[Farsightedness; diagnosis by the family physician].
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Biomedical subjects
Publications and source records attributed to B C Polak.
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High plasma levels of von Willebrand factor, an indicator of endothelial cell dysfunction, have been reported in both diabetic retinopathy and nephropathy. It is unclear, however, whether von Willebrand factor is related to diabetic retinopathy in the absence of diabetic nephropathy. The relationship between retinal status and plasma von Willebrand factor concentration was investigated in a cohort of 17 patients with Type 1 (insulin-dependent) diabetes mellitus who were followed-up for a median of 42 months. The patients were examined three times. They were selected for having had normal urinary albumin excretion and no evidence of retinopathy (on fundoscopy) at the first and second examination. They were then divided into two groups, according to absence (Group A; n = 9) or presence (Group B; n = 8) of retinopathy on fundoscopy or fluorescein angiography at the third examination. Urinary albumin excretion remained normal in all patients. Plasma von Willebrand factor levels were similar in both groups: (median) 128 vs 123%, 164 vs 132% and 159 vs 130% (first, second and third examination, respectively). Median changes in plasma von Willebrand factor were also similar: +7 vs +9% and +5 vs +1% (first-second and second-third examination). Patients in whom the plasma von Willebrand factor concentration increased had higher systolic blood pressure at the third examination (150 +/- 30 vs 130 +/- 12 mmHg, p = 0.02) when compared to those in whom plasma von Willebrand factor did not increase, but were of similar age and had similar diabetes duration, retinal status, diastolic blood pressure, glycated haemoglobin and serum cholesterol concentration.(ABSTRACT TRUNCATED AT 250 WORDS)
Decreased humoral defense mechanisms may be involved in the occurrence of keratic ulcerations after contact lens wear. To investigate the effect of contact lens wear on tear protein composition a prospective study was performed whereby tears were collected with Schirmer papers from 42 healthy individuals, before and at varying times after contact lens wear. Tear proteins were quantitated using HPLC analysis. Analysis of tear fluid by HPLC is a rapid and simple technique to detect the major tear proteins. Four separate peaks containing respectively IgA, lactoferrin, TSPA and lysozyme can easily be identified. The results show that the mean relative level of secretory IgA in the collected tear samples decreased significantly after the first months of contact lens wear but was not significantly altered after one year. The decrease in IgA was accompanied by a significant increase in the relative amount of lysozyme, whereas the levels of lactoferrin and TSPA remained the same. Certain individuals showed a marked decrease in their tear secretory IgA levels after wearing the lenses for more than one year. Future studies will clarify whether such individuals are at higher risk to develop corneal complications.
In 32 patients with long-term contact lens wear (up to 19 years), deep whitish opacities directly adjacent to Descemet's membrane were seen in the central part of the cornea. These opacities were seen in soft hydroxyethylmethacrylate (HEMA) as well as in hard (polymethylmethacrylate, PMMA) contact lens wear. These conditions could reduce visual acuity. When contact lens wear was discontinued or when the HEMA or PMMA lenses were replaced by gas-permeable rigid lenses, the lesions gradually diminished and resolved completely in most patients. One possible cause of these opacities is an allergic reaction to thimerosal. Another possible cause is chronic anoxia of the corneal stroma and endothelium. Endothelial cell density was not abnormal, but there was a marked polymegethism of the endothelium as a sign of endothelial stress.
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The number of contact lenses worn has increased steadily in the last decades. The number and types of complications have increased in approximately the same degree. New, hitherto unknown, complications are continually described. The complications are classified according to the factors which cause them: complications of mechanical origin; complications due to metabolic disorders; allergic reactions; exogenous infections; disorders of tear production. The lesions found in the cornea and the conjunctiva are described. The complications caused by hard lenses are usually noticed earlier by the patient than those due to soft lenses, because the lesions caused by hard lenses are usually painful, whereas those due to soft lenses are not.