Clinical imaging of macular pigment optical density and spatial distribution

Clinical research continues to provide an increasing number of studies that reveal an association between macular pigment optical density (MPOD) and both visual function and ocular health. As a result, there is a growing need for repeatable, accurate measures of MPOD that can describe peak optical density as well as spatial distribution. Measurement of MPOD in a research setting has an established history encompassing a number of both objective and subjective techniques. Transition of these techniques to a clinical setting has produced an array of commercial devices using three primary methods: heterochromatic flicker photometry, fundus autofluorescence and fundus reflectometry. The inherent differences among the techniques create difficulty in making direct comparisons between MPOD measurement devices. Understanding the limitations of each technique is critical in the clinical interpretation of MPOD results. Here, both the objective and subjective methods of MPOD measurement are reviewed with emphasis on the commercially available devices used in clinical settings.     

Comparison of the human electro-oculographic response to green and near-ultraviolet stimuli

We recorded the electro-oculogram from 27 normal subjects by means of green and near-ultraviolet (UVA) stimulation. After a 40-minute dark-adaptation period, baseline responses were recorded. In response to the green stimulus, the electro-oculogram increased from this level by an average (± standard error of the mean) of 49.5% ±4.0%. Although the predicted scotopic effectiveness of the ultraviolet stimulus was more than 3 log units below that of the green stimulus, the near-ultraviolet-induced electro-oculogram increased to an average of 21.9% ±3.0% above baseline. This response cannot be due to lens fluorescence to the near-ultraviolet stimulus, since two aphakic subjects had electro-oculographic responses of 32% and 76% above baseline to near-ultraviolet stimuli. Neither the green nor the ultraviolet electro-oculogram changed significantly with age. These large responses to near-ultraviolet stimulation demonstrate the need for standardizing light sources for electro-oculographic testing because the degree of near-ultraviolet irradiance varies considerably according to their design characteristics.     

Isolated Intracardiac Echogenic Focus on Routine Ultrasound: Implications for Practice

Ultrasound is widely used as a screening tool for fetal anomalies. An intracardiac echogenic focus (ICEF) is associated with fetal aneuploidy, particularly trisomy 21, when found with other minor abnormalities known as soft markers. However, when found in isolation, intracardiac echogenic foci are morphologic variations with little or no pathologic significance for the fetus. Ambiguity about the significance of ICEF and other soft markers and the lack of preparation prior to ultrasound can result in unnecessary worry for women and their partners. A variety of tools exist that providers can use to help pregnant women and their partners make informed decisions about ultrasound and fetal screening.     

Physiology and pathobiology of the microcirculation

The delivery of nutrients to the tissues and the removal of waste products from the tissues is made possible by forcing a stream of blood through an arborizing network of microscopic blood vessels that comprise the microcirculation. The rapidity of the flow stream and, therefore, the rate of nutrient delivery to the tissue, is regulated by the automatic adjustment of the caliber of the precapillary arterioles that serve as the primary loci of vascular resistance. Exchange between the blood stream and the parenchymal cells occurs in capillaries and pericytic venules. Pathologic processes such as inflammation, diabetes, ischemia, and hypertension are characterized by abnormalities in microvascular structure and function.