maintained the transparency of the crystalline lens; the spectral transmission measured immediately after defrosting at room temperature coincided exactly with that of the freshly extracted lens. Conclusions: The transparency of porcine crystalline lens is affected by the storage method. The visible spectrum is the most affected, evidenced by the effect on the transparency and consequently the amount of light transmitted. The results show that freezing at -80°C maintains the transparency of the crystalline lens for at least 4 weeks. Olho de porco é frequentemente usado como modelos de pesquisa. Este estudo analisa o efeito de diferentes métodos de armazenamento na preservação da transparência do cristalino de porco. Métodos: Uma curva de transmissão espectral (de 220 até 780 nm) para o cristalino foi experimentalmente determinada após armazenamento em diferentes condições: solução salina, formol, óleo de mamona e congelamento a -80°C. Transmissão total do espectro visível, que foi usada como um índice de transparência foi calculada a partir dessas curvas. Para fins comparativos, lentes frescas foram avaliadas e usadas como controles. Resultados: O armazenamento do cristalino suíno em solução salina ou óleo de mamona resultou uma perda de transparência de aproximadamente 10% após 24 h e o armazenamento em formol resultou uma perda de quase 30%. O armazenamento por congelamento a -80°C durante 4 semanas manteve a transparência do cristalino; a transmissão espectral medida imediatamente após o descongelamento à temperatura ambiente coincidiu exatamente com a da lente extraída recentemente. Conclusão: A transparência do cristalino suíno é afetada pelo método de armazenamento. O espectro visível é o mais afetado, evidenciado pelo efeito sobre a transparência e consequentemente a quantidade de luz transmitida. Os resultados mostram que o congelamento a -80°C mantém a transparência do cristalino suíno por pelo menos 4 semanas.

Foreign-body (FB) ingestion is less common in adults than in children, but still occurs. Diagnostic management of patients with suspected FB ingestion in emergency departments depends on FB type and location, both of which are related to the patient profile. In adults, fish and chicken bones are the most common FB types, and the oropharynx and cricopharyngeal muscle are the most common locations. Once accidentally swallowed, an FB may become lodged in the oropharynx, and in such cases indirect or fiberoptic laryngoscopy is the first clinical management option. For FBs that have passed beyond this location, radiologic study is recommended, including anteroposterior and lateral neck radiographs (LNRs) using the soft-tissue technique. This is a quick and simple imaging method that in emergency departments achieves detection rates of 70%-80% in assessing FBs in the hypopharynx and upper cervical esophagus. Careful initial evaluation using LNRs can determine the presence and nature of an FB, which helps with predicting the location and risk assessment, making further imaging-including computed tomography-unnecessary. Prevertebral soft-tissue swelling is a nonspecific indirect sign, which in the appropriate clinical context raises suspicion of a radiolucent FB or related complications. LNRs can sometimes be difficult to interpret due to the presence of multiple overlapping soft-tissue structures and variable patterns of laryngeal cartilage calcification in adults. Adequate performance in interpreting LNRs along with familiarity with the full diagnostic process in these patients will enable radiologists to use the right imaging technique for the right patient, as described in the clinical algorithm proposed by the authors. ©RSNA, 2017.

Purpose: To analyze the optical quality of intraocular lenses (IOL) with an orange (PC440Y) and a yellow (SN60AT) filter, and correlate these results with the visual quality of patients with these implants. Setting: Fisabio Oftalmología Médica, Valencia, Spain. Design: Randomized prospective study. Materials and Methods: The IOL optical quality was determined using the modulation transfer function (MTF) and the spectral transmission. The visual quality of 87 eyes with cataract (51 with orange filter and 36 with yellow filter) was determined by best corrected visual acuity (BCVA) and contrast sensitivity function (CSF) under photopic and mesopic conditions. To analyze the results, we use a Student's t-test. Results: Orange lens filtered more of the blue spectrum (cut-off wavelength of 370 nm) than the yellow lens (390 nm). The MTF of the yellow lens was better than the orange lens (average modulation of 0.676 for natural and 0.672 for orange). The patients’ BCVA was 0.02 + 0.10 logMAR for both lenses. The CSF obtained with the yellow lens was slightly better, although without statistically significant differences (P > 0.05). Conclusions: Both lenses are of good optical quality. The patients’ visual quality was similar with both lenses, and optical quality was also similar. The color of the lens does not affect the visual quality of the patient.

Purpose: To determine the spectral transmission of contact lenses (CLs), with and without an ultraviolet (UV) filter to evaluate their capacity for protection under UV radiation from artificial illumination (incandescent, fluorescent, xenon (Xe) lamps, or white LEDs (light-emitting diode)). Methods: The transmission curves of nine soft CLs were obtained by using a PerkinElmer Lambda 35 UV-vis spectrophotometer. A CIE standard was used for the emission spectra of incandescent and fluorescent lamps, and Xe lamps and white LEDs were measured by using an International Light Technologies ILT-950 spectroradiometer. Results: Five of the nine soft CLs analysed state that they incorporate UV filters, but the other four do not specify anything in this regard. The spectral transmission of all the CLs studied is excellent in the visible region. The CLs with UV filters filter out this radiation more or less effectively. Xe lamps emit a part in the UV region. Incandescent, fluorescent and white LEDs do not emit at all in the UV. Conclusions: Incorporating UV filters is important when the illumination is from a Xe lamp since this light source emits in the UV region. This, however, does not occur with incandescent and fluorescent lamps or white LEDs. The CLs that do incorporate UV filters meet all the standard requirements that the U.S. FDA (Food and Drug Administration) has for UV-blocking CLs Class II (OcularScience, CooperVision and Neolens), and AcuvueMoist and HydronActifresh400 even comply with the stricter Class I. The CLs without UV filters let UVA, UVB and even some UVC through. (C) 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

To assess the diagnostic performance of computed tomographic (CT) angiography as the initial diagnostic examination for patients presenting to the emergency room with acute lower intestinal bleeding.The study was reviewed and approved by the ethics committee, and written informed consent was obtained from each patient or their closest relative when the clinical condition precluded consent by the patient. This prospective study comprised 47 patients (27 men, 20 women; mean age, 68 years) with acute lower gastrointestinal tract bleeding who were referred to undergo emergency colonoscopy for evaluation. CT angiography was performed in all patients shortly after arrival to the emergency room. Findings identified at CT angiography included active extravasation (ongoing hemorrhage) or hyperattenuating intraluminal contents on noncontrast material-enhanced images (recent hemorrhage). Presence and location of bleeding and likely cause of hemorrhage were determined and compared with the standard of reference (angiography, colonoscopy, or surgical findings). Data collected were analyzed with a statistical software package. Sensitivity, specificity, and positive and negative predictive values of CT angiography in depicting ongoing or recent hemorrhage were calculated and compared with those of standard of reference.CT angiography demonstrated active bleeding in 14 patients and intraluminal hyperattenuating material in six patients. The sensitivity, specificity, positive predictive value, and negative predictive value of CT angiography in depicting active or recent bleeding were 100% (19 of 19), 96% (27 of 28), 95% (19 of 20), and 100% (27 of 27), respectively. Findings of CT angiography and the standard of reference were concordant for determining definite or potential cause of bleeding in 44 of 47 patients (93% accuracy).CT angiography performed in the emergency setting in patients with acute lower intestinal bleeding is feasible and correctly depicts the presence and location of active or recent hemorrhage, as well as the potential cause, in the majority of patients.

Purpose. To evaluate the most common lens opacities in Valencia (Spain), analyzed by gender, grade, and type of cataracts. The results are compared with other studies performed at other geographical latitudes and on different races. Methods. A total of 1951 eyes of patients diagnosed with cataracts, aged between 30 and 96 years, were evaluated in accordance with age, gender, type and degree of the cataract, bilaterality and symmetry of this disease. Lens Opacities Classification System III was used to classify the cataract and the degree was graded as mild or moderate to advanced. Results. The most common type of cataract is corticonuclear in the elderly and subcapsular in younger subjects. The most common are nuclear (28.4%) followed by cortical (6.2%), if combined cataracts are ruled out. There is a greater incidence of cortical cataracts in women (70%) and subcapsular cataracts in men (70%). Conclusions. The results suggest the existence of a gender factor in cataract formation and coincide with those obtained in similar studies performed in areas at a similar latitude (40° N) and with different race population. The geographical location (intensity and length of exposure to solar radiation) seems to be a determining factor in the formation of a specific type of cataract, more than race, although there are other factors that contribute in the formation of a specific type of cataract.

Purpose To compare the spectral transmission of different intraocular lenses (IOLs) with either ultraviolet (UV) or blue-light filters, and to analyze the performance of these filters with artificial light sources as well as sunlight. Design Experimental study. Methods The spectral transmission curve of 10 IOLs was measured using a PerkinElmer Lambda 800 UV/VIS spectrometer (Waltham, MA). Different filtering simulations were performed using the D65 standard illuminant as daylight and standard incandescent lamp and fluorescent bulb illuminants. Main Outcomes Measures Spectral transmittance of the IOLs. Results All the IOLs studied provide good UVC (200–280 nm) and UVB (280–315 nm) protection, except for one that presented an appreciable window at 270 nm. Nevertheless, both natural and artificial sources have practically no emission under 300 nm. In the UVA (315–380 nm) range the curves of the different IOLs manifested different degrees of absorption. Conclusions Not all the UV filters incorporated in different IOLs protect equally. The filters that provide greater photoprotection against UV radiation, even blue light, are yellow and orange. Then, yellow and orange IOL filters may be best suited for cases requiring special retinal protection . The filters that favor better photoreception of visible light (380–780 nm) are those that transmit this radiation close to 100%. Artificial illumination practically does not emit in the UV range, but its levels of illumination are very low when compared with solar light. A possible balance between photoprotection and photoreception could be a sharp cutoff filter with the cutoff wavelength near 400 nm and a maximum transmittance around 100%. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Purpose To study the relationship between the optics quality of multifocal intraocular lenses (IOLs) and distance-corrected near, intermediate, and distance visual acuity to determine the degree to which optics quality must change to produce a significant difference in visual acuity. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods Monocular distance-corrected visual acuity (decimal and logMAR) was measured at 4 m, 70 cm, and 30 cm under photopic and mesopic conditions in eyes with 1 of 3 multifocal IOL models. Visual acuity versus the “average modulation” of the IOL was assessed. Results The pupil diameter and patient age were similar between the 3 IOL groups (20 eyes each). A difference in average modulation (ie, optics quality) up to 15% did not produce significant differences in mean visual acuity between 2 groups; however, there was a significant difference in mean visual acuity between 2 groups when the average modulation values differed by at least 25%. The slope of the linear correlation between visual acuity and average modulation was 0.018 ( r 2 = 0.91) under photopic conditions and 0.024 ( r 2 = 0.089) under mesopic conditions. Conclusions There was a strong linear correlation between IOL optics quality and visual acuity with distance correction under photopic conditions with a pupil of approximately 3.5 mm in a cohort in which the patient age was controlled. The correlation was similar under mesopic conditions. The eye's tolerance to modulation transfer function decay was approximately 15% of the average modulation value. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Purpose The imaging quality provided by a piggyback integrated by a monofocal intraocular lens (IOL) + a bifocal IOL of zero power and +3.75 diopters of addition is compared with the optics quality of a simple multifocal IOL of the same power and addition. Methods The imaging quality was evaluated by determining the modulation transfer function (MTF), using an artificial eye simulating in vivo conditions of the anterior chamber, including an artificial cornea and a wet cell containing physiologic solution where the IOL was positioned. The MTFs of the bifocal piggyback for near and distance vision were measured, with pupil diameters of 3 and 5 mm, and compared with the MTFs of an equivalent power of ReSTOR and TECNIS multifocal IOLs measured under the same conditions. Results The MTFs for distance and near focus of the bifocal piggyback are similar to the MTFs of the ReSTOR and TECNIS multifocal IOLs with the two diameters of pupil. A more accurate comparison, values of average modulation, and Strehl ratio show a greater similitude with ReSTOR than with TECNIS. Conclusions The bifocal piggyback system provides a similar imaging quality to that obtained with a ReSTOR multifocal IOL and, like the ReSTOR, provides better performance in distance vision than in near vision, whereas the TECNIS multifocal IOL provides the best performance.

Purpose To determine whether the difference in optic quality between 2 types of phakic intraocular lenses (pIOLs) affects visual quality. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods Before implantation of a pIOL for myopia, all eyes had an examination including corrected (CDVA) and uncorrected (UDVA) distance visual acuity testing, corneal endothelial cell count (ECC), and intraocular pressure (IOP) measurement. The postoperative outcomes, determined at least 1 year after surgery, were CDVA; UDVA; contrast sensitivity function under photopic, mesopic, and mesopic with glare conditions; ECC; IOP; keratometry (Scheimpflug photography); and total ocular aberration (Hartmann-Shack aberrometry). Results Twelve eyes had implantation of an Artisan pIOL (rigid pIOL group) and 18 eyes, of an Artiflex pIOL (flexible pIOL group). The mean preoperative CDVA was 0.04 logMAR ± 0.01 (SD) in both groups ( P >.5). The mean postoperative CDVA was 0.01 ± 0.02 logMAR in the rigid IOL group and 0.01 ± 0.06 logMAR in the flexible IOL group ( P >.9). The photopic contrast sensitivity function was better with the rigid pIOL, and the mesopic contrast sensitivity function was slightly better with the flexible pIOL; however, neither difference was statistically significant. Conclusions Optic quality, measured by modulation transfer function and evaluated by average modulation, was approximately 13% better with the rigid pIOL than with the flexible pIOL. However, the difference was not enough to affect visual quality. At 1 year, the 2 groups had similar CDVA and contrast sensitivity function values, indicating that other optical or neural factors compensate for differences in optic quality.

Purpose To evaluate the efficacy of a standard double intraocular lens (IOL) system (IOL-Vip) in patients with low vision and central scotoma due to macular degeneration and assess the predictability of the residual refraction and magnification. Setting Ophthalmology Department, Hospital General Universitario, Valencia, Spain. Methods This interventional prospective noncomparative case series comprised 13 consecutive surgical procedures in 10 patients with central scotoma. Follow-up was 12 months. Evaluation included the difference between preoperative and postoperative best corrected visual acuity (BCVA), refraction, position of the IOLs, endothelial cell density, and occurrence of postoperative complications. Residual refraction and eye magnification were calculated using a theory developed in a previous study, and the values were compared with the clinical results. Results The mean BCVA was 1.37 logMAR preoperatively and 0.68 logMAR 1 year postoperatively. The mean best corrected clinical gain was 44%. There was no statistically significant difference between the clinically evaluated and theoretically calculated residual refractions ( P = .17). No intraoperative or postoperative complications occurred. Conclusions Implantation of the double IOL system improved BCVA in patients with low vision due to advanced maculopathy. The results were best in myopic patients (long eyes); patients with hyperopia (short eyes) had high residual refraction. The postoperative clinical gain and residual refraction were predictable, showing the feasibility of implanting a customized double IOL.

Purpose To analyze the image quality with a refractive and 2 hybrid refractive–diffractive multifocal intraocular lenses (IOLs) in vitro to determine the IOL modulation transfer function (MTF) following the EN-ISO international standard for distance and near vision and to study the IOLs' behavior with different pupil sizes. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods This study evaluated 4 IOLs: the hybrid refractive–diffractive AcrySof ReSTOR SN60D3 (Alcon) and Tecnis ZM900 (AMO), the refractive ReZoom NXG (AMO), and the monofocal AcrySof SN60WF (Alcon). The MTF was calculated from the cross-line spread function recorded with the OPAL Vector System (Image Science Ltd.) using fast Fourier transform techniques. The artificial eye model simulated in vivo conditions of the anterior chamber and included an artificial cornea and physiological solution, in which the IOLs were positioned. The pupil sizes varied between 2.0 mm and 5.0 mm in steps of 0.5 mm. Results For distance vision and small pupils (2.0 to 3.5 mm), the refractive IOL provided better image quality than the 2 hybrid IOLs. When the pupil was larger, the distance vision was similar with all IOLs. The 2 hybrid IOLs gave better image quality than the refractive IOL for near vision with any pupil size. With the refractive IOL and pupils smaller than 3.5 mm, near focusing did not occur, resulting in poor image quality. Of the hybrid IOLs, the AcrySof ReSTOR SN60D3 provided better distance image quality and the Tecnis ZM900 provided better near image quality. Conclusions The refractive IOL gave better image quality than the hybrid IOLs at distance and with small pupils. With pupils larger than 3.5 mm, the quality was similar. Hybrid IOLs gave significantly better image quality for near vision with all pupil sizes. AcrySof ReSTOR SN60D3 IOLs give better distance vision than Tecnis ZM900 IOLs; the latter gave better near vision. The reference monofocal IOL provided better distance images than any multifocal IOL with all pupil sizes.

Objective. To analyze the photoprotection and phototransmission that various intraocular lenses (10Ls) provide under the illumination of a xenon (Xe) lamp and white LEDs (light emitting diode). Methods. The spectral transmission curves of six representative 10Ls were measured using a Perkin-Elmer Lambda 35 UV/VIS spectrometer. Various filtering simulations were performed using a Xe lamp and white LEDs. The spectral emissions of these lamps were measured with an ILT-950 spectroradiometer. Results. The 10Ls analyzed primarily show transmission of nearly 100% in the visible spectrum. In the ultraviolet (UV) region, the filters incorporated in the various 10Ls did not filter equally, and some of them let an appreciable amount of UV through. The Xe lamp presented a strong emission of ultraviolet A (UVA), and its emission under 300 nm was not negligible. The white LED did not present an appreciable emission under 380 nm. Conclusions. The cut-off wavelength of most filters is between 380 and 400 nm (Physiol Hydriol60C, IOLTECH Alcon SA6OAT, Alcon IQ SN6OWFI'), so that their UV protection is very effective. Nonetheless, the IOL OPHTEC Oculaicr contains a filter that, when a Xe lamp is used, lets through up to 20% for 350 nm and up to 15% for 300 nm, which at this point is ultraviolet B (UVB). The OPHTEC Artisan IOL has a transmission peak below 300 nm, which must be taken into account under Xe illumination. White LEDs do not emit energy below 380 nm, so no special protection is required in the UV region. (C) 0 2016 Elsevier Masson SAS. All rights reserved.

The aim of this work is to study the prevalence of osteoporotic vertebral fractures in Spanish women over 45 years of age, based on the selection of a nationwide sample. An observational, cross-sectional, multicenter study was conducted during 2006, in all of Spain's regions. The sample analyzed was of 5000 individuals, representative of the female population over age 45 in Spain. A questionnaire was used to determine which factors are most often associated with vertebral fractures. We also assessed whether the Prevalent Vertebral Fracture Index, proposed by Vogt, is useful in indicating a possible osteoporotic vertebral fracture. Five hundred orthopedic surgeons, from various Spanish regions, were trained in different aspects of the study: inclusion and exclusion criteria, management of the risk factor questionnaire, and implementation of the Vogt questionnaire. The number of fracture cases was 1549 (31.79%). 528 Women (34.08%) had a single vertebral fracture, and 1021 (65.92%) had multiple vertebral fractures. The following factors were statistically significantly associated with vertebral fracture: age, late menarche, early menopause, diabetes mellitus, hyperparathyroidism, rheumatoid arthritis, height loss, daily physical activity, corticosteroid therapy, personal history of osteoporotic fracture and previous diagnosis of osteoporosis. The differences in Vogt score according to age and fracture status were statistically significant. The conclusion of the study is that vertebral osteoporotic fracture in the female Spanish population is frequent. The high prevalence in the Spanish population older than 60 years is probably related to malnutrition in the period from 1936 to 1952.

PURPOSE: To evaluate the effect of pupil size on image quality of a sectorial multifocal intraocular lens (IOL), the Lentis Mplus (Oculentis GmbH, Berlin, Germany), and the Acri.LISA IOL (Carl Zeiss Meditec, Jena, Germany). METHODS: The authors measured the MTFs of the Lentis Mplus LS-312 IOL and the Acri.LISA 366D IOL with three different sizes of pupil diameters: 3, 4, and 5 mm. The MTF was calculated from the cross-line spread function recorded with the OPAL Vector System (Image Science Ltd., Oxford, UK) by using fast Fourier-transform techniques. RESULTS: In distance focus, the image quality provided by the Lentis Mplus IOL was better than that of the Acri. LISA IOL with all pupil diameters. In near focus, the MTF of the Acri.LISA IOL was better with a 3-mm pupil, but poor with larger pupils. The aberration effect was equal in both IOLs in distance focus, but in near focus and with a 3-mm pupil, the Acri.LISA IOL was less affected by the aberration than the Lentis Mplus IOL. CONCLUSION: The Lentis Mplus IOL provides better distance image quality than the Acri.LISA IOL, whereas the near image quality of the Acri.LISA IOL is better with small-pupil diameter. The sectorial design makes this IOL more suitable for patients with a pupil diameter greater than 3 mm. [ J Refract Surg . 2015;31(4):230–235.]

This study presents a method for measuring scattering in explanted intraocular lenses (IOLs). Currently, determining scattering in IOLs is usually performed by Scheimpflug cameras and the results are expressed in the units used by this apparatus. The method we propose uses a spectrophotometer and this makes it possible to measure the total transmission of the IOL by using an integrating sphere; the direct transmission is determined by the double-beam mode. The difference between these two transmissions gives a value of the scattering in percentage values of light lost. In addition, by obtaining the spectral transmission curve, information about the most scattered wavelengths is also obtained. The IOL power introduces errors when directly measured, particularly with high powers. This problem can be overcome if a tailor-made cuvette is used that shortens the distance between the IOL and the condensing lens of the spectrophotometer when the IOL powers are below 24 diopters. We checked the effectiveness of this method by measuring the scattering of three explanted IOLs from cornea donors. This method, however, does not make it possible to ascertain whether the scattering measured is caused by surface light scattering or internal light scattering.

A new technique for analysing the optical quality of the human cornea is presented. Corneal maps are obtained through keratographies and then converted into phase maps. The propagated fields generated from this surface are plotted and studied. It is shown that any irregularity in the cornea affects the propagated field and the energy distribution at the focal plane. Simple applications are also indicated.

The conventional quantizer design based on average error minimization over a training set does not guarantee a good subjective behavior on individual images even if perceptual metrics are used. In this work a novel criterion for transform coder design is analyzed in depth. Its aim is to bound the perceptual distortion in each individual quantization according to a non-linear model of early human vision. A common comparison framework is presented to describe the qualitative behavior of the optimal quantizers under the proposed criterion and the conventional rate-distortion based criterion. Several underlying metrics, with and without perceptual non-linearities, are used with both criteria. Analytical results show that the proposed design criterion gives rise to a JPEG-like quantization if a simple linear metric is used. Experimental results show that significant improvements over the perceptually weighted rate-distortion approach are obtained if a more meaningful non-linear metric is used.

Acute gastrointestinal bleeding is a common reason for emergency department admissions and an important cause of morbidity and mortality. Factors that complicate its clinical management include patient debility due to comorbidities; intermittence of hemorrhage; and multiple sites of simultaneous bleeding. Its management, therefore, must be multidisciplinary and include emergency physicians, gastroenterologists, and surgeons, as well as radiologists for diagnostic imaging and interventional therapy. Upper gastrointestinal tract bleeding is usually managed endoscopically, with radiologic intervention reserved as an alternative to be used if endoscopic therapy fails. Endoscopy is often less successful in the management of acute lower gastrointestinal tract bleeding, where colonoscopy may be more effective. The merits of performing bowel cleansing before colonoscopy in such cases might be offset by the resultant increase in response time and should be weighed carefully against the deficits in visualization and diagnostic accuracy that would result from performing colonoscopy without bowel preparation. In recent years, multidetector computed tomographic (CT) angiography has gained acceptance as a first-line option for the diagnosis and management of lower gastrointestinal tract bleeding. In selected cases of upper gastrointestinal tract bleeding, CT angiography also provides accurate information about the presence or absence of active bleeding, its source, and its cause. This information helps shorten the total diagnostic time and minimizes or eliminates the need for more expensive and more invasive procedures.

PURPOSE: To evaluate the changes in optical quality when toric intraocular lenses (IOL) are rotated or tilted and to demonstrate that IOL rotation produces an increasing effect of aberrations. METHODS: Modulation transfer function (MTF) and average modulation were used to analyze the image quality of a toric IOL. The axis of the toric IOL was rotated 5°, 10°, 15°, 20°, 25°, and 30° in successive MTF measurements. The tilt values were 0° to 5°, in increments of 1°, plus a tilt of 15°. Pupil diameters of 3 and 5 mm were used. RESULTS: The MTF decay due to aberrations was more sensitive to rotation than tilt. The main decrement in the average modulation, of approximately 50% in both pupils, occurs when the IOL rotates from 0° to 5°. Between 0° and 1° tilt, the average modulation decreases approximately 25% for both pupils; with tilt >1°, the average modulation remains virtually unchanged. The points representing average modulation versus rotation angle are satisfactorily fitted by an exponential function, R=0.98. Average modulation versus tilt angle provides lower correlation degrees, R=0.91 and R=0.79, for 3- and 5-mm pupils, respectively. CONCLUSIONS: The MTF of the toric IOL decays with rotation and tilt, with greater decrement occurring in rotation from 0° to 5°. An asymptotic value exists in the average modulation decay, meaning that for angles higher than 15°, the average modulation of the toric IOL remains virtually constant.

The reaction time (RT) vs spatial frequency (SF) curve is determined, using gratings from 1 to 40 c/deg, at seven different contrast levels between 0.95 and 0.02. The form of the RT/SF function: (a) replicated the inverse of the contrast sensitivity function (CSF) at near threshold contrast levels; (b) behaved differently at higher contrasts, exhibiting two branches at contrast close to 1. The interpretation is that there are two factors determining this function: (1) the transition from the operation of fast transient channels at low SF to the operation of slow sustained channels at high SF, the transition taking place within a narrow SF band close to 6 or 8 c/deg (depending on the subject) and (2) the contrast attenuation by the optical and neural transfer function, operating throughout the SF range. At high contrasts, the effect of the first factor can be clearly observed, because the effect of the second factor does not change with spatial frequency except in a region where the RT/SF function changes rapidly. At lower contrasts, however, the second factor becomes increasingly relevant while the first becomes less and less observable.

Purpose An increase in lens thickness is often described as a linear function of age. However, contradictory opinions exist about whether the lens thickness continues to increase after 50 years of age. Differences in slope exist between this increase in younger and older people, but these findings are inconsistent with the linear behavior of an increase in the lens thickness throughout life. We investigated among different functions, including slope variation, which would be the best to show the relation between lens thickness and age. An available model portraying lens growth could be advantageous in many practical applications. The possibility of differences between sexes in lens thickness growth is also analyzed. Methods We evaluated 102 eyes of patients aged between 15 and 84 years: 41 men, 61 women. The biometric measurements were performed with the aid of the OcuScan® (Alcon, USA). Results Both logarithmic and potential functions provide a good fit for the data (R2 = 0.905 and 0.906, respectively). The results do not show significant differences between men and women in any age range, nor when the data of the whole sample are considered (p = 0.29). Conclusions The best fits for the data are both logarithmic and double logarithmic functions. According to this model, lens growth continues throughout life, but after 50 years, age-related thickness variations are lower than statistical variability. No differences were found between the sexes.

Purpose To analyze changes in the eye’s refractive properties when a toric intraocular lens (IOL) rotates. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Design Experimental study. Methods The matrix definition of astigmatism was used in this theoretical study and compared with another vector representation. Two methods were compared: (1) The cylinder, C, resulting from the addition of 2 cylinders C1 and C2 whose axes form an angle a, is obtained by the addition of 2 vectors of values C1 and C2 forming an angle 2a; (2) the power matrix, F, of a thin astigmatic dioptric system that decomposes naturally into 3 orthogonal components: the purely spherical part Fnes, the ortho-astigmatism For, and oblique astigmatism Fob. Results The residual cylinder was one third of the corneal astigmatism when a toric IOL rotated ±10 degrees when the cylinder values for the cornea (C1) and IOL (C2) were equal. Nevertheless, in most cases C1 is greater than C2; therefore, the residual astigmatism did not change noticeably with small rotations. The angle of rotation, b, which annuls the astigmatism correction, could be obtained from the following: cos(π + 2b) = −r/2, with r being the ratio between the IOL and cornea cylinders. Conclusions The 2 methods gave equivalent results. When the IOL cylinder had a value different from that of the corneal astigmatism, a better choice would be a lower, rather than higher, cylinder value to reduce residual astigmatism. In general, toric IOL rotations less than 10 degrees changed the eye’s refraction less than 0.50 diopter. Thus, small axis rotations are not an obstacle for satisfactory astigmatism correction with toric IOLs. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Purpose To analyze the effect of different optical parameters of the eye on the outcomes of implantation of a double intraocular lens (IOL) magnification device in patients with low vision. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods The eye's refraction and magnification before and after surgery were evaluated using a theoretical eye model based on paraxial optics approximation. Four parameters on which refraction and magnification are dependent were evaluated: anterior chamber depth (ACD), axial length (AL), mean keratometry (Km), and the distance between the 2 implanted IOLs. The 4 variables were analyzed separately in the first stage. Next, different combinations of ACD, AL, and Km values were studied. The goal was to predict what type of eye (in terms of ACD, AL, and Km values) is suitable for successful implantation of the double-IOL magnification device. Results Axial length had a significant influence on eye magnification. The Km value mainly affected refraction. The ACD did not influence the success of the procedure. The distance between the 2 IOLs was a decisive parameter in the analysis. Conclusions Analysis of optical and biometric eye parameters could guide selection of patients for implantation of the double-IOL magnification device. Eyes with higher AL and Km values (myopic eyes) are the most suitable for this procedure.

Spontaneous abdominal wall fistulas are rare in Crohn's disease. We report a case of enterourachocutaneous fistula in a woman with Crohn's disease and present the sonographic, computed tomographic, and sinographic findings.

We show how contrast (C) affects the recognition of defocused letters. To do this, the maximum distance (threshold distance) at which a subject, with an induced refraction of -5.5 D, can recognize a letter was determined. Our results show that when C = 1, the recognition threshold distance is such that the ratio eta/xi, between the pseudoimage of the letter (eta) and the blur circle (xi), corresponding to any point of the letter at this distance is about eta/xi = 2; the exact value depends on the difficulty of recognition, in agreement with previous experiments. This ratio represents the sharpness of the image in a geometrical treatment of image formation, providing a geometrical criterion for recognition. Reduction in contrast can be compensated by improving the geometrical sharpness; i.e. bringing the object closer to the subject's are point. Our results show that the increment of eta/xi as a function of the contrast is between C = 0.1 and 1.0. We suggest that a similar geometrical criterion for recognition could be used for any contrast (at least down to C = 0.1 and defocus1 D), provided that the proper value of eta/xi is used in each case. On this basis we propose a purely geometrical model, which agrees well with the data and predicts the relationships between tolerance to defocus, contrast and visual acuity; including the well-known relation between visual acuity and defocus when contrast is unity.

Purpose To experimentally measure the spectral transmission of human crystalline lenses belonging to adult and elderly persons, and to determine the color and total transmission of visible light of such crystalline lenses. Methods The spectral transmission curve of 32 human crystalline lenses was measured using a PerkinElmer 800UV/VIS spectrometer. Total transmission of visible light and the chromatic coordinates of these crystalline lenses were determined from these curves for solar illumination. Results The crystalline lens that filters UV and its transmission in the visible spectrum decreases with age; such a decrease is greater for short wavelengths. The total transmission of visible light decreases, especially after the age of 70 years, and the crystalline color becomes yellower and saturated. Conclusions The great variability existing in the spectral transmission of the human crystalline lens is lesser between the ages of 40 and 59 years, but greater from the age of 60 and older. The decrement in transmittance between these two age groups varies from 40% for 420 nm to 18% for 580 nm. Nevertheless, it is proven that age is not the only parameter affecting crystalline transmission. In the range of 40 to 59 years, age does not bear an influence on total transmission of light, but from 60 years and older it does. Moreover, the light transmitted decreases with age. This total transmission of light is similar to or lower than the amount that the different intraocular lenses transmit, even with a yellow or orange filter. The color of the human lens becomes yellowish and saturated with age.

Until now, subjective image distortion measures have partially used diverse empirical facts concerning human perception: non-linear perception of luminance, masking of the impairments by a highly textured surround, linear filtering by the threshold contrast frequency response of the visual system, and non-linear post-filtering amplitude corrections in the frequency domain. In this work, we develop a frequency and contrast dependent metric in the DCT domain using a fully non-linear and suprathreshold contrast perception model: the Information Allocation Function (IAF) of the visual system. It is derived from experimental data about frequency and contrast incremental thresholds and it is consistent with the reported noise adaptation of the visual system frequency response. Exhaustive psychophysical comparison with the results of other subjective metrics confirms that our model deals with a wider range of distortions more accurately than previously reported metrics. The developed metric can, therefore, be incorporated in the design of compression algorithms as a closer approximation of human assessment of image quality.

Visual acuity in coherent and incoherent light has been determined by using square-wave gratings of 100% contrast. Luminance was varied from 3 to 400 cd/m2. Coherent illumination resulted in a 40% loss of visual acuity. This is probably due to the masking effect of coherent spatial noise (speckle). However, the most interesting finding is the change in shape of the photopic visual-acuity-luminance function. With coherent illumination, the function is vertically displaced and of a different gradient. An increase in luminance produces a decrease in visual acuity. This indicates that the masking effect of the speckle is dependent on luminance. Two observers were used, and similar results were obtained by both.