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At least 217 records · Page 12Linked to original sources
PubMed2000

Refractive Error Study in Children: results from Mechi Zone, Nepal.

PURPOSE: To assess the prevalence of refractive error and vision impairment in school age children in the terai area of the Mechi zone in Eastern Nepal. METHODS: Random selection of village-based clusters was used to identify a sample of children 5 to 15 years of age. Children in the 25 selected clusters were enumerated through a door-to-door household survey and invited to village sites for examination. Visual acuity measurements, cycloplegic retinoscopy, cycloplegic autorefraction, ocular motility evaluation, and anterior segment, media, and fundus examinations were done from May 1998 through July 1998. Independent replicate examinations for quality assurance monitoring took place in all children with reduced vision and in a sample of those with normal vision in seven villages. RESULTS: A total of 5,526 children from 3,724 households were enumerated, and 5,067 children (91.7%) were examined. The prevalence of uncorrected, presenting, and best visual acuity 0.5 (20/40) or worse in at least one eye was 2.9%, 2.8%, and 1.4%, respectively; 0.4% had best visual acuity 0.5 or worse in both eyes. Refractive error was the cause in 56% of the 200 eyes with reduced uncorrected vision, amblyopia in 9%, other causes in 19%, with unexplained causes in the remaining 16%. Myopia -0.5 diopter or less in either eye or hyperopia 2 diopters or greater was observed in less than 3% of children. Hyperopia risk was associated with female gender and myopia risk with older age. CONCLUSIONS: The prevalence of reduced vision is very low in school-age children in Nepal, most of it because of correctable refractive error. Further studies are needed to determine whether the prevalence of myopia will be higher for more recent birth cohorts.

Adolescent↗
PubMed2000

Refractive Error Study in Children: results from La Florida, Chile.

PURPOSE: To assess the prevalence of refractive errors and vision impairment in school-age children in a suburban area (La Florida) of Santiago, Chile. METHODS: Random selection of geographically defined clusters was used to identify a representative sample of children 5 to 15 years of age. Children in the 26 selected clusters were enumerated through a door-to-door survey and invited to report to a community health clinic for examination. Visual acuity measurements, cycloplegic retinoscopy, cycloplegic autorefraction, ocular motility evaluation, and examination of the external eye, anterior segment, media, and fundus were done from April through August 1998. Independent replicate examinations of all children with reduced vision and a sample of those with normal vision were done for quality assurance monitoring in six clusters. RESULTS: A total of 6,998 children from 3,830 households were enumerated, and 5,303 children (75.8%) were examined. The prevalence of uncorrected, presenting, and best visual acuity 0.50 (20/40) or worse in at least one eye was 15.8%, 14.7%, and 7.4%, respectively; 3.3% had best visual acuity 0.50 or worse in both eyes. Refractive error was the cause in 56.3% of the 1,285 eyes with reduced vision, amblyopia in 6.5%, other causes in 4.3%, with unexplained causes in the remaining 32.9%. Myopia -0.50 diopter or less in either eye was present in 3.4% of 5-year-old children, increasing to 19.4% in males and 14.7% in females by age 15. Over this same age range, hyperopia 2.00 diopters or greater decreased from 22.7% to 7.1% in males and from 26.3% to 8.9% in females. Females had a significantly higher risk of hyperopia than males. CONCLUSIONS: Refractive error, associated primarily with myopia, is a major cause of reduced vision in school-age children in La Florida. More than 7% of children could benefit from the provision of proper spectacles. Efforts are needed to make existing programs that provide free spectacles for school children more effective. Further studies are needed to determine whether the upward trend in myopia continues far beyond 15 years of age.

Adolescent↗
PubMedDate not supplied

Management of traumatic hyphema.

Hyphema (blood in the anterior chamber) can occur after blunt or lacerating trauma, after intraocular surgery, spontaneously (e.g., in conditions such as rubeosis iridis, juvenile xanthogranuloma, iris melanoma, myotonic dystrophy, keratouveitis (e.g., herpes zoster), leukemia, hemophilia, von Willebrand disease, and in association with the use of substances that alter platelet or thrombin function (e.g., ethanol, aspirin, warfarin). The purpose of this review is to consider the management of hyphemas that occur after closed globe trauma. Complications of traumatic hyphema include increased intraocular pressure, peripheral anterior synechiae, optic atrophy, corneal bloodstaining, secondary hemorrhage, and accommodative impairment. The reported incidence of secondary anterior chamber hemorrhage, that is, rebleeding, in the setting of traumatic hyphema ranges from 0% to 38%. The risk of secondary hemorrhage may be higher in African-Americans than in whites. Secondary hemorrhage is generally thought to convey a worse visual prognosis, although the outcome may depend more directly on the size of the hyphema and the severity of associated ocular injuries. Some issues involved in managing a patient with hyphema are: use of various medications (e.g., cycloplegics, systemic or topical steroids, antifibrinolytic agents, analgesics, and antiglaucoma medications); the patient's activity level; use of a patch and shield; outpatient vs. inpatient management; and medical vs. surgical management. Special considerations obtain in managing children, patients with hemoglobin S, and patients with hemophilia. It is important to identify and treat associated ocular injuries, which often accompany traumatic hyphema. We consider each of these management issues and refer to the pertinent literature in formulating the following recommendations. We advise routine use of topical cycloplegics and corticosteroids, systemic antifibrinolytic agents or corticosteroids, and a rigid shield. We recommend activity restriction (quiet ambulation) and interdiction of non-steroidal anti-inflammatory agents. If there is no concern regarding compliance (with medication use or activity restrictions), follow-up, or increased risk for complications (e.g., history of sickle cell disease, hemophilia), outpatient management can be offered. Indications for surgical intervention include the presence of corneal blood staining or dangerously increased intraocular pressure despite maximum tolerated medical therapy, among others.

Adrenal Cortex Hormones↗
PubMed2002

Effects of longitudinal chromatic aberration on accommodation and emmetropization.

PURPOSE: Less accommodation was found when human subjects read in blue (peak at about 440 nm) than when they read in red light (above 600 nm; [Kroger & Binder, British Journal of Ophthalmology 84 (2000) 890]). On the other hand, emmetropization in chickens did not appear to compensate for the chromatic defocus (385 nm versus 665 nm; [Rohrer, Schaeffel & Zrenner, Journal of Physiology 449 (1992) 363]). The apparently contradictory result was studied in more detail in humans and chickens. METHODS: Accommodation was measured with an eccentric infrared photorefractor, the PowerRefractor, in human subjects reading under quasi-monochromatic illumination conditions. Chickens were refracted in quasi-monochromatic ambient illumination but with no particular fixation target. In a second experiment, they were also raised in monochromatic light for two days and subsequently refracted both in complete darkness, in monochromatic light, and in white light, both without and with cycloplegia. RESULTS: Consistent with the initial report by Kroger and Binder [British Journal of Ophthalmology 84 (2000) 890], accommodation in human subjects was found to shift in accordance with the chromatic aberration function. An immediate shift in accommodation tonus was also found in the chickens when they were refracted under red and in blue ambient illumination (average difference between refractions in both conditions: 1.26+/-0.54 D, p<0.001 paired t-test). This value is close to the chromatic focus difference between the two wavelengths (1.5 D [Mandelman & Sivak, Vision Research 23 (1983) 1555]). When chickens were raised in blue or red light for two days, and their refractions were subsequently measured in complete darkness, they showed also a difference in refractions (1.41+/-1.00 D; ANOVA: p<0.0012, post hoc t-test: at least p<0.05 among different groups). This difference was no longer significant when they were refracted in white light but became again significant when they were cyclopleged (0.57+/-0.58 D, p=0.039, unpaired t-test). The latter observation makes it unlikely that the difference resulted just from a shift in the resting tonus of accommodation. CONCLUSIONS: (1) Imposed chromatic defocus produces a shift in accommodation tonus in both humans and chickens which is, in the case of the chicken, followed by a shift in cycloplegic refractive state into the same direction, (2) the difference to the previous study by Rohrer, Schaeffel and Zrenner [Journal of Physiology 449 (1992) 363] can be explained from the fact that shorter wavelengths were used than in the present study, at which emmetropization was no longer functional and, (3) the small amplitude and the variability of the shifts in refraction do not allow clear statements about the role of the "lag of accommodation" in refractive development but they show that several cone types contribute to emmetropization.

Accommodation, Ocular↗
PubMed2001

Does cryotherapy affect refractive error? Results from treated versus control eyes in the cryotherapy for retinopathy of prematurity trial.

PURPOSE: To evaluate the effect of cryotherapy on refractive error status between ages 3 months and 10 years in children with birth weights of less than 1251 g in whom severe retinopathy of prematurity (ROP) developed in one or both eyes during the neonatal period. DESIGN: Randomized clinical trial. PARTICIPANTS: Two hundred ninety-one children in whom severe ROP developed during the neonatal period. INTERVENTION: Cryotherapy for ROP. MAIN OUTCOME MEASURES: Cycloplegic Refraction METHODS: The children underwent repeated follow-up eye examinations, including cycloplegic retinoscopy, between 3 months and 10 years after term due date. Refractive error data from all eyes that were randomized to cryotherapy were compared with data from all eyes that were randomized to serve as controls. Refractive error data were also compared for a subset of children who had both a treated and a control eye that could be refracted. RESULTS: At all ages, the proportion of treated eyes that were unable to be refracted because of retinal detachment, media opacity, or pupillary miosis was approximately half the proportion of the control eyes that were unable to be refracted. When data from all eyes that could be refracted were considered, the distribution of refractive errors between fewer than 8 diopters (D) of myopia and more than 8 D of hyperopia was similar for treated and control eyes at all ages. The proportion of eyes with 8 D or more of myopia was much higher in treated than in control eyes at all ages after 3 months. In the subset of children who had a treated eye and a control eye that could be refracted, distributions of refractive errors in treated versus control eyes were similar at most ages. CONCLUSIONS: In both treated and control eyes, there was an increase in the prevalence of high myopia between 3 and 12 months of age. Between 12 months and 10 years of age, there was little change in distribution of refractive error in treated or control eyes. The higher prevalence of myopia of 8 D or more in treated eyes, as compared with control eyes, may be the result of cryotherapy's preservation of retinal structure in eyes that, in the absence of cryotherapy, would have progressed to retinal detachment.

Astigmatism↗
PubMed2002

Risk factors for self-reported visual symptoms with Intacs inserts for myopia.

OBJECTIVE: Potential risk factors and visual performance measures were evaluated for relationship to self-report of clinical visual symptoms after the refractive procedure for placement of Intacs microthin prescription inserts for myopia. DESIGN: Retrospective nonrandomized comparative study. PARTICIPANTS/INTERVENTION: Patients were participants in the U.S. Food and Drug Administration phase III KeraVision prospective clinical trials. MAIN OUTCOME MEASURES: Study participants (n = 263) were retrospectively classified into one of three outcome groups on the basis of postoperative self-reported visual symptoms and/or request for Intacs inserts removal through month 24. Differences between outcome groups in visual acuity, refractive error, corneal geometry, corneal topography, type of preoperative corrective lens wear, and demographic variables were evaluated with multivariate logistic regression. RESULTS: Clinical trial participants who had preoperative mean keratometry >45 diopters (D) (adjusted odds ratio [OR], 0.43; 95% confidence interval [CI], 0.21, 0.85, P = 0.02), manifest refractive astigmatism of 0.75 D or 1.00 D (adjusted OR, 0.52; 95% CI, 0.25, 1.08, P = 0.08), measured uncorrected visual acuity > or =2 lines better than that predicted by their respective cycloplegic refractive error (adjusted OR, 0.39; 95% CI, 0.14, 1.12, P = 0.08) and/or had worn soft contact lenses (adjusted OR, 0.58; 95% CI, 0.32, 1.04, P = 0.07) tended to be less likely to report postoperative clinical visual symptoms with Intacs inserts. Risk of clinical visual symptoms and request for Intacs inserts removal approximately doubled for each 0.50 D of additional postoperative defocus equivalent (crude OR, 1.86; 95% CI, 1.39, 2.48, P = 0.00). Controlling for postoperative defocus and important preoperative risk factors, subjects who reported significant clinical visual symptoms were more likely to have had preoperative uncorrected visual acuity that was worse than that predicted by their respective cycloplegic refractive error (adjusted OR, 1.84; 95% CI, 0.98, 3.42, P = 0.06). Risk of reporting clinical visual symptoms was increased with mesopic pupil diameter > or =6.5 mm (adjusted OR, 1.76; 95% CI, 0.96, 3.24, P = 0.07). Within the group of patients who reported postoperative clinical visual symptoms, 71 of 122 (58%) had ceased reporting them by month 24. CONCLUSIONS: Adjusting for important risk factors simultaneously, this study suggested that certain preoperative characteristics may increase or decrease the likelihood, depending on the characteristic, of refractive surgery candidates to report significant clinical visual symptoms with Intacs inserts.

Adult↗
PubMed2002

Removal of INTACS for myopia.

OBJECTIVE: To evaluate the safety and efficacy of the removal of INTACS. DESIGN: Subgroup analysis from a nonrandomized comparative interventional trial. PARTICIPANTS: Four hundred fifty-two patients with best spectacle-corrected visual acuity of 20/20 or better and myopia (1.0-3.5 diopters [D]) were enrolled in the U.S. Food and Drug Administration clinical trials of INTACS. Forty-six eyes among a total of 684 underwent INTACS removal. INTERVENTION: INTACS removal. METHODS: Safety and efficacy of INTACS removal was assessed by comparison of results from preoperative and 3-month postremoval visits. Safety was assessed by maintenance of preoperative best spectacle-corrected acuity and induction of astigmatism (measured by manifest refraction). Efficacy was assessed by comparison of mean spherical equivalent measured by both manifest and cycloplegic refraction, as well as percentage of eyes within +/- 0.5 D and +/- 1.0 D of baseline values. A subset of 27 patients completed a prospective questionnaire assessing the frequency of six visual symptoms (glare, halos, double vision, photophobia, night vision difficulties, and fluctuating vision). MAIN OUTCOMES MEASURES: Best spectacle-corrected visual acuity, manifest refraction, and cycloplegic refraction. RESULTS: Forty-one of 46 patients' eyes that had undergone INTACS removal had reached the 3-month postremoval visit. Of these eyes, 73% (30 of 41) had returned to within +/- 0.5 D and 97% (40 of 41) to within +/- 1.0 D of baseline spherical equivalent as measured by manifest refraction. With respect to astigmatism, 88% (36 of 41) had returned to within +/- 0.5 D and 100% (41 of 41) to within +/- 1.0 D of preoperative value. No patient had a loss of best spectacle-corrected acuity of more than 2 lines, with equal numbers of eyes having a loss or gain of 1 line (nine eyes) and 2 lines (one eye). For most eyes, INTACS removal was associated with a substantial reduction in the six types of visual symptoms; however, in some eyes (up to 15%) symptoms that had not been detected preoperatively were noted after INTACS removal. CONCLUSIONS: INTACS removal was not associated with a loss (> 2 lines) of best spectacle-corrected visual acuity or induction (> 1 D) of astigmatism or myopia. INTACS removal was associated with a reversal to preoperative values in most cases.

Adult↗
PubMed1996

One-year results of a prospective multicenter study of the Casebeer system of refractive keratotomy. Casebeer Chiron Study Group.

PURPOSE: To evaluate the clinical results, predictability, stability, safety, and the patient satisfaction after refractive keratotomy for the correction of myopia and astigmatism using a defined protocol (the Casebeer system). METHODS: The authors enrolled 324 patients (615 eyes) in a prospective study conducted by 18 surgeons. All procedures were performed using ultrasonic pachymetry with the diamond knife blade set at a length of 100% of the temporal paracentral corneal thickness reading and four to eight centripental (Russian style) incisions with or without fixation of the globe. Straight transverse incisions were done for astigmatism in 222 (36%) eyes. One to eight repeated operations (enhancements) were done on 241 (39%) eyes. RESULTS: Mean baseline cycloplegic refraction was -3.68 +/- 1.59 diopters (D) (range, -0.88 to -8.25 D). One-year data were available for 546 eyes (89%). At 1 year, mean spherical equivalent cycloplegic refraction was -0.27 +/- 0.78 D (range, -3.13 to +3.00 D). There were 373 (68%) eyes with a refraction of +/- 0.50 D, and 483 eyes (89%) within +/- 1.00 D of emmetropia. Ten eyes (2%) were overcorrected by more than 1.00 D. Mean baseline refractive cylinder was 1.01 +/- 0.75 D (range, 0-5.75 D); at 1 year, the mean cylinder was 0.40 +/- 0.55 D (range, 0-2.50 D). Uncorrected visual acuity was 20/20 or better in 297 (54%) eyes and 20/40 or better in 93%. Six eyes (1%) lost two to three lines of spectacle-corrected visual acuity; the worst visual acuity was 20/30. Of patients responding to a standardized questionnaire, 320 (77%) wore no spectacles for distance or near vision; there was a significant increase in glare and fluctuation of vision from baseline; and 247 (90%) were very satisfied with the outcome. CONCLUSIONS: Refractive keratotomy using radial incisions with or without transverse incisions and following the Casebeer system effectively reduces and often eliminates myopia and astigmatism with a high degree of safety. Enhancement surgery was required in 39% of eyes. Glare and fluctuation of vision increased postoperatively but were rated mild, and patient satisfaction was high.

Adult↗
PubMed1992

Results of photorefractometric screening for amblyogenic defects in children aged 20 months.

This report evaluates the validity of a preventive programme in a population which underwent refractometric screening at the ages of 20 months and 4 years. In 1987, 1,046 children born in 1985 in the territory of the Veneto National Health Unit No. 19 were invited to undergo screening for amblyogenic factors such as meridional hyperopia greater than or equal to +2.50 diopters (D), myopia less than or equal to -2.50 D, anisometropia greater than or equal to 2 D, opacity of the dioptric media and strabismus. The test method was non-cycloplegic photorefractometry (PhR). Seven hundred and ninety-five children were tested (76%); positive cases underwent subsequent cycloplegic autorefractometry (AR) and corrective lenses were prescribed as necessary. In 1989, an eye test was performed on 653 children who had taken part in the previous PhR screening and on 350 similar children who had not: the test included evaluation of visual acuity, stereopsis and AR. An eye with a corrected visual acuity of less than 0.7 was considered amblyopic. PhR demonstrated a sensitivity of 80%, a specificity of 96% and a positive prediction rating of 46% in the identification of amblyogenic factors. The prevalence of amblyopia at 4 years of age in the group which had undergone previous screening was 1.07% vs. 2.57% in the group which had not (P: not significant). The progress of the myopia was studied in a group with full optical correction used continuously (Group A) and in a control group under-corrected by at least 1.5 D (Group B).(ABSTRACT TRUNCATED AT 250 WORDS)

Amblyopia↗
PubMed2003

Autorefractometry after laser in situ keratomileusis.

PURPOSE: To correlate cycloplegic subjective refraction with cycloplegic autorefractometry in eyes that have had laser in situ keratomileusis (LASIK). SETTING: Vlemma Eye Institute, Athens, Greece. METHODS: Subjective refraction and autorefractometry under cycloplegia were performed in 73 eyes of 46 patients 1, 6, and 12 months after LASIK to correct myopia or myopic astigmatism. The preoperative subjective refraction and autorefractometry under cycloplegia in the same eyes served as controls. RESULTS: A statistically significant difference between subjective refraction and autorefraction was found in the sphere and cylinder at all postoperative times. No statistically significant difference was found in the axis. There was no statistically significant difference in the control eyes. CONCLUSIONS: Automated refractometry in eyes that had had LASIK was reliable in the axis only. Retreatments after LASIK should always be based on subjective refraction.

Adult↗
PubMed2004

Predictive formula for calculating the probability of LASIK enhancement.

PURPOSE: To develop a formula to predict a patient's need for laser in situ keratomileusis (LASIK) enhancement. SETTING: Northwestern Laser Vision Center, Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. METHODS: In this retrospective study, charts of patients who received LASIK with the Visx Star excimer laser for myopia and myopic astigmatism were reviewed. Laser in situ keratomileusis enhancement was performed in 130 of 720 eyes. Variables such as age, keratometry, spherical power, power and axis of astigmatism, and surgeon factor were compared in patients who required retreatment and those who did not. Multivariate logistic regression analysis was used to determine a formula for the probability of enhancement surgery. RESULTS: Age (P<.0001), preoperative cycloplegic sphere (P<.0001), and surgeon (P<.0001) were the statistically significant factors for predicting retreatment. The predictive formula derived from these factors had a sensitivity of 79%, a specificity of 61%, and positive and negative predictive values of 31% and 93%, respectively. CONCLUSIONS: Older age, higher preoperative cycloplegic sphere, and surgeon significantly influenced a patient's likelihood for LASIK retreatment. A formula based on these predisposing factors helps to more accurately predict the need for retreatment.

Adolescent↗
PubMed1996

Evaluation of bidirectional radial and astigmatic keratotomy.

PURPOSE: To analyze the outcome of incisional radial and astigmatic keratotomy using a bidirectional keratome. METHODS: We used a bidirectional cutting diamond keratome on 100 consecutive eyes (mean patient age 38 years, range 18 to 67 years) whose mean preoperative cycloplegic refraction was -4.64 (range of sphere -1.50 to -15.25) and +1.25 of cylinder (range of cylinder +0.50 to +5.00). RESULTS: Mean postoperative cycloplegic refraction was -0.31 (range +0.50 to -1.25) and +0.25 cylinder (range 0 to +1.00). At the end of 1 year, 97% of eyes had an uncorrected visual acuity of 20/40 or better. The rate of enhancement of the original keratotomy was 10%; all of these eyes had more than -6.25 diopters (D) of sphere or +2.00 D of cylinder preoperatively. Side effects were minimal, and no sight-threatening complications occurred. CONCLUSION: In this study, bidirectional incisional radial and astigmatic keratotomy was an accurate and predictable technique for myopia and astigmatism; all patients were satisfied with the procedure.

Adolescent↗
PubMed2000

Accuracy and accommodation capability of a handheld autorefractor.

PURPOSE: To determine the accuracy of measurement by the Nikon Retinomax handheld autorefractor and its ability to relax accommodation. SETTING: Pediatric Section, Department of Ophthalmology, University of Mainz, Germany. METHODS: To perform a series of comparative measurements, autorefractor readings were obtained on healthy young adults (students) and on children aged 2 to 12 years. The autorefractor readings were compared with subjective refractions of the young adults and with cycloplegic retinoscopy of the children. RESULTS: In adults, the accuracy of the handheld autorefractor measurements was comparable to that of conventional tabletop autorefractors. In children, the autorefractor measurements performed under cycloplegia were reliable; when cycloplegic agents were not administered, 24% were overcorrected by more than -2.0 diopters. CONCLUSION: Cycloplegia is often necessary to obtain accurate autorefractor results.

Accommodation, Ocular↗
PubMed1999

Therapeutic outcomes of cryotherapy versus transpupillary diode laser photocoagulation for threshold retinopathy of prematurity.

INTRODUCTION: We undertook this study to compare the clinical outcomes in patients treated for threshold retinopathy of prematurity (ROP) with transpupillary diode laser photocoagulation versus transscleral cryotherapy. METHODS: A retrospective chart review was performed of patients treated for threshold ROP at our institution between 1988 and 1997. Cryotherapy was used to treat patients before 1992, and diode laser was used thereafter. One hundred fifteen eyes of 63 patients underwent cryotherapy, and 130 eyes of 70 patients underwent laser treatment. Because strong concordance exists between fellow eyes treated for ROP, statistical analysis was done for right eye outcomes only. Demographics, short-term complications, and treatment parameters were compared on the entire cohort of patients. Structural outcomes were compared between a group of 79 cryotreated eyes (39 OD, 40 OS) and a group of 113 laser-treated eyes (56 OD, 57 OS). Mean cycloplegic refraction was compared between a group of 38 cryotreated eyes (18 OD, 20 OS) and a group of 90 laser-treated eyes (46 OD, 44 OS). Visual acuity for preverbal and nonverbal children was estimated and converted to a Snellen visual acuity equivalent. Geometric mean visual acuity was then compared between a group of 44 cryotreated eyes (22 OD, 22 OS) and a group of 92 laser-treated eyes (47 OD, 45 OS). Patients were included in each outcome analysis if adequate documentation was present in the patient record. RESULTS: Demographics and short-term complications were not significantly different between the 2 groups. In the statistical group, 22 of 39 right eyes (56.4%) in the cryotherapy group versus 49 of 56 right eyes (87.5%) in the laser group had resolution of ROP after treatment (P = .0008). Mean spherical equivalent cycloplegic refraction at 12 months of age and over the follow-up period was not significantly different between the cryotherapy and laser groups. Estimated geometric mean visual acuity in the cryotherapy group was 20/103 and in the laser group was 20/49 at 12 months of age (P= .0099). CONCLUSIONS: Diode laser photocoagulation was associated with a better long-term structural outcome and visual acuity compared with cryotherapy for the treatment of threshold ROP. Refractive error was not significantly different between the 2 groups over an equivalent follow-up period.

Child, Preschool↗
PubMed1999

Refractive errors in children with cerebral palsy, psychomotor retardation, and other non-cerebral palsy neuromotor disabilities.

The aim of this study was to analyse the refractive state of four different groups of children: those with spastic cerebral palsy (CP), aged between 7 and 81 months (N=50); psychomotor retardation, aged between 19 and 70 months (N=16); other neuromotor dysfunctions, aged between 12 and 75 months (N=37); and without psychomotor retardation, aged between 9 and 73 months (N=181). Refractive errors were determined using cycloplegic retinoscopy and non-cycloplegic retinoscopy (Mohindra's technique). We found higher percentages of hyperopia, tendency toward hyperopia, and other refractive anomalies in all the pathological groups of children than in the non-pathological control groups. Children from both the non-CP pathological control group and the group with psychomotor retardation had similar or even higher levels of hyperopia than children from the group with spastic CP. Our results in different age groups indicate a less effective normal emmetropization course in all the pathological groups of children studied. The correction of refractive errors is needed in these children before the end of the neural plasticity period.

Cerebral Palsy↗
PubMedDate not supplied

Visual acuity losses in pigeons with lesions of the nucleus of Edinger-Westphal that disrupt the adaptive regulation of choroidal blood flow.

Choroidal blood flow (ChBF) in birds is regulated by a neural circuit whose components are the retina, the suprachiasmatic nucleus, the medial division of the Edinger-Westphal nucleus (EWM), the ciliary ganglion, and the choriod. We have previously shown that lesions of EWM appear to result in pathological alterations in the retina. To determine whether EWM lesions also lead to altered visual functions, we have examined the effects of EWM lesions on visual acuity in pigeons. Bilateral lesions of EWM were made electrolytically, and visual acuity for high-contrast, square-wave gratings was determined behaviorally about 1 year later and compared to that of a group of pigeons that had received sham lesions of EW about 1 year prior to acuity testing. Because lesions targeting EWM invariably resulted in damage to the adjoining lateral part of the Edinger-Westphal nucleus (EWL), which controls pupillary constriction and accommodation, two additional control groups were studied. In one such control group, bilateral lesions in the area pretectalis (AP), which innervates the pupillary control part of EWL and thereby controls pupillary constriction, were made and the effects on visual acuity determined about 1 year later. In the second such control group, the effects of acute accommodative and pupillary dysfunction on acuity were studied in pigeons made cycloplegic. The accuracy of all lesions was later confirmed histologically. The mean acuities of birds with AP lesions (9.1+/-1.4 cycles/deg) and sham lesions (7.1+/-1.5 cycles/deg) were not significantly different from normal, based on published normative data on pigeons. In contrast, pigeons with lesions that completely destroyed EW bilaterally showed visual acuity (2.7+/-0.1 cycles/deg) that was well below the acuity of the sham and AP-lesion control groups. The acuity of the cycloplegic pigeons (4.8+/-0.3 cycles/deg) and one pigeon with a nearly complete bilateral EWL but a unilateral EWM lesion (6.4 cycles/deg) indicated that only about half of the loss with a bilateral EW lesion could be attributed to accommodative dysfunction. Thus, bilateral destruction of EWM appears to have led to a loss in visual acuity. This conclusion suggests that disruption of adaptive neural regulation of ChBF may impair visual function. Destruction of EWM was, however, associated with damage to the somatic components of the oculomotor and trochlear nuclei. The possibility cannot be excluded that such damage also contributed to the acuity loss.

Adaptation, Physiological↗
PubMed1998

National survey of corneal abrasion treatment.

PURPOSE: To survey the different methods used in the management of corneal abrasions (including iatrongenic cases) nationally. METHOD: A questionnaire survey of all 162 ophthalmic units in the UK was carried out in 1997. RESULTS: The response rate was 134 of 162 (83%). The majority of units do not have an established policy for the treatment of corneal abrasions. Topical antibiotic alone and antibiotic together with a cycloplegic are the commonest immediate treatments, whilst the most common treatment course is topical antibiotic. Padding and patient follow-up is practised some of the time by most units and all of the time by the remaining minority. Use of a soft bandage contact lens is uncommon. There is no statistically significant difference (p > 0.05) between the policy-holders and non-policy-holders in their use of the various topical regimes, padding and soft bandage contact lens. CONCLUSION: The traditional trio of topical antibiotic, cycloplegic and padding is still the mainstay of corneal abrasion treatment amongst units nation-wide. However, there is a lack of reproducible scientific evidence to support this treatment. Larger randomised trials looking at the efficacy of the different treatment options are needed.

Anti-Bacterial Agents↗
PubMed2005

[Surgical treatment of cyclodialysis].

PURPOSE: Cyclodialysis is a rare complication following blunt traumatic bulb injuries or surgical interventions. When treatment with cycloplegics or steroids is ineffective in attaching the ciliary body, cyclodialysis should be surgically treated. However, for reliable diagnosis and surgical therapy, an exact identification (size and extent) of the cyclodialysis cleft is imperative. Ultrasound biomicroscopy (UBM) provides the appropriate information. CASE REPORT: Four patients (19 to 65 years old, mean 45 years) with a detached ciliary body are described. Three patients had suffered an injury, and one patient presented with a prior trabeculotomy. The diagnosis was established with UBM. The location of the cyclodialysis cleft ranged between 2 and 3 o'clock (mean 2.4 o'clock). In spite of an intense treatment with cycloplegics and steroids no reattachment of the cyclodialysis took place. Therefore, a surgical intervention was performed. The span between the injury and trabeculotomy, respectively, and the cyclodialysis operation ranged from 3 to 30 months (mean 12 months). On average, visual acuity was increased from 0.3 preoperatively to 0.6 postoperatively, and the intraocular pressure was 6 mm Hg before and 15 mm Hg after operation. Symptoms preoperatively found without exception (choroidal detachment, papilledema "e vacuo", macular edema) had a complete recovery after operation. CONCLUSION: In cases where drug therapies are unsuccessful in attaching the ciliary body, an operative fixation is recommended. UBM is a very useful tool for making an exact diagnosis and defining the location of cyclodialysis as well as for follow-up of surgical treatment.

Adult↗