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Topic Review
Ophthalmology Clinics in Alzheimer’s Disease
Alzheimer’s disease (AD) is the leading cause of dementia, which is a growing public health concern. Although there is no curative treatment for established AD, early recognition and modification of the known risk factors can reduce both severity and the rate of progression.  Currently, an early diagnosis of AD is rarely achieved, as there is no screening for AD. The cognitive decline in AD is gradual and often goes unnoticed by patients and caregivers, resulting in patients presenting at later stages of the disease.  Primary care physicians (general practitioners in the UK) can administer a battery of tests for patients presenting with memory problems and cognitive impairment, however final diagnosis of AD is usually made by specialised tertiary level clinics.  Recent studies suggest that in AD, visuospatial difficulties develop prior to the development of memory problems and screening for visuospatial difficulties may offer a tool to screen for early stage AD. AD and cataracts share common risk and predisposing factors, and the stage of cataract presentation for intervention has shifted dramatically with early cataract referral and surgical intervention becoming the norm. This presentation offers an ideal opportunity to administer a screening test for AD, and visuospatial tools can be administered at post-operative visits by eye clinics.  Abnormal findings can be communicated to primary care physicians for further follow up and assessment, or possible interventions which modify risk factors such as diabetes, hypertension and obesity can be undertaken.
  • 657
  • 05 Nov 2020
Topic Review
Overcoming Antimicrobial Resistance in Endophthalmitis
Endophthalmitis is a rare but vision-threatening infection characterized by marked inflammation of intraocular fluids and tissues, uncommonly seen following surgery and intravitreal injection. Antimicrobials are used worldwide in the prophylaxis and treatment of bacterial and fungal infections of the eye and are standard treatment in the preoperative and postoperative care of surgical patients. However, antimicrobials are reported to be overprescribed in many parts of the world, which contributes to antimicrobial resistance (AMR). AMR complicates the prophylaxis and treatment of endophthalmitis. 
  • 656
  • 18 Mar 2024
Topic Review
Pituitary Adenylate Cyclase-Activating Polypeptide Role in the Eye
Pituitary Adenylate Cyclase-Activating Polypeptide (PACAP) is a neuropeptide with widespread distribution throughout the central and peripheral nervous system as well as in many other peripheral organs. It plays cytoprotective effects mediated mainly through the activation of specific receptors. PACAP is known to play pleiotropic effects on the eye, including the cornea, protecting it against different types of insult. 
  • 655
  • 18 Jan 2022
Topic Review
Diabetic Macular Edema
Diabetic retinopathy (DR), with increasing incidence, is the major cause of vision loss and blindness worldwide in working-age adults. Diabetic macular edema (DME) remains the main cause of vision impairment in diabetic patients, with its pathogenesis still not completely elucidated. Vascular endothelial growth factor (VEGF) plays a pivotal role in the pathogenesis of DR and DME. 
  • 650
  • 02 Nov 2022
Topic Review
Conjunctival Melanoma and its Therapies
Conjunctival melanoma (CM) is a rare ocular disease, accounting for about 2% of all ocular malignancies. Its incidence has been increasing in recent years, with 0.3–0.8 cases per million people in Western countries, mainly in Caucasian ethnicity, but can occur in African or in Afro-Americans as well. It most commonly appears in middle-aged or elderly white individuals. In the US, the incidence increased by 295% from 1973 to 1999.
  • 649
  • 25 Jan 2021
Topic Review
Ocular Extra-Intestinal Manifestations in Adults Inflammatory Bowel Disease
Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic, inflammatory, polygenic, multifactorial, and multifactorial illness with unknown etiology. Studies have reported extraintestinal manifestations (EIMs) or issues in several organ systems, including musculoskeletal, dermatologic, ocular, pulmonary, renal, and hepatobiliary systems.
  • 644
  • 15 Dec 2022
Topic Review
Medication for Macular Degeneration
Age-related macular degeneration (AMD) is central vision loss with aging, was the fourth main cause of blindness in 2015, and has many risk factors, such as cataract surgery, cigarette smoking, family history, hypertension, obesity, long-term smart device usage, etc. In general, AMD drug candidates from natural products are more effective at treating early and intermediate AMD.
  • 637
  • 05 Nov 2021
Topic Review
Protein Analysis of Gene Mutations in Conjunctival Melanoma
Genetics is the basis of many neoplasms, including conjunctival melanoma (CM). Here, we analyzed five proteins associated with CM, namely BRAF, NRAS, c-KIT, NF1, and PTEN and investigated structures of BRAF, NRAS, c-KIT, and PTEN generated with AlphaFold, and NF1 structure from the Protein Databank (PDB). The Predictor of Natural Disordered Protein Regions (PONDR®), the web server for the prediction of intrinsically unstructured regions of proteins (IUPred), and the mean disorder profile (MDP) were utilized to analyze each protein for intrinsically disordered protein regions (IDPRs). AlphaFold and PDB structures show the presence of IDPRs in all five proteins. The bioinformatics analysis confirmed high levels of disorder in these proteins, with most disordered being BRAF (45.95%), followed by PTEN (31.76%), NF1 (22.19%), c-KIT (21.82%), and NRAS (14.81%). Our STRING analysis found that each of these five proteins had more predicted interactions then expected (p-value < 1.0 × 10−16). Our analysis demonstrates that the mutations linked to CM likely affected IDPRs and possibly altered their highly complex PPIs. Quantifying IDPRs in BRAF, NRAS, c-KIT, NF1, and PTEN and understanding these protein regions are important processes as IDPRs can be possible drug targets for novel targeted therapies for treating CM.
  • 635
  • 21 Oct 2021
Topic Review
Associations between CKD, Retina, and CVD
The kidney, brain, and retina are highly metabolic organs that require specialized vascular networks to carry out their function. Cohort studies suggest that retinopathy, cerebrovascular disease (CVD), and chronic kidney disease (CKD) frequently coincide. The frequently concurrent prevalence of retinopathy, CVD, and CKD suggests a common basis for pathology.
  • 629
  • 08 Oct 2022
Topic Review
Principle of Optical Coherence Tomography Angiography
Diagnosis and quantification of ischemia in ocular burns is essential to determine the need for interventions in the acute phase and the final prognosis. Clinical signs in isolation are rarely sufficient to accurately assess limbal ischemia. With anterior segment optical coherence tomography angiography (AS-OCTA), the presence and extent of ischemia can be objectively confirmed and quantified.
  • 627
  • 19 May 2022
Topic Review
The Role of Ocular Fundus in Systemic Infections
Examining the ocular fundus demonstrates significant clinical relevance in systemic infections among inpatients. The necessity of such evaluations is not universal for all infectious cases but critical when systemic infections, notably those demonstrating a potential for ocular involvement. The utilization of a collaborative decision tree is proposed to guide clinicians in identifying patients who may derive substantial benefit from fundus examinations, thereby enhancing diagnostic accuracy and tailoring therapeutic interventions. A well-structured, interdisciplinary approach, combining systemic and ocular assessments, is crucial to establish diagnostic clarity and refine therapeutic approaches, especially in the complex clinical scenarios often presented by inpatients with systemic infections. Ultimately, adopting this strategic framework aims to promote better patient outcomes through informed and timely intervention strategies.
  • 625
  • 22 Dec 2023
Topic Review
Matrix Metalloproteinases and Glaucoma
Matrix metalloproteinases (MMPs) are enzymes that decompose extracellular matrix (ECM) proteins. MMPs are thought to play important roles in cellular processes, such as cell proliferation, differentiation, angiogenesis, migration, apoptosis, and host defense. MMPs are distributed in almost all intraocular tissues and are involved in physiological and pathological mechanisms of the eye. MMPs are also associated with glaucoma, a progressive neurodegenerative disease of the eyes. MMP activity affects intraocular pressure control and apoptosis of retinal ganglion cells, which are the pathological mechanisms of glaucoma. It also affects the risk of glaucoma development based on genetic pleomorphism. In addition, MMPs may affect the treatment outcomes of glaucoma, including the success rate of surgical treatment and side effects on the ocular surface due to glaucoma medications. Glaucoma is a neurodegenerative disorder affected by multiple factors, from which more than 60 million patients worldwide suffer. It is characterized by irreversible progressive loss of retinal ganglion cells (RGC) and distinct optic nerve head (ONH) deterioration, which is related to corresponding visual field loss.
  • 618
  • 08 Oct 2022
Topic Review
Stem Cell Therapies in AMD
Age-related macular degeneration (AMD) is a highly prevalent irreversible impairment in the elderly population worldwide. Stem cell therapies have been considered potentially viable for treating AMD through the direct replacement of degenerated cells or secretion of trophic factors that facilitate the survival of existing cells. 
  • 618
  • 31 May 2021
Topic Review
Aqueous Prostaglandin Eye Drop Formulations
Glaucoma is one of the leading causes of irreversible blindness worldwide. It is characterized by progressive optic neuropathy in association with damage to the optic nerve head and, subsequently, visual loss if it is left untreated. Among the drug classes used for the long-term treatment of open-angle glaucoma, prostaglandin analogues (PGAs) are the first-line treatment and are available as marketed eye drop formulations for intraocular pressure (IOP) reduction by increasing the trabecular and uveoscleral outflow. PGAs have low aqueous solubility and are very unstable (i.e., hydrolysis) in aqueous solutions, which may hamper their ocular bioavailability and decrease their chemical stability. Additionally, treatment with PGA in conventional eye drops is associated with adverse effects, such as conjunctival hyperemia and trichiasis. It has been a very challenging for formulation scientists to develop stable aqueous eye drop formulations that increase the PGAs’ solubility and enhance their therapeutic efficacy while simultaneously lowering their ocular side effects.
  • 608
  • 28 Oct 2022
Topic Review
Retinal Vasculitis
Retinal vascular diseases have distinct, complex and multifactorial pathogeneses yet share several key pathophysiological aspects including inflammation, vascular permeability and neovascularisation. In non-infectious posterior uveitis (NIU), retinal vasculitis involves vessel leakage leading to retinal enlargement, exudation, and macular oedema. Neovascularisation is not a common feature in NIU, however, detection of the major angiogenic factor—vascular endothelial growth factor A (VEGF-A)—in intraocular fluids in animal models of uveitis and patient samples may be an indication for a role for this cytokine in a highly inflammatory condition. Suppression of VEGF-A by directly targeting the leukotriene B4 (LTB4) receptor (BLT1) pathway indicates a connection between leukotrienes (LTs), which have prominent roles in initiating and propagating inflammatory responses, and VEGF-A in retinal inflammatory diseases.
  • 606
  • 22 Sep 2021
Topic Review
Cannabineyed
The word cannabineyed refers to endocannabinoid system (ECS) physiology, dysregulation and modulation in the context of ocular and periocular tissues and structures. It derives by placing the word eye into the original one, cannabinoid. Specifically, the endocannabinoid system (ECS) is a complex regulatory system, highly conserved among vertebrates. It has been widely described in nearly all human tissues. In the eye, the ECS expression has been demonstrated both in the anterior and in the posterior segment. In this context, the ECS is believed to play a pivotal role in the modulation of the local inflammatory state as well as in the regulation of tissue repair and fibrosis, neo-angiogenesis, pain perception, intraocular pressure (IOP) control and neuroprotection.
  • 592
  • 12 Feb 2021
Topic Review
Diagnosis of Fungal Endophthalmitis
In large case series of fungal endophthalmitis (FE), the most frequent etiologic agents for all types of FE are molds (usually Aspergillus species, while Fusarium is the prevalent etiology in keratitis-related FE). Candida was the organism found in most cases of endogenous FE. Lately, polymerase chain reaction (PCR) was increasingly used for the diagnosis of FE, allowing for very high diagnostic sensitivity, while the costs become more affordable with time. The most important shortcoming of PCR—the limited number of pathogens that can be simultaneously searched for—may be overcome by newer techniques, such as next-generation sequencing. There are even hopes of searching for genetic sequences that codify resistance to antifungals. 
  • 591
  • 10 May 2022
Topic Review
Intelligent Sensor arrays for Early Detection of Diabetes
At present, it is unquestionable that machine learning (ML) modeling is one of the most promising and powerful tools for the development of diagnosis methods and technologies. It permits the fast cribbage and analysis of huge amounts of data from overwhelmingly complex biological matrices which, applied to diagnostics, can be translated into valuable support technologies that would ease rapid decision-making in early diagnosis and screening programs. It has been seen that one can find a great number of colorimetric and electrochemical sensing methods for the detection of biomarkers related to diabetes mellitus (DM) and diabetic rethinopathy (DR), including some recent efforts towards the development of sensor-array technologies exploiting or not ML models for the sensing of diverse biomarkers and for diagnose purposes (including DM). 
  • 591
  • 14 Mar 2022
Topic Review
Subthreshold Nano-Second Laser Treatment
The presence of drusen is an important hallmark of age-related macular degeneration (AMD). Laser-induced regression of drusen, first observed over four decades ago, has led to much interest in the potential role of lasers in slowing the progression of the disease. In this article, we summarise the key insights from pre-clinical studies into the possible mechanisms of action of various laser interventions that result in beneficial changes in the retinal pigment epithelium/Bruch’s membrane/choriocapillaris interface. Key learnings from clinical trials of laser treatment in AMD are also summarised, concentrating on the evolution of laser technology towards short pulse, non-thermal delivery such as the nanosecond laser. The evolution in our understanding of AMD, through advances in multimodal imaging and functional testing, as well as ongoing investigation of key pathological mechanisms, have all helped to set the scene for further well-conducted randomised trials to further explore potential utility of the nanosecond and other subthreshold short pulse lasers in AMD.
  • 590
  • 12 Feb 2021
Topic Review
Choroidal Neovascular Membranes in Retinal and Choroidal Tumors
Choroidal neovascularizations are historically associated with exudative macular degeneration, nonetheless, they have been observed in nevus, melanoma, osteoma, and hemangioma involving the choroid and retina. 
  • 589
  • 08 Feb 2023
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