PRELIMINARY

The primary functions of the ocular lens are to transmit incident light and to focus it on the retina. This requires that the lens be transparent, a condition dependent on the highly regular organization of the cells of the lens and the high degree of short-range order of the proteins in the lens cytoplasm. Protein concentration in lens fiber cells is extremely high, resulting in an index of refraction significantly greater than that of the surrounding fluids and enabling the lens to refract incident light. Cataract occurs when the lens loses its transparency by either scattering or absorbing light such that visual acuity is compromised. Cataracts can result from genetic, metabolic, nutritional, or environmental insults or may be secondary to other ocular or systemic diseases, such as diabetes or retinal degenerative diseases. By far the most important risk factor is age; aging-related cataract constitutes the great majority of all cataracts. This type of cataract is a major public health problem in the United States. In developing countries like Indonesia, where the availability of surgical facilities is limited, aging-related cataract is the leading cause of blindness. Because at present there is no efficacious nonsurgical therapy for cataract, the problem is expected to increase in magnitude as the world population becomes progressively older in coming decades. This is unfortunate, considering that the visual morbidity brought about by age-related cataract is reversible. As such, early detection, close monitoring, and timely surgical intervention must be observed in the management of senile cataracts. The succeeding section is a general overview of senile cataract and its management.

LENS STRUCTURE AND FUNCTION The lens is an asymmetric structure bounded on the anterior surface by a single layer of epithelial cells and on the posterior surface by fiber cells (Fig. 1). This apparent asymmetry initiated a number of double-chamber experiments that appeared to show a translens (posterior to anterior) flux of sodium ions correlated with a translens short circuit current.11,12 Studies such as these have given rise to the pump-leak model of lens transport. However, more recent studies performed using a vibrating probe to measure radiating currents13,14 have shown asymmetries that are more marked between the equator and the two poles than there

are between the two poles themselves, and this has given rise to the internal flow model for the lens.5 Fig. 1. Cross-sectional

view of the mammalian lens. The lens is an

morphologically

asymmetric structure with a single layer of epithelial cells at the anterior

surface. The anterior cells in Section A, although coupled to each other, do not appear to be well coupled to the fibers beneath nor does there appear to be many junctional complexes between fiber cells in this region. Cells in the equatorial section (E) do appear to be well coupled at the fiber-fiber and fiber-epithelium interface. Functionally, therefore, the lens appears to behave as two symmetric structures superimposed. The anterior (leaky) epithelium represents one system and the fiber cells represent the other. This model accounts for the radial distribution of currents around the lens and also explains why only a small asymmetry voltage is observed in double-chamber experiments. The posterior surface (P) has no epithelial cells, and the differentiated fibers in the inner cortex (IC) and nucleus (N) have lost their organelles. See text for further details. There is little doubt that the membranes of the anterior epithelial cells have a very different array of channels and pumps than the fiber cell membranes. This fact, allied to an asymmetric distribution of internal gap junctions that seem to favor an internal flow of current toward the equator rather than from posterior to anterior, makes the two models difficult to reconcile.5 However, if an amalgam of the two asymmetry models is considered, then it is possible to merge the two separate ideas into one working hypothesis. The model is presented here and the evidence scrutinized later. It is suggested that the lens consists of two symmetric and superimposed structures that are only intimately connected at the equator. In this model (see Fig. 1), the anterior epithelium and dynamic bow cells represent one system and the mature fiber cells another. The cells within each system are known to be in good electrical communication with other cells within the same system,15,16 but it is likely that good communication between the systems exists only

at the bow region.17 If we also assume that the resting potential of the epithelial cells, on average, is higher than the mature fiber cell membrane potential (again on average), then current flows in at the fiber cell membranes and out through the epithelial cells. If the anterior epithelial layer is assumed to act as a leaky epithelium with little potential difference between the apical and basal surfaces, then the only net current that is observed is inward at the poles and outward at the equator. Furthermore, when the anterior and posterior surfaces are isolated, then the anterior epithelium lies in series with the rest of the lens and a small voltage difference (the net transepithelial voltage) wouldbe expected to be observed. In fact, using an oil to isolate the two surfaces of the bovine lens in a nondisruptive manner, Duncan and colleagues18 observed a maximum potential difference of + 6.5 mV (anterior positive). It should be noted that if the anterior epithelial cells were well-connected to the whole mass of underlying fibers, then a much greater asymmetry in polar currents would be expected than that actually observed as the high voltage of the anterior face membranes would give a strong outward current across the whole of the anterior surface.

Figure 1. Schematic picture shows the different stages of pterygia. Stage 1: The head of pterygia did not reach the midline between the limbus and pupillary margin. Stage 2: The head of pterygia passed the midline but did not reach the pupil. Stage 3: The head of pterygia passed the pupillary margin.