Age-Related Changes of the Human Eye (eBook)

Preface 6
Contents 8
Contributors 12
Chapter 1 15
Aging as Risk Factor in Eye Disease 15
Keywords Cataract, Glaucoma, ARM D, Corneal opacity, Diabetic retinopathy 15
References 21
Recommended Bibliographic Resources 22
Recent Books on Vision Disorders in Old Age (www.amazon.com) 22
Chapter 2 23
Age-Related Changes of the Eyelid 23
Introduction 23
Changes in Anatomy and Kinematics 25
Myofiber Abnormalities 27
Mitochondrial Alterations 31
Sarcoplasma 36
Connective Tissue Changes 42
References 44
Chapter 3 49
Aging Effects on the Optics of the Eye 49
Introduction 49
Retinal Image Quality as a Function of Age 50
Aberrations of the Eye as a Function of Age 53
Aberrations of Cornea as a Function of Age 54
Coupling of Corneal and Internal Aberrations as a Function of Age 55
Optics of the Aging Eye and Intraocular Lenses 55
References 57
Chapter 4 59
Aging of the Cornea 59
Clinical Conditions 59
Corneal Arcus 59
Prevalence 60
Biochemical Aspects 61
Deep Crocodile Shagreen 61
White Limbal Gridle of Vogt 62
Hassall-Henle Bodies 62
Cornea Shape 63
Astigmatism 63
Structure 65
Corneal Thickness 64
Corneal Aberration 65
Structure 65
Epithelium 65
Bowman’s Membrane 66
Subbasal Nerve Plexus 66
Stroma 67
Descemet’s Membrane 69
Endothelium 70
References 71
Chapter 5 75
The Aging of the Human Lens 75
Introduction 75
Lens Embryology 76
Morphology of the Human Lens 78
Lens Capsule 80
Anatomy of the Lens Capsule 80
Ultrastructure of the Lens Capsule 81
Growth and Thickness of the Lens Capsule 81
Mechanical Properties of the Posterior Lens Capsule 82
Aging of the Lens Capsule 83
The Ocular Lens Epithelium 83
Ultrastructure of the Lens Epithelium 83
The Epithelium as the Major Site of Transport, Metabolism and Detoxification 85
Programmed Cell Death and the Lens Epithelium 85
Lens Fiber Cells 86
Fiber Cell Organization and Development of Lens Sutures 86
The Contribution of Major Fiber Proteins to Sutural Development and Growth 87
Lens Sutural Anatomy 87
Suture Formation after Birth 89
Simple Star Suture Formation 89
Star and Complex Star Suture Formation 89
The Physical Basis for Transparency of the Crystalline Lens 91
Small Particle Scattering 92
Large Particle Scattering 92
The Influence of Sutural Architecture on Lens Optical Quality 93
Nuclear Fiber Compaction as a Function of Aging and Cataractogenesis 94
Biometric, Optical and Physical Changes in the Human Crystalline Lens with Aging 96
The Change in Equivalent Refractive Index and the Lens Paradox 97
Crystalline Lens Position Modification with Age 98
Zonular Apparatus 98
Synthesis and Structural Organization of Zonular Fibers During Development and Aging 98
Zonular Fibers Electron Microscopy 99
Anterior Shift of Zonular Insertion onto the Anterior Surface of Lens with Age 99
Anatomical Changes of the Zonular Insertion 99
Lens Metabolic Changes with Age and the Effects of External Agents 100
Introduction 100
Age-related Changes in Calcium, Sodium, Potassium and Lens Membrane Permeability 101
Lens Phospholipid Changes with Age and Cataracts 101
Age-related Changes in Ganglioside Composition 103
Water Content Modifications in Lens with Aging 104
Oxidative Stress in the Aging Lens 104
Age-related Decline in Ibiquitin Conjugation 105
Hormonal Influence on Lens with Aging 106
The Effect of Physical Agents on the Aging Lens 107
Ultraviolet Radiation 107
Medications and Cataracts 109
Aspirin and Nonsteroidal Anti-inflammatory Drugs 109
Diuretics and Antihypertensives 110
Cholesterol-lowering Medications 111
Allopurinol 111
Antimalarials 111
Phenothiazines 111
Amiodarone 112
A Clinical Approach to Lens Modifications with Aging 112
Introduction 112
Lens Bio-densitometric Changes Through Aging 112
Scheimpflug Photography Features 112
Results from Scheimpflug Photography 113
Optical Changes of the Human Crystalline Lens Through Life 116
Modulation Transfer Function 116
MTF Results Measured with the Optical Quality Analysis System 117
Wavefront Analysis 118
Results on Ocular and Corneal Wavefront Errors Measured with a Hartmann–Shack Aberrometer 119
Conclusions 119
References 125
References – Lens Embryology 125
References – Morphology of the Human Lens 126
References – Capsule 127
References – Epithelium 129
References – Lens Sutural Anatomy 130
References – Physical Basis for Transparency 131
References – Sutural Architecture Influences Lens Optical Quality 132
References – Sutural Architecture Influences Lens Optical Quality 132
References – Nuclear Fiber Compaction as a Function of Aging and Cataractogenesis 133
References – Biometric, Physical, Optical, Refractive Index Changes and Lens Paradox 134
References – Crystalline Lens Position Modification with Age 135
References Zonular Apparatus Modifications 135
References – Electrolites and Membrane Permeability Modifications 136
References – Phospholipid Changes 137
References – Gangliosides Modifications 138
References – Water Content Modifications 138
References – Oxidative stress in cataracts 139
References – Age-related Decline in Ubiquitin Conjugation 140
References – Hormonal Influence on Lenses with Aging 141
References – UVR Effect on the Lens 142
References – Medications and Cataracts 143
References – Clinical Approach to Lens Modifications with Ageing 145
Chapter 6 147
The Extracellular Matrix of the Aged Human Trabecular Meshwork: Changes of Glucosaminoglycans 147
Introduction 147
Materials and Methods 149
Light Microscopy 149
Transmission Electron Microscopy (TEM) 150
Staining of Acidic Proteoglycans 150
ALCIAN-PAS Method 150
Quantitative Analysis of Images 151
Statistics 151
Results 151
Discussion 156
Stroma of the Trabecular Meshwork 157
Morphological Changes of the Trabecular Meshwork 157
Description of Extracellular Matrix 157
Conclusions 157
References 158
Chapter 7 161
Glial and Mobile Cells in the Iris of the Aging Human Eye 161
Introduction 161
Microglia 163
Aging of the Macroglia (Müller Cells and Astrocytes) 163
Astrocytes in Elderly Individuals 164
Glial Cells in Elderly Individuals 164
Reactive Astrocytes 165
Hypertrophic Astrocytes 165
Aging of the Microglia 166
Lymphocytes 166
Macrophages 167
References 168
Other Linked and Recent References 169
Chapter 8 171
Age-Related Diseases of the Vitreous 171
Introduction 171
Vitreous Composition 172
Vitreous Architecture 173
Aging 174
Detachment of the Posterior Vitreous 175
Amyloidosis 178
Asteroid Hyalosis 180
Synchysis Scintillans 181
Vitreous Membranes 182
Proliferative Vitreoretinopathy 187
Treatment 188
Cells within the Vitreous 189
Primary Ocular Lymphoma 190
Treatment 193
Vitreous Hemorrhage 194
Summary 197
References 197
Chapter 9 207
Age-Related Changes and/or Diseases in the Human Retina 207
Senile Lesions of the Retina 207
Age-related Changes of the Human Retina 208
Major Senile Diseases of the Retina 208
Senile Cataracts 209
Senile Detachment of the Retina 209
Cystic Degeneration of the Periphery of the Retina 209
Paved, Cobblestone or Pavement Degeneration as Proposed by Straatsma8 or Gonin’s Foci of Atrophic Choroidosis 210
Senile Degeneration of the Vitreous 210
Vascular Alterations 211
Senile Peripheral Pigment Degeneration 211
Cystic Degeneration 212
Retinoschisis 212
Latex Degeneration 213
Cobblestone Degeneration 213
Prevention 214
References 214
Chapter 10 217
Aging of the Retinal Pigmented Epithelium 217
Retinal Pigmented Epithelium (RPE) 217
Micro-anatomical Details 218
Increase in Granules of Lipofuscin 220
Increase in Melanin Granules 221
Increase of Complex Granules 222
Personal Results 222
Light Microscopy 222
Staining of Lipids 223
Transmission Electron Microscopy (TEM) 223
Quantitative Analysis of Images 223
Statistical Analysis of Data 223
Results 224
Discussion 227
References 228
Recent Books on RPE Disorders in Old Age 229
Chapter 11 231
The Aging of the Choroid 231
Anatomy of the Choroid 231
Histology 232
The Suprachoroidal Layer or Lamina Fusca 232
Choroidal Stroma 232
The Choriocapillaris 232
The Lamina Vitrea or Bruch’s Membrane 233
Vascularization 233
The Anterior Ciliary Arteries 233
The Posterior Ciliary Arteries 234
Short Posterior Ciliary Arteries (SPCA) 234
Long Posterior Ciliary Arteries (LPCA) 234
Vascular Patterns of the Posterior Ciliary Arteries and their Branches 234
Areas Supplied by the Anterior Ciliary Arteries 236
Areas Supplied by the Short Posterior Ciliary Arteries 236
Areas Supplied by the Long Posterior Ciliary Arteries 237
The Watershed Zone in the Vascular Bed of the PCAs 237
Watershed Zones Between the Territories Supplied by the PCAs and the Anterior Ciliary Arteries 237
Venous Drainage of the Choroid 238
Physiology of the Choroid 238
Growth and Aging 238
Age-related Changes in the Choroid 239
Histological Studies of Age-related Changes in the Choroid 239
Accumulation of Debris 239
Lipid Deposits 240
Changes in the Extracellular Matrix 240
Age-related Changes in ICG-angiographic Findings in Normal Subjects 240
Age-related Diseases that Preferentially Target the Choroid 243
Age-related Macular Degeneration (AMD) 244
Disorders Affecting the PCAs Circulation 245
Acute Ischemic Lesions of the Choroid 246
Evolutionary Stage of the Lesions 246
Size of the Artery or Arteriole Involved in the Occlusion 246
Severity of the Ischemia 246
Ischemic Lesions of the Macular Choroid 246
Hypertensive Choroidopathy 247
Anomalies Involving the Choroidal Vascular Bed 248
Lesions of the RPE 248
Serous Detachment of the Neuroretina 248
Conclusion 248
References 249
Chapter 12 253
Age-Related Macular Degeneration I:Types and Future Directions 253
Introduction 253
Etiology and Pathogenesis 254
RPE 254
Bruch’s Membrane 255
Basal Lamina Deposits 255
Drusen 255
Risk Factors for AMD 256
Age 256
Family History 256
Gender 256
Race 257
Smoking 257
Hypertension 257
Nutrition 257
Comorbidity 257
AMD Types 258
Neovascular AMD 258
Flouresceine Angiography 258
Optical Coherence Tomography 260
Non-neovascular AMD 261
Current Treatment Options 262
NV-AMD 262
Laser Photocoagulation 262
Photodynamic Treatment 262
Transpupillary Thermotherapy 262
Anti-angiogenic Therapies 263
Cortisone and Cortisene 264
Surgical Removal 264
Retinal Rotation 265
Transplantation 265
NN-AMD 266
Vitamins 266
Lutein and Zeuxanthin 266
Rheopheresis 266
Laser Application 266
Future Directions 266
References 267
Chapter 13 271
Age-Related Macular Degeneration II: Idiopathic Macular Holes 271
Macular Holes 271
Diagnostic Tools 272
Treatment Options 273
References 276
Chapter 14 279
Age-Related Macular Degeneration III: Epiretinal Membranes 279
Introduction 279
Diagnostic Tools 280
Treatment options and prognosis 282
References 284
Chapter 15 287
Macular Degeneration: Ultrastructural Age-Related Changes 287
Introduction 288
Methods 289
Selection of Materials 289
Transmission Electron Microscopy 290
Light Microscopy 290
Polarization Microscopy 290
For the Study of Lipids 290
For the Study of Proteoglycan Structures 290
For the Study of Collagen Fibrils 291
Statistical Analysis 291
Results 291
Alterations of the RPE 291
Bruch’s Membrane Changes 292
Age-related Changes in the Macular Region 292
Basement Membrane of RPE 292
Thicking of Capillary Basement 292
Peroxisomal Contribution to Basement Membrane Thickening of RPE 292
Histochemical Composition of Bruch’s Membrane 293
Statistical Analysis of Anisotropy 293
Discussion 294
Conclusions 298
References 298
Chapter 16 301
Non-Exudative Macular Degeneration and Management 301
Introduction 301
Normal Aging Changes 302
Non-neovascular Abnormalities in AMD 302
Stages of Non-Exudative AMD 303
Management of Non-Exudative AMD: Clinical Trials 304
Age-Related Eye Disease Study (AREDS)6 305
Complications of Age-Related Macular Degeneration Prevention Trial (CAPT)8 305
Prophylactic Treatment of Age-Related Macular Degeneration (PTAMD)7 305
Choroidal Neovascularization Prevention Trial (CNVPT)5 306
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 307
Age-related Eye Disease Study II (AREDS II) 307
Conclusion 307
References 308
Chapter 17 309
Treatment of Intraocular Pressure in Elderly Patients 309
Introduction 310
Material and Methods 311
Results 312
Discussion 313
References 316
Chapter 18 319
Aging of the Lachrymal Gland 319
Anatomy of the Lachrymal Gland 320
Gross Anatomy of the Lachrymal Gland 320
Histology of the Lachrymal Gland 320
Innervation of the Lachrymal Gland 321
Secretory Function of the Lachrymal Gland 322
Protein Secretion 322
Water Secretion 322
Age-Related Changes to Tear Fluid 323
Age-Related Changes in the Lachrymal Gland 323
Human Studies 324
Animal Studies 326
Conclusion 328
References 328
Chapter 19 333
The World According to Blink: Blinking and Aging 333
Neuroanatomical and Neurophysiological Background of the Blink Circuit 334
Blink Rate 338
Eyelid Kinematics 339
Facial Movement Disorders 342
Hemifacial paralysis (Bell’s palsy) 342
Apraxia 346
Hemifacial spasm 346
Blepharospasm 348
Blinking as a Tool in Timing of Reflexes 350
Conclusion 350
References 351
Chapter 20 357
Age-Related Changes in the Oculomotor System 357
Introduction 357
Structural and Functional Organization of the Human Oculomotor System 359
Age-related Changes in the Supranuclear Level of the Human Oculomotor System 360
The Cerebellum 360
Age-related Changes in the Vestibulocerebellar Pathway 363
Age-related Changes in the Spinocerebellar Pathway 365
The Muscle Spindle 366
Tendon Receptors 368
Age-related Changes in the Cerebrocerebellum and the Pontocerebellar Pathway 370
The Frontal Eye Field (FEF) 370
The Parietal Eye Field (PEF) 372
The Paramedian Pontine Reticular Formation (PPRF) 372
Superior Colliculus (SC) 373
Age-Related Changes in the Subnuclear System of the Oculomotor System 374
Cranial Nerves 375
Extraocular Muscles 377
Age-related Changes in the Muscle Fiber Population 379
Age-related Changes in the Distal Insertions and Associated Structures 382
Restitution of the Oculomotor System 383
References 384
Chapter 21 389
Rehabilitation of Low Vision in Aged People 389
Visual Impairment in the Elderly 389
Management of Glaucoma 392
Degenerative Myopia 400
References 401
Chapter 22 407
Many Suggestions to Protect the Eyes in Aging People 407
Five Steps for Protecting Your Eyesight 407
Common Eye Problems 408
Eye Diseases and Disorders 408
Age-related Macular Degeneration (AMD) 409
Diabetic Retinopathy 409
Retinal Detachment 410
Low Vision 410
References 411
Index 413