Storage, surgery, outcome, complications, and new developments in corneal and conjunctival grafts

This review covers last year's literature on corneal, limbal, and conjunctival transplantation including tissue storage and eye banking. In this area, the main themes were related to a better evaluation of tissue viability and the exclusion of disease transmission. An analysis of the changing indications for penetrating keratoplasty shows the differences between American and European series. Most efforts in relation to surgical techniques are oriented toward obtaining better refractive results, whereas the study of large series sheds new light on the risk factors for graft failure and other complications. Limbal transplants have acquired the status of a new field in the surgical treatment of ocular surface disease, particularly in relation to corneal stem cell deficiencies.     

Glaucoma, apoptosis, and neuroprotection

The demise of the retinal ganglion cell represents the final common pathway of glaucomatous vision loss. Various studies demonstrate that ganglion cells die by the mechanism of apoptosis in conditions such as experimental animal models of glaucoma and optic nerve transection, and in human glaucoma. Apoptosis is a basic cell death mechanism noted in a number of neurodegenerative conditions. It constitutes a genetically coded "suicide" program activated when cells are no longer needed or have been seriously damaged, and is typified by rapid phagocytosis without inflammation. These cells demonstrate characteristic morphological changes on electron microscopy: nuclear chromatin condensation, compaction of cytoplasmic organelles, and membrane blebbing. Neurotrophin withdrawal and excitotoxic neurotransmitters have been implicated in apoptosis in ganglion cells damaged by glaucoma. Understanding the cellular and molecular biological events involved in ganglion cell death may lead to novel approaches to the treatment of glaucoma.     

Maculas, monkeys, models, AMD and aging

Age related macular degeneration (AMD) signs may be found reliably in monkeys (Macaca mulatta) bred selectively in Florida after 14 generations of inbreeding in a closed colony at the University of Puerto Rico. Progression, ultrastructure and functional losses are parallel to those found in humans.     

Seeing, sensing, and scrutinizing

Large changes in a scene often become difficult to notice if made during an eye movement, image flicker, movie cut, or other such disturbance. It is argued here that this change blindness can serve as a useful tool to explore various aspects of vision. This argument centers around the proposal that focused attention is needed for the explicit perception of change. Given this, the study of change perception can provide a useful way to determine the nature of visual attention, and to cast new light on the way that it is - and is not - involved in visual perception. To illustrate the power of this approach, this paper surveys its use in exploring three different aspects of vision. The first concerns the general nature of seeing. To explain why change blindness can be easily induced in experiments but apparently not in everyday life, it is proposed that perception involves a virtual representation, where object representations do not accumulate, but are formed as needed. An architecture containing both attentional and nonattentional streams is proposed as a way to implement this scheme. The second aspect concerns the ability of observers to detect change even when they have no visual experience of it. This sensing is found to take on at least two forms: detection without visual experience (but still with conscious awareness), and detection without any awareness at all. It is proposed that these are both due to the operation of a nonattentional visual stream. The final aspect considered is the nature of visual attention itself - the mechanisms involved when scrutinizing items. Experiments using controlled stimuli show the existence of various limits on visual search for change. It is shown that these limits provide a powerful means to map out the attentional mechanisms involved.     

Light, vision, and aging

Recent research on aging of chromatic and spatial vision processes is reviewed. Changes in these visual processes with advancing age are largely continuous. Age-related declines in visual performance may be explained in terms of reductions in the illuminance of the visual stimulus due to changes in the ocular media and losses of efficiency at a neural level. Thus, some prominent characteristics of the senescent visual system are similar to those of the younger visual system operating at a lower ambient light level. One important determinant of retinal aging may be the light history of the individual, i.e., cumulative exposure to high-energy photons from solar radiation may accelerate retinal aging. If these abstractions from the literature are valid, then it will become more important to control the light environment throughout the life span.