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Biomedical subjects

S L Fine

Publications and source records attributed to S L Fine.

At least 73 records · Page 4Linked to original sources
PubMed1988

Assessment of visual function in patients with age-related macular degeneration and low visual acuity.

The visual function of 100 eyes with low visual acuity of 100 patients with age-related macular degeneration was examined using measurements of visual acuity, peak contrast sensitivity, and the ability to read, to tell time, and to distinguish colors, products, and facial expressions. Visual acuity and peak contrast sensitivity were correlated (r = .62); however, a range of peak contrast sensitivities was observed at each level of acuity. When considered individually, visual acuity and peak contrast sensitivity were related to the ability to perform each of the tasks. When multivariate methods were applied, both visual acuity and peak contrast sensitivity contributed independently to the ability to read and tell time. Among patients with the same contrast sensitivity, visual acuity had little or no relationship to the ability to identify colors, products, and faces.

Aged↗
PubMed1988

Enucleation versus plaque irradiation for choroidal melanoma.

The Collaborative Ocular Melanoma Study (COMS) is an international, multicenter-controlled study. The organization includes an Executive Committee, Steering Committee, 6 Central Units, 32 Clinical Centers, and a Data and Safety Monitoring Committee. Scientifically, the COMS consists of (1) a randomized trial of patients with medium choroidal melanoma treated with enucleation versus iodine-125 plaque irradiation, (2) a randomized trial of patients with large choroidal melanoma treated with enucleation versus preenucleation external beam irradiation and enucleation, and (3) a prospective observational study of patients with small choroidal melanoma to determine whether a randomized trial of treatment is appropriate. In design and conduct of the COMS, special consideration is given to biostatistics and sample size considerations, iodine-125 plaque irradiation of choroidal melanoma, and coordinated ocular melanoma research. Recruitment is in progress. However, the pool of eligible patients is limited and the COMS needs the continued support and cooperation of ophthalmologists throughout the United States and Canada.

Brachytherapy↗
PubMed1988

Subfoveal neovascularization in the ocular histoplasmosis syndrome. A natural history study.

The visual outcome of 74 eyes with the ocular histoplasmosis syndrome and active subfoveal subretinal neovascular membranes was studied retrospectively. Follow-up time ranged from 12 to 109 months (median, 36.5 months). Ten eyes (14%) retained visual acuity of 20/40 or better. Fifty-seven eyes (77%) suffered visual loss of 20/100 or worse and 36 eyes (49%) suffered visual loss of 20/400 or worse. Factors significantly associated with retaining vision of 20/40 or better were: age less than 30 years (P = 0.008); smaller membrane size (P = 0.0002); and absence of visual loss secondary to ocular histoplasmosis in the fellow eye (P = 0.053). Factors significantly associated with vision decreasing by four or more lines were: older patient age (P = 0.006); better initial visual acuity (P = 0.090); and more than 50% involvement of the foveal avascular zone (P = 0.059). These results were confirmed by multiple logistic regression. Final vision of 20/40 or better was associated with better initial visual acuity using univariate analysis, but this result was not confirmed by multiple logistic regression.

Adult↗
PubMed1988

Linkage studies of Best's macular dystrophy.

Genetic linkage studies are presented for nine kindreds with Best's vitelliform macular dystrophy (BVMD). This condition is an autosomal dominant macular dystrophy with reduced penetrance and highly variable expressivity. Asymptomatic carriers were identified with electro-oculography, fundus photographs and fluorescein angiography. Blood and saliva specimens were obtained from informative family members and genotyped for 26 polymorphic genetic traits. No firm evidence was found for linkage between BVMD and 18 informative markers; the highest positive lod score was z = 0.57 for GPT1 at a recombination fraction of theta = 0.30. An atypical form of vitelliform macular dystrophy (VMD-1) is linked to GPT1 (theta less than 0.05) and is provisionally assigned to chromosome 16pter-p11. Our data are not sufficient to rule out loose linkage for GPT1 and BVMD. Thus we were not able to determine whether BVMD and VMD-1 are allelic mutations or separate genetic disorders. Additional linkage and gene mapping studies of these loci and BVMD (as well as other atypical forms of macular dystrophy) would be useful to further delineate these disorders.

Gene Expression Regulation↗
PubMed1988

Anterior segment ischaemia following laser photocoagulation in a patient with systemic lupus erythematosus.

The authors report the occurrence of occlusive retinal arterial disease and retinal neovascularisation in a 44-year-old woman with systemic lupus erythematosus (SLE). Two days after uncomplicated panretinal photocoagulation the patient developed an acute anterior segment ischaemic syndrome. To our knowledge this complication has not been reported in any other patient following laser photocoagulation or in association with SLE.

Adult↗
PubMed1987

Ten years after the Diabetic Retinopathy Study.

The Diabetic Retinopathy Study (DRS) demonstrated that prompt argon laser photocoagulation, in comparison to indefinite delay in treatment, could reduce by more than 50% the risk of severe visual loss from proliferative diabetic retinopathy. The DRS also enlightened two generations of ophthalmologists about the value of the randomized controlled clinical trial as a way of assessing new and existing treatments for unsolved therapeutic problems. After the example of the DRS, laser treatment was shown to be effective in reducing vision loss in selected patients with branch retinal vein occlusion, age-related macular degeneration, ocular histoplasmosis, and diabetic macular edema. Existing trials, supported by the National Eye Institute, are seeking to determine the appropriate treatment for selected patients with newly diagnosed glaucoma, vascularized corneas, retinopathy of prematurity, proliferative vitreoretinopathy and complicated retinal detachment, and choroidal melanoma. Clinical practice has benefited enormously from these studies all of which owe their existence, at least in part, to the prototypical clinical trial, the DRS. This symposium discusses the DRS and places it in today's perspective, with a look to the past as well.

Clinical Trials as Topic↗
PubMed1987

Skin necrosis following fluorescein extravasation. A survey of the Macula Society.

Three patients developed cellulitis and skin necrosis following fluorescein dye extravasation. This experience prompted a survey of the Macula Society membership to determine whether this complication of fluorescein angiography is as rare as the paucity of cases in the literature suggests. In addition, the manufacturer was asked to reexamine the dye lot to determine whether an impurity had been introduced unintentionally during the manufacturing process. No impurity was found in the dye lots tested. The survey disclosed only nine additional cases of skin necrosis, leading to the conclusion that skin necrosis probably represents a rare, idiosyncratic reaction. Although fluorescein angiography remains a safe procedure, efforts should be directed toward prevention of dye extravasation. When extravasation does occur, prompt and proper medical attention with close follow-up study may minimize the likelihood of skin necrosis.

Aged↗
PubMed1986

Parafoveal telangiectasis and diabetic retinopathy.

Five patients with mild nonproliferative diabetic retinopathy had visual loss associated with parafoveal telangiectasis. Minimal macular edema with characteristic parafoveal plaques of subretinal pigment epithelial hyperplasia was seen in all patients. Fluorescein angiography revealed the presence of ectatic, dilated, leaking perifoveal capillaries. The occurrence of parafoveal telangiectasis in patients with diabetic retinopathy has, to our knowledge, not been previously described. One previous clinicopathologic report described the histologic appearance of parafoveal telangiectasis in a nondiabetic patient to be similar to that seen in diabetic patients. The association of parafoveal telangiectasis and diabetic retinopathy raises interesting speculations into the pathogenesis of the entity of parafoveal telangiectasis. In addition, the importance of obtaining fluorescein angiography prior to therapy of diabetic macular edema is emphasized.

Aged↗
PubMed1986

Earliest symptoms caused by neovascular membranes in the macula.

One hundred three patients with neovascular maculopathy and relatively recent vision loss were surveyed to determine the most frequent symptoms and to assess the reliability of the Amsler grid in helping patients to detect early symptoms. Blurred vision and distortion, most often with near vision, were the most frequent first symptoms reported by patients. Of 49 patients who said that they were observing the Amsler grid on a regular basis, only five indicated that the Amsler grid abnormality was the first visual symptom. However, all but five of 49 patients did notice an Amsler grid abnormality during the office examination, suggesting noncompliance as the probable explanation for failure to detect an Amsler grid abnormality earlier. Patients at risk for neovascular maculopathy should be encouraged to assess a variety of visual functions--including reading vision, color saturation, and image clarity--in addition to observing the Amsler grid, in order to help them detect the earliest symptoms of submacular fluid from a potentially treatable neovascular membrane.

Choroid↗
PubMed1986

Severe retinal vaso-occlusive disease in systemic lupus erythematous.

Retinopathy in systemic lupus erythematosus generally consists of cotton-wool spots with or without intraretinal hemorrhages. Although rare, a more severe retinal vaso-occlusive disease, termed retinal vasculitis, has been described. We report data from 11 patients with SLE and severe retinal vaso-occlusive disease. Visual outcome was often poor, with 55% of the involved eyes suffering visual loss, frequently to an acuity of worse than 20/200. The systemic feature significantly associated with severe retinal vascular disease was central nervous system involvement (CNS lupus), present in eight (73%) of the 11 patients vs an overall prevalence of 37%. The association of CNS lupus with severe retinal vaso-occlusive disease probably reflects a similar pathogenetic mechanism and microangiopathy.

Adult↗
PubMed1986

Subfoveal choroidal neovascular membranes in age-related macular degeneration. Visual prognosis in eyes with relatively good initial visual acuity.

We determined the visual prognosis of 94 eyes in 92 patients having age-related macular degeneration, a discrete choroidal neovascular membrane directly under the center of the foveal avascular zone (subfoveal), and an initial visual acuity of 20/100 or better. Of the patients who were reexamined 24 months following their initial presentation, 77% had lost at least four lines of vision and 64% had lost at least six lines. Estimation of visual loss using a conservative assessment procedure showed four-line visual loss in 65% of the patients and six-line loss in 50%. In general, the better the visual acuity at the initial examination, the more likely the patient was to have a smaller choroidal neovascular membrane. These results suggest that it may be reasonable to consider a randomized clinical trial of laser photocoagulation for this group of patients with a relatively poor visual prognosis.

Age Factors↗
PubMed1986

Functional vision in patients with neovascular maculopathy and poor visual acuity.

Central visual function is characteristically reported as Snellen acuity at distance and near. We performed functional tests in a group of patients with visual acuity of 20/100 or worse due to macular disease to determine whether there was a relationship between Snellen acuity and functional performance among these patients with poor visual acuity. Our tests of functional performance included currency discrimination, color recognition, reading a clock, and reading large print. Our results suggest that there is a correlation between Snellen acuity and functional vision, even among patients with poor visual acuity. Hence, therapeutic efforts to keep patients' visual acuity at 20/200 rather than 20/400, for example, appears to be justifiable in that better acuity levels seem to be associated with improved functional performance.

Aging↗
PubMed1986

Cell proliferation after laser photocoagulation in primate retina. An autoradiographic study.

Argon blue-green laser and krypton red laser (KRL) photocoagulation were applied to primate retinas at intervals ranging from two to 23 days before the animals were killed. An injection of tritiated thymidine was given intravitreally three days before death. Argon blue-green laser photocoagulation induced cell proliferation in the retina and retinal pigment epithelium seven days after treatment, with quiescence at 23 days. Krypton red laser photocoagulation induced similar cell proliferation not only in the retina and retinal pigment epithelium but also around choroidal vessels and in the stroma of the choroid. Peak thymidine uptake occurred seven days after KRL treatment. There was less uptake at two and 11 days and no uptake at 23 days. Thymidine uptake in the retina and choroid also was detected with low levels of KRL treatment. True cell hyperplasia (cell division) occurred after laser treatment; only KRL treatment induced cellular reaction in the choroid.

Animals↗
PubMed1986

Massive hemorrhage complicating age-related macular degeneration. Clinicopathologic correlation and role of anticoagulants.

Reported are 15 cases of age-related macular degeneration (AMD) complicated by massive subretinal and/or vitreous hemorrhage. Clinicopathologic correlation is presented in four of the seven cases studied histopathologically. Salient histologic findings include: subretinal and subretinal pigment epithelium (sub-RPE) fibrovascular scar in the posterior pole; discontinuities in Bruch's membrane with choroidal neovascularization; extensive hemorrhagic detachment of the RPE and sensory retina; and vitreous hemorrhage. In three cases, a choroidal artery, emerging from breaks in Bruch's membrane, had ruptured walls. The authors have reviewed the previously reported cases of AMD complicated by massive hemorrhage and found that 19% of the patients were taking Coumadin (warfarin) or aspirin treatment when the bleeding occurred. Forty percent had a positive history of systemic hypertension and cardiovascular diseases. Although the occurrence of hypertension is expected in the aged population with AMD, use of anticoagulants or antithrombotics by such patients may predispose them to serious ocular hemorrhagic complications.

Aged↗
PubMed1986

The role of fluorescein angiography in national collaborative studies.

Over the past 20 years, fluorescein angiography has demonstrated its value in the diagnosis and management of most diseases of the retinal vessels and choroidal vessels, including diabetic retinopathy, aging macular degeneration, and venous occlusive disorders. Fluorescein angiography has become so important for diagnostic purposes and for laser management that it has become a standard technique in the authors' most carefully performed clinical research studies such as randomized clinical trials. These clinical trials demand fluorescein angiography not only for diagnosis and eligibility of patients, but also to document the adequacy of laser photocoagulation. The use of fluorescein angiography has encouraged the development of newer photographic techniques and has encouraged a commendable level of expertise among photographers. Experience with fluorescein angiography in clinical trials has led to the development of general guidelines for the use of angiography for the management of patients outside the confines of a clinical trial; we emphasize the importance of recent angiography as a general guideline for all patients with macular edema or choroidal neovascularization before consideration of laser photocoagulation.

Aspirin↗
PubMed1986

The natural history of serous retinal pigment epithelium detachment in patients with age-related macular degeneration.

One hundred ten patients with serous detachment of the retinal pigment epithelium (RPE) were reexamined to enhance our knowledge of the natural course of this condition. All patients were greater than 50 years of age, had age-related macular degeneration, and had neither blood, lipid, nor angiographic evidence of a definite choroidal neovascular membrane (NVM) at the time of the initial examination. All patients were followed up for at least six months except for two patients who had developed a choroidal NVM within the first six months of the initial exam. Forty-five of 140 eyes (32%) developed a choroidal NVM within an average of 19.6 months (median, 12 months). This was associated with a final visual acuity of 20/200 or worse (P less than 0.0001). Ophthalmoscopic and angiographic features present at the initial visit which were associated with the development of NVM and poor final visual acuity were: sensory retinal detachment; increased size of PED; hot spot; late filling; notching; and irregular filling. At the most recent examination, 39% of the eyes had a final visual acuity of 20/20 to 20/40, while 24% of the eyes had a final visual acuity of less than or equal to 20/200.

Aged↗