Posterior persistent hyperplastic primary vitreous.
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Arteries↗
Biomedical subjects
D M Cockburn
Publications and source records attributed to D M Cockburn.
Clinical significance of hemorrhages in the optic disc.
A consecutive series of 8029 first visit optometric examinations revealed 20 patients having hemorrhages of the optic disc. Assessment of optic disc contour, intraocular pressure (IOP), and visual fields was undertaken at detection of the hemorrhage and at follow-up not less than 3 months later. The disc hemorrhage patients were assessed for the presence of systemic occlusive disease. The sensitivity of disc hemorrhage as a sign of glaucoma was 0.3 in the sample. There was some risk of visual field loss after detection of a hemorrhage in eyes having glaucoma (1 of 6 eyes); a similar risk was observed in non-glaucomatous eyes in which bleeding occurred (4 of 14 eyes). Hemorrhages occurred in 8 eyes that remained clinically normal during the course of follow-up. Notching of the neural rim of the disc was common but overall changes in contour of the disc were observed in only one patient. An association between disc hemorrhage and systemic disease could not be established.
Adult↗
Are vitreous asteroid bodies associated with diabetes mellitus?
Twenty-seven subjects having vitreous asteroid bodies were matched for age and sex with control subjects. The results of random blood glucose analysis and 2-hr glucose tolerance tests were used to determine the presence of diabetes mellitus or impaired glucose tolerance. Five of the subjects having asteroid bodies were diabetic and four had impaired glucose tolerance. In the control group there were no diabetics; however, three subjects had impaired glucose tolerance. These results confirm that a relation exists between the occurrence of vitreous asteroid bodies and diabetes mellitus (p = 0.036). There was no statistically significant difference between random blood glucose levels of the two cohorts. Four of the five diabetics were excluded from the 2-hr glucose tolerance tests; however, for the remainder of the asteroid body group, there was no significant difference in the results of this test compared with the control group. These results suggest that the relation between asteroid bodies and diabetes may not be dependent on blood glucose levels. Diabetics having asteroid bodies may form a special subgroup of the disease in which there is accelerated degeneration and mineralization of collagen associated with increased intraocular vascular permeability.
Aged↗
Glaucoma enigma.
This paper addresses the complex questions of the definition of primary open-angle glaucoma, its pathological changes, the sites at which these changes could operate, and the temporal order in which they might occur. A vascular model is proposed that could satisfy the several clinical forms of presentation of open-angle glaucoma. Questions are raised concerning areas deserving of research that will help solve the existing enigma of glaucoma.
Axonal Transport↗
Reversible glaucomatous cupping of the disc.
A nine-year-old girl under medical treatment for uveitis was brought for optometrical examination. In addition to a low grade anterior uveitis she was found to have high intraocular pressures, a reduced light sense, pulsation of the arteries on the disc and extensive optic disc cupping. The most probable diagnosis was juvenile rheumatoid arthritis. Photographs show reversal of the cupping over a four-month period during which intraocular pressures were brought into the normal range. Optometrists are cautioned that they should assess not only the progress of treatment of an established eye disease but should also review the entire ocular status of patients coming under their care.
Arthritis, Juvenile↗
Does reduction of intraocular pressure (IOP) prevent visual field loss in glaucoma?
The visual fields of 54 eyes (27 patients) having a medical diagnosis of open-angle glaucoma and receiving treatment were compared with the visual fields recorded at the time of diagnosis of the disease. Visual fields remained stable in 34 (62%) of the glaucomatous eyes. However, reduction of the intraocular pressure (IOP) did not prevent the progression of existing field defects in 16 of 21 eyes nor prevent field damage from occurring in 4 of 33 eyes which had normal visual fields at the commencement of treatment. The presence of a visual field defect at the time of diagnosis was clearly associated with a high risk of continued field decay during treatment. Intraocular pressure at the time of diagnosis did not identify which eyes would develop visual field loss or suffer further loss despite hypotensive treatment. Likewise, the extent to which the IOP was reduced by treatment did not appear to be related to the decay of visual field.
Adult↗
Signs and symptoms of stroke and impending stroke in a series of optometric patients.
A sample of 1000 consecutively attending patients aged 50 years or more yielded 126 (12.6%) subjects having completed stroke or presenting with signs or symptoms indicating risk of stroke. The findings included 82 patients who had experienced transient ischemic attacks, 61 with cervical bruit, 24 with retinal signs of vascular insufficiency, and 26 who had suffered a completed stroke. The high incidence of stroke and the common occurrence of prodromal signs and symptoms of impending stroke justifies the inclusion of cervical auscultation and an extended history taking in the optometric examination. It is suggested that these procedures should be carried out on diabetic or hypertensive patients and all patients aged 50 years or older. Patients identified as being at risk of stroke should be referred for medical management.
Aged↗
The prevalence of ocular hypertension in patients of an optometrist and the incidence of glaucoma occurring during long-term follow-up of ocular hypertensives.
Ocular hypertension was found in 54 (5.4%) of 1000 consecutive patients of an optometrist. In a separate trial, 50 ocular hypertensive subjects were followed for a mean follow-up time of 6.9 years. Five of the ocular hypertensive subjects (10%) developed primary open angle glaucoma and 2 (4%) developed primary angle-closure glaucoma. No single test could have enabled diagnosis in all five cases that developed open-angle glaucoma. Guidelines are recommended for the optometric management of patients having ocular hypertension.
Female↗
Tilted disc and medullated nerve fibres.
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Humans↗
Slitlamp estimate of anterior chamber depth as a predictor of the gonioscopic visibility of the angle structures.
A method is described which allows prediction of the anterior angle landmarks that are likely to be visible by gonioscopy from a slitlamp assessment of anterior chamber width at the limbus. This prediction can assist the recognition of gonioscopic features when the angle presents difficulties of identification and can also help clinicians who are learning the technique of gonioscopy. It may be used as a screening procedure to select those eyes in which the angle is sufficiently narrowed that gonioscopic examination should be performed. It was found that slitlamp estimates of 0.2 corneal units or less indicate a narrowing of the angle sufficient to warrant gonioscopic assessment and that estimates of 0.3 units should be considered to be the threshold of risk of angle closure.
Anterior Chamber↗
Prevalence and significance of narrow anterior chamber angles in optometric practice.
Assessment of anterior chamber width made according to the visibility of the angle structures during gonioscopic examination was carried out on 300 consecutively attending optometric patients. The assessments were made in the superior quadrant of the chamber angle of the left eyes. The sample yielded 6.0% of eyes in which some or all the trabeculae were obscured and 2.0% in which only the anterior half of the trabeculae was visible. The clinical import of these findings is discussed.
Adolescent↗
Indications for gonioscopy and assessment of gonioscopic signs in optometric practice.
The indications for optometrists to carry out gonioscopic examination are proposed and their significance is discussed. Gonioscopic examination is directed toward recognition of angle closure, or risk of closure, as well as neovascularization, neoplastic activity, inflammation, the results of injury, or degenerative changes at the angle. A schema sets out the decision-making processes which may be used to assist interpretation of gonioscopic signs and their correlation with other clinical data.
Anterior Chamber↗
A new method for gonioscopic grading of the anterior chamber angle.
A method of gonioscopic grading of the anterior chamber angle is reported in which a linear scale is based on a unit that is the apparent combined width of the trabeculae and scleral spur. The scale indicates what proportion of the structures of the angle is gonioscopically visible. A within-observer trial of reliability indicates that the degree of precision inherent in the method is justified.
Anterior Chamber↗
A decision-making schema for the detection of glaucoma.
A schema is proposed for management of optometrical patients who may have glaucoma or any of 22 risk factors of glaucoma. The assessment system has established decision points and management pathways based on risk factors in glaucoma which employ only clinical procedures appropriate to current optometrical practice. This schema is particularly designed to permit diagnosis of early angle-closure glaucoma while the disease is in the symptomless phase, prior to chronic elevation of intraocular pressure and the development of damage to the optic disc and visual fields. A recommendation is made for inclusion of the Van Herick test as routine and in the assessment of patients entering the schema. Gonioscopy should form part of the diagnostic workup, but an alternative pathway is established for use when this technique is omitted.
Adult↗
A foot-operated camera trip for the Nikon photo slit lamp.
A simple foot-operated shutter cable frees both hands for holding the gonioscope lens and adjusting the Nikon slit lamp during photography of the recess of the anterior-chamber angle.
Anterior Chamber↗
Anterior-chamber damage as a result of mild ocular trauma.
Relatively mild ocular trauma may cause lesions within the anterior chamber which are easily overlooked. The frequent onset of secondary glaucoma after such injuries emphasizes the importance of carefully evaluating the anterior chamber for the presence of hyphema, iridodialysis, and anterior-chamber recession. A case is reported in which relatively mild trauma caused iridodialysis, anterior-chamber recession, and tearing of the iris stroma and pupillary margin.
Anterior Chamber↗
Spontaneous internal jugular vein thrombosis and venous-stasis retinopathy.
A case is presented in-which the detection of venous-stasis retinopathy in one eye led to investigation of the carotid circulation. There were no neurologic symptoms of carotid insufficiency, and noninvasive tests failed to reveal significant carotid pathology. Digital subtraction angiography and carotid angiography demonstrated a carotid plaque of doubtful significance. At carotid endarterectomy, the venous-stasis retinopathy was found to be associated with venous thrombosis distant from the eye and in the internal jugular vein. This site is beyond the range over which isolated ocular vascular effects would be expected and was thought to be unrelated to the hemodynamically insignificant, nonulcerated carotid artery plaque. The possibility of this association being causal is discussed.
Aged↗