Age-Related Changes of the Human Eye

Preface

Contents

Contributors

Chapter 1

Aging as Risk Factor in Eye Disease

Keywords Cataract, Glaucoma, ARM D, Corneal opacity, Diabetic retinopathy

References

Recommended Bibliographic Resources

Recent Books on Vision Disorders in Old Age (www.amazon.com)

Chapter 2

Age-Related Changes of the Eyelid

Introduction

Changes in Anatomy and Kinematics

Myofiber Abnormalities

Mitochondrial Alterations

Sarcoplasma

Connective Tissue Changes

References

Chapter 3

Aging Effects on the Optics of the Eye

Introduction

Retinal Image Quality as a Function of Age

Aberrations of the Eye as a Function of Age

Aberrations of Cornea as a Function of Age

Coupling of Corneal and Internal Aberrations as a Function of Age

Optics of the Aging Eye and Intraocular Lenses

References

Chapter 4

Aging of the Cornea

Clinical Conditions

Corneal Arcus

Prevalence

Biochemical Aspects

Deep Crocodile Shagreen

White Limbal Gridle of Vogt

Hassall-Henle Bodies

Cornea Shape

Astigmatism

Structure

Corneal Thickness

Corneal Aberration

Structure

Epithelium

Bowman’s Membrane

Subbasal Nerve Plexus

Stroma

Descemet’s Membrane

Endothelium

References

Chapter 5

The Aging of the Human Lens

Introduction

Lens Embryology

Morphology of the Human Lens

Lens Capsule

Anatomy of the Lens Capsule

Ultrastructure of the Lens Capsule

Growth and Thickness of the Lens Capsule

Mechanical Properties of the Posterior Lens Capsule

Aging of the Lens Capsule

The Ocular Lens Epithelium

Ultrastructure of the Lens Epithelium

The Epithelium as the Major Site of Transport, Metabolism and Detoxification

Programmed Cell Death and the Lens Epithelium

Lens Fiber Cells

Fiber Cell Organization and Development of Lens Sutures

The Contribution of Major Fiber Proteins to Sutural Development and Growth

Lens Sutural Anatomy

Suture Formation after Birth

Simple Star Suture Formation

Star and Complex Star Suture Formation

The Physical Basis for Transparency of the Crystalline Lens

Small Particle Scattering

Large Particle Scattering

The Influence of Sutural Architecture on Lens Optical Quality

Nuclear Fiber Compaction as a Function of Aging and Cataractogenesis

Biometric, Optical and Physical Changes in the Human Crystalline Lens with Aging

The Change in Equivalent Refractive Index and the Lens Paradox

Crystalline Lens Position Modification with Age

Zonular Apparatus

Synthesis and Structural Organization of Zonular Fibers During Development and Aging

Zonular Fibers Electron Microscopy

Anterior Shift of Zonular Insertion onto the Anterior Surface of Lens with Age

Anatomical Changes of the Zonular Insertion

Lens Metabolic Changes with Age and the Effects of External Agents

Introduction

Age-related Changes in Calcium, Sodium, Potassium and Lens Membrane Permeability

Lens Phospholipid Changes with Age and Cataracts

Age-related Changes in Ganglioside Composition

Water Content Modifications in Lens with Aging

Oxidative Stress in the Aging Lens

Age-related Decline in Ibiquitin Conjugation

Hormonal Influence on Lens with Aging

The Effect of Physical Agents on the Aging Lens

Ultraviolet Radiation

Medications and Cataracts

Aspirin and Nonsteroidal Anti-inflammatory Drugs

Diuretics and Antihypertensives

Cholesterol-lowering Medications

Allopurinol

Antimalarials

Phenothiazines

Amiodarone

A Clinical Approach to Lens Modifications with Aging

Introduction

Lens Bio-densitometric Changes Through Aging

Scheimpflug Photography Features

Results from Scheimpflug Photography

Optical Changes of the Human Crystalline Lens Through Life

Modulation Transfer Function

MTF Results Measured with the Optical Quality Analysis System

Wavefront Analysis

Results on Ocular and Corneal Wavefront Errors Measured with a Hartmann–Shack Aberrometer

Conclusions

References

References – Lens Embryology

References – Morphology of the Human Lens

References – Capsule

References – Epithelium

References – Lens Sutural Anatomy

References – Physical Basis for Transparency

References – Sutural Architecture Influences Lens Optical Quality

References – Sutural Architecture Influences Lens Optical Quality

References – Nuclear Fiber Compaction as a Function of Aging and Cataractogenesis

References – Biometric, Physical, Optical, Refractive Index Changes and Lens Paradox

References – Crystalline Lens Position Modification with Age

References Zonular Apparatus Modifications

References – Electrolites and Membrane Permeability Modifications

References – Phospholipid Changes

References – Gangliosides Modifications

References – Water Content Modifications

References – Oxidative stress in cataracts

References – Age-related Decline in Ubiquitin Conjugation

References – Hormonal Influence on Lenses with Aging

References – UVR Effect on the Lens

References – Medications and Cataracts

References – Clinical Approach to Lens Modifications with Ageing

Chapter 6

The Extracellular Matrix of the Aged Human Trabecular Meshwork: Changes of Glucosaminoglycans

Introduction

Materials and Methods

Light Microscopy

Transmission Electron Microscopy (TEM)

Staining of Acidic Proteoglycans

ALCIAN-PAS Method

Quantitative Analysis of Images

Statistics

Results

Discussion

Stroma of the Trabecular Meshwork

Morphological Changes of the Trabecular Meshwork

Description of Extracellular Matrix

Conclusions

References

Chapter 7

Glial and Mobile Cells in the Iris of the Aging Human Eye

Introduction

Microglia

Aging of the Macroglia (Müller Cells and Astrocytes)

Astrocytes in Elderly Individuals

Glial Cells in Elderly Individuals

Reactive Astrocytes

Hypertrophic Astrocytes

Aging of the Microglia

Lymphocytes

Macrophages

References

Other Linked and Recent References

Chapter 8

Age-Related Diseases of the Vitreous

Introduction

Vitreous Composition

Vitreous Architecture

Aging

Detachment of the Posterior Vitreous

Amyloidosis

Asteroid Hyalosis

Synchysis Scintillans

Vitreous Membranes

Proliferative Vitreoretinopathy

Treatment

Cells within the Vitreous

Primary Ocular Lymphoma

Treatment

Vitreous Hemorrhage

Summary

References

Chapter 9

Age-Related Changes and/or Diseases in the Human Retina

Senile Lesions of the Retina

Age-related Changes of the Human Retina

Major Senile Diseases of the Retina

Senile Cataracts

Senile Detachment of the Retina

Cystic Degeneration of the Periphery of the Retina

Paved, Cobblestone or Pavement Degeneration as Proposed by Straatsma8 or Gonin’s Foci of Atrophic Choroidosis

Senile Degeneration of the Vitreous

Vascular Alterations

Senile Peripheral Pigment Degeneration

Cystic Degeneration

Retinoschisis

Latex Degeneration

Cobblestone Degeneration

Prevention

References

Chapter 10

Aging of the Retinal Pigmented Epithelium

Retinal Pigmented Epithelium (RPE)

Micro-anatomical Details

Increase in Granules of Lipofuscin

Increase in Melanin Granules

Increase of Complex Granules

Personal Results

Light Microscopy

Staining of Lipids

Transmission Electron Microscopy (TEM)

Quantitative Analysis of Images

Statistical Analysis of Data

Results

Discussion

References

Recent Books on RPE Disorders in Old Age

Chapter 11

The Aging of the Choroid

Anatomy of the Choroid

Histology

The Suprachoroidal Layer or Lamina Fusca

Choroidal Stroma

The Choriocapillaris

The Lamina Vitrea or Bruch’s Membrane

Vascularization

The Anterior Ciliary Arteries

The Posterior Ciliary Arteries

Short Posterior Ciliary Arteries (SPCA)

Long Posterior Ciliary Arteries (LPCA)

Vascular Patterns of the Posterior Ciliary Arteries and their Branches

Areas Supplied by the Anterior Ciliary Arteries

Areas Supplied by the Short Posterior Ciliary Arteries

Areas Supplied by the Long Posterior Ciliary Arteries

The Watershed Zone in the Vascular Bed of the PCAs

Watershed Zones Between the Territories Supplied by the PCAs and the Anterior Ciliary Arteries

Venous Drainage of the Choroid

Physiology of the Choroid

Growth and Aging

Age-related Changes in the Choroid

Histological Studies of Age-related Changes in the Choroid

Accumulation of Debris

Lipid Deposits

Changes in the Extracellular Matrix

Age-related Changes in ICG-angiographic Findings in Normal Subjects

Age-related Diseases that Preferentially Target the Choroid

Age-related Macular Degeneration (AMD)

Disorders Affecting the PCAs Circulation

Acute Ischemic Lesions of the Choroid

Evolutionary Stage of the Lesions

Size of the Artery or Arteriole Involved in the Occlusion

Severity of the Ischemia

Ischemic Lesions of the Macular Choroid

Hypertensive Choroidopathy

Anomalies Involving the Choroidal Vascular Bed

Lesions of the RPE

Serous Detachment of the Neuroretina

Conclusion

References

Chapter 12

Age-Related Macular Degeneration I:Types and Future Directions

Introduction

Etiology and Pathogenesis

RPE

Bruch’s Membrane

Basal Lamina Deposits

Drusen

Risk Factors for AMD

Age

Family History

Gender

Race

Smoking

Hypertension

Nutrition

Comorbidity

AMD Types

Neovascular AMD

Flouresceine Angiography

Optical Coherence Tomography

Non-neovascular AMD

Current Treatment Options

NV-AMD

Laser Photocoagulation

Photodynamic Treatment

Transpupillary Thermotherapy

Anti-angiogenic Therapies

Cortisone and Cortisene

Surgical Removal

Retinal Rotation

Transplantation

NN-AMD

Vitamins

Lutein and Zeuxanthin

Rheopheresis

Laser Application

Future Directions

References

Chapter 13

Age-Related Macular Degeneration II: Idiopathic Macular Holes

Macular Holes

Diagnostic Tools

Treatment Options

References

Chapter 14

Age-Related Macular Degeneration III: Epiretinal Membranes

Introduction

Diagnostic Tools

Treatment options and prognosis

References

Chapter 15

Macular Degeneration: Ultrastructural Age-Related Changes

Introduction

Methods

Selection of Materials

Transmission Electron Microscopy

Light Microscopy

Polarization Microscopy

For the Study of Lipids

For the Study of Proteoglycan Structures

For the Study of Collagen Fibrils

Statistical Analysis

Results

Alterations of the RPE

Bruch’s Membrane Changes

Age-related Changes in the Macular Region

Basement Membrane of RPE

Thicking of Capillary Basement

Peroxisomal Contribution to Basement Membrane Thickening of RPE

Histochemical Composition of Bruch’s Membrane

Statistical Analysis of Anisotropy

Discussion

Conclusions

References

Chapter 16

Non-Exudative Macular Degeneration and Management

Introduction

Normal Aging Changes

Non-neovascular Abnormalities in AMD

Stages of Non-Exudative AMD

Management of Non-Exudative AMD: Clinical Trials

Age-Related Eye Disease Study (AREDS)6

Complications of Age-Related Macular Degeneration Prevention Trial (CAPT)8

Prophylactic Treatment of Age-Related Macular Degeneration (PTAMD)7

Choroidal Neovascularization Prevention Trial (CNVPT)5

16 Non-Exudative Macular Degeneration and Management 293In both arms of the study, the area of Drusen decreased with laser treatment.Although the incidence of CNV was negligibly increased in the treatment groupversus the observation group in the Bilateral Drusen Study (2.6% vs. 1.3%), the rateof CNV was higher in the Fellow Eye Study (16.9% vs. 3.3%). Visual acuityremained similar between both treatment and observation groups in the BilateralDrusen Study, but was worse in the treatment group of the Fellow

Age-related Eye Disease Study II (AREDS II)

Conclusion

References

Chapter 17

Treatment of Intraocular Pressure in Elderly Patients

Introduction

Material and Methods

Results

Discussion

References

Chapter 18

Aging of the Lachrymal Gland

Anatomy of the Lachrymal Gland

Gross Anatomy of the Lachrymal Gland

Histology of the Lachrymal Gland

Innervation of the Lachrymal Gland

Secretory Function of the Lachrymal Gland

Protein Secretion

Water Secretion

Age-Related Changes to Tear Fluid

Age-Related Changes in the Lachrymal Gland

Human Studies

Animal Studies

Conclusion

References

Chapter 19

The World According to Blink: Blinking and Aging

Neuroanatomical and Neurophysiological Background of the Blink Circuit

Blink Rate

Eyelid Kinematics

Facial Movement Disorders

Hemifacial paralysis (Bell’s palsy)

Apraxia

Hemifacial spasm

Blepharospasm

Blinking as a Tool in Timing of Reflexes

Conclusion

References

Chapter 20

Age-Related Changes in the Oculomotor System

Introduction

Structural and Functional Organization of the Human Oculomotor System

Age-related Changes in the Supranuclear Level of the Human Oculomotor System

The Cerebellum

Age-related Changes in the Vestibulocerebellar Pathway

Age-related Changes in the Spinocerebellar Pathway

The Muscle Spindle

Tendon Receptors

Age-related Changes in the Cerebrocerebellum and the Pontocerebellar Pathway

The Frontal Eye Field (FEF)

The Parietal Eye Field (PEF)

The Paramedian Pontine Reticular Formation (PPRF)

Superior Colliculus (SC)

Age-Related Changes in the Subnuclear System of the Oculomotor System

Cranial Nerves

Extraocular Muscles

Age-related Changes in the Muscle Fiber Population

Age-related Changes in the Distal Insertions and Associated Structures

Restitution of the Oculomotor System

References

Chapter 21

Rehabilitation of Low Vision in Aged People

Visual Impairment in the Elderly

Management of Glaucoma

Degenerative Myopia

References

Chapter 22

Many Suggestions to Protect the Eyes in Aging People

Five Steps for Protecting Your Eyesight

Common Eye Problems

Eye Diseases and Disorders

Age-related Macular Degeneration (AMD)

Diabetic Retinopathy

Retinal Detachment

Low Vision

References

Index