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PubMed1979

Gentian violet keratoconjunctivitis.

A case of bilateral keratoconjunctivitis caused by self-instillation of a 1% aqueous solution of gentian violet was complicated by a secondary uveitis and gram-negative conjunctivitis. The patient was treated with cycloplegics and specific antibiotics and after resolution of the bacterial infection, a mild topical corticosteroid was used. After six months the patient had completely recovered from the keratitis, but bilateral corneal vascularization, had unilateral posterior synechiae, corneal scarring, and cataract formation were present. Cationic dyes such as gentian violet appear to be toxic to the ocular surfaces and tend to produce severe intraocular inflammation.

Administration, Topical↗
PubMed1980

Risk factors for genetic typing and detection in retinitis pigmentosa.

An outpatient population with retinitis pigmentosa was evaluated with respect to best corrected visual acuity, cycloplegic refractive error, appearance of the lenses, presence or absence of bone spicule pigmentation, age of onset of night blindness by history, and presence or absence of a history of parental consanguinity. The population included 489 affected patients subdivided into the four following groups: 69 (14.1%) dominant, 67 (13.7%) autosomal recessive, 34 (7.0%) X-chromosome-linked, and 319 (65.2%) isolate. Contingency table and life table analyses showed that significant differences existed for these criteria among the various groups. An analysis based on data from 35 families showed significant differences with respect to best corrected visual acuity and cylindrical refractive error when comparing affected patients with their age-matched normal relatives. These findings support the idea that observations in a routine ocular examination can aid in genetic classification of affected patients and in selection of relatives of affected patients who are at higher risk for having early stages of retinitis pigmentosa.

Adolescent↗
PubMed1980

Central anterior chamber depth after laser iridectomy.

We found the true anterior chamber depth to be unaffected by successful laser iridectomy in ten eyes treated by this modality for chronic angle-closure glaucoma. The apparent general deepening seemed to be the result of peripheral chamber deepening combined with the common use of strong cycloplegic agents, reversing the shallowing effect of preoperative miotic medications.

Anterior Chamber↗
PubMed1981

Anterior uveitis in Kawasaki's disease.

Kawasaki's disease (mucocutaneous lymph node syndrome) is an acute febrile illness primarily affecting children. Slit-lamp examinations of six children with kawasaki's disease, ranging in age from 22 months to 16 years, showed that five had anterior uveitis during the acute phase of the illness. Two of the children were treated with corticosteroids and cycloplegic drugs and three received no treatment. In all five, the anterior uveitis resolved completely within a few weeks.

Adolescent↗
PubMed1982

Shallow anterior chamber and uveal effusion after nonperforating trauma to the eye.

Three patients (a 51-year-old man, an 8-year-old boy, and a 70-year-old man) developed shallowing of the anterior chamber and uveal effusion after blunt ocular injuries. After treatment with antibiotics (all three patients), corticosteroids (one patient), a mydriatic-cycloplegic solution (two patients), and antiglaucoma drugs (one patient), the shallowing and uveal effusion resolved. Because resolution occurred within two weeks in all three cases, surgical intervention was unnecessary. Both hypotony, which is common after nonpenetrating ocular injuries, and shallowing of the anterior chamber, which is rare, may result from localized uveal effusion that is clinically undetectable.

Aged↗
PubMed1984

Argon laser treatment of the ciliary processes in aphakic glaucoma with flat anterior chamber.

We treated three patients (a 72-year-old man, a 68-year-old woman, and a 60-year-old man) with aphakic glaucoma with flat anterior chamber by administering laser burns to the ciliary processes (11 ciliary processes in one case, 27 in the second, and three in the third). There was some improvement in all three cases; in one case the intraocular pressure decreased from more than 50 mm Hg to less than 20 mm Hg. In each case the anterior chamber deepened immediately without administration of cycloplegics.

Aged↗
PubMed1986

Bilateral angle-closure glaucoma in association with the acquired immune deficiency syndrome.

Two homosexual men, 35 and 42 years old, had bilateral acute angle-closure glaucoma in association with the acquired immune deficiency syndrome. In one patient, the angle-closure attack was the initial manifestation of AIDS. Choroidal effusion with secondary anterior rotation of the ciliary body at the scleral spur appeared to be the pathophysiologic mechanism. Pupillary block, angle crowding, and inflammatory synechial angle closure must be differentiated from anterior rotation of the ciliary body as the mechanism of the angle closure to provide optimal treatment. Whereas primary angle closures are treated with miotics and iridectomy, secondary angle closure may be worsened with this treatment. Cycloplegics and, if necessary, drainage of suprachoroidal fluid may be curative in AIDS-related angle closure associated with a choroidal detachment. Both patients died before the long-term efficacy of this treatment could be assessed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Corrective measures for myopia.

Many myopic people, expressing dissatisfaction with traditional methods of optical correction, are interested in a permanent correction of their refractive error which would alleviate dependence on corrective lenses. Although much effort has been put forth in the last century, there is still no method of correcting myopia which is broadly acceptable as safe and effective. The nonsurgical procedures of orthokeratology and the topical use of cycloplegics have not been well proven. Surgical measures are the current vectors of hope. Surgical procedures on parts of the eye other than the cornea have proven to be difficult. Surgery which alters the refractive power of the cornea (refractive keratoplasty) has been used frequently in the past decade. These procedures include keratomileusis, epikeratophakia and radial keratotomy. The latter is currently the most often performed method for the correction of myopia. This paper critiques the major methods, explains their historical development and basic procedures, lists major published studies and discusses their problems and promise for their future.

Contact Lenses↗
PubMedDate not supplied

Bilateral angle-closure glaucoma associated with uveal effusion: presenting sign of HIV infection.

A 40-year-old homosexual man presented with acute myopia and bilateral angle-closure glaucoma. Recognition of an anterior chamber configuration of a modestly shallowed central chamber with marked peripheral shallowing clinically suggested uveal effusion. B-scan echography provided definitive, confirmatory evidence of diffuse choroidal thickening with ciliochoroidal effusion. Treatment with aqueous suppressants, cycloplegics, and topical steroids resulted in complete resolution of the angle closure and reversal of induced myopia. The patient, who was systemically well without signs of AIDS or AIDS-related complex, was later tested and found to be serologically-positive for the human immunodeficiency virus.

Adult↗
PubMed1988

Accommodation, refractive error and eye growth in chickens.

We raised chickens with defocusing lenses of differing powers in front of their eyes. For this purpose, small hoods made from soft, thin leather were carefully fitted to their heads. Lenses were attached to the hoods by velcro fasteners and could be easily removed for cleaning. The powers of the lenses were such that their optical effects could be compensated for by accommodation. It was verified by infrared (IR) photoretinoscopy that the chickens could keep their retinal images in focus. Wearing a lens resulted in a consistent shift of the non cycloplegic refractive state (measured without the lens) which was in the direction to compensate for the lens. We used a sensitive technique (precision = +/- 50 micron as estimated from the variability of repeated measurements) to measure the posterior nodal distance (PND) in excised eyes of birds grown with lenses. The PND, in turn, was used to compare eyes treated with different lenses. It was found that the PND was increased in eyes which were treated with negative lenses compared to those treated with positive lenses. This effect occurs independently in both eyes and it is not due to changes in corneal curvature. We discuss our result in terms of a closed-loop feedback system for the regulation of eye growth.

Accommodation, Ocular↗
PubMed1992

Normal development of refractive state and ocular component dimensions in the tree shrew (Tupaia belangeri).

The normal development of refractive state, ocular components and simple visually-guided behaviors was examined in maternally-reared tree shrews. Six groups consisting of 5 animals each were anesthetized and examined after 0, 15, 30, 45, 60 and 75 days of normal binocular visual exposure. Measures in the 75-day group provided values for an improved schematic eye of the tree shrew. Cycloplegic refraction showed a marked hyperopia (+25 D) at eye opening which decreased rapidly during the first 15 days of visual exposure and stabilized near the value (+5 D) expected in an eye of this axial length (approx. 7.8 mm). Corneal radius increased slightly during development. Anterior segment depth, measured by A-scan ultrasonography, seemed to complete most of its development at an earlier age (15-30 days of visual exposure) than did other ocular parameters. Lens thickness increased steadily throughout development. Vitreous chamber depth increased rapidly until 15 days of visual exposure, and then decreased because the lens thickness increased more rapidly than axial length. Crude orienting to, and following of, large objects developed shortly after eye opening (median age at onset, 5 and 6 days, respectively). Triggered visual placing responses developed at about the same time that the refractive state completed the rapid drop from highly hyperopic values. The slowed rate of ocular development after 15 days of visual exposure may be related to increased retinal activity that is permitted by neural maturation and by the presence of a relatively well-focussed retinal image. The increased activity may influence the final dimensions of the eye to coordinate the axial length with the focal length of the eye.

Animals↗
PubMed1996

Consequences of monocular diplopia for the contrast sensitivity function.

Though the human eye generally creates a single image on the retina, the literature contains many examples showing perceptual monocular diplopia. Previously, monocular diplopia resulting from astigmatic defocus has been demonstrated to cause a notch (local minimum) in the contrast sensitivity function (CSF). We examine Verhoeff's (1900) model which explains how monocular diplopia can occur through an interaction between defocus and common ocular aberrations. From the measured ocular transverse aberration function and from the measured monocular diplopia of three cyclopleged subjects we predicted multiple notches in the CSF with hyperopic spherical defocus. Monochromatic and polychromatic CSF were measured for vertical gratings with best refraction and with simulated myopia and hyperopia. Multiple notches in CSF were observed experimentally. Notches in the polychromatic CSF were smaller and broader than those found in the monochromatic CSF. Our aberration model was successful in predicting notches in the CSF with hyperopic spherical defocus. The implications for clinical measurement of CSF are discussed.

Adult↗
PubMed1996

Monocular diplopia caused by ocular aberrations and hyperopic defocus.

As a single aperture, approximately monofocal optical system, the human eye generally creates a single image on the retina. However, the literature contains many reports of perceptual monocular diplopia. While it is easy to understand how distortion may produce monocular diplopia, its reported high incidence in normal eyes is less easily understood. We examine a model which ascribes monocular diplopia to an interaction between defocus and ocular spherical aberration. Using a psychophysical hyperacuity-based alignment procedure we measured the transverse aberration function in 0.5 mm steps horizontally across the pupil in the eyes of three cyclopleged subjects. Ocular transverse aberration functions were derived with best refraction and with simulated myopia and hyperopia. Monocular diplopia was also measured under the same conditions. All three subjects showed significant, but different, degrees of positive spherical aberration. The measured ocular transverse aberration functions were predictably modified by the hyperopic and myopic defocus. Hyperopic defocus combined with positive (myopic) spherical aberration changes a monotonic transverse aberration function with a single inflection point into a biphasic function with two inflection points. The locations of the inflections predict the presence and magnitude of the perceived diplopia. These experimental results confirm Verhoeff's (1900) hypothesis for the ocular cause of monocular diplopia.

Adult↗
PubMed2004

Photorefractive keratectomy for pediatric anisometropia: safety and impact on refractive error, visual acuity, and stereopsis.

PURPOSE: To establish the safety and possible efficacy of excimer laser photorefractive keratectomy (PRK) for treatment of pediatric anisometropia. DESIGN: Interventional case series METHODS: This is a prospective, noncomparative interventional case series at an individual university practice of photorefractive keratectomy in 11 children aged 2 and 11 years with anisometropic amblyopia who were unable or unwilling to use contact lens, glasses, and occlusion therapy to treat the amblyopia. The eye with the higher refractive error was treated with PRK using a standard adult nomogram. The refractive treatment goal was to decrease the anisometropia to 3 diopters or less. Main outcome measures were cycloplegic refraction, refractive correction, degree of corneal haze, uncorrected and best spectacle-corrected visual acuity, and stereopsis over 12 months. RESULTS: All patients tolerated the procedure well. The mean refractive target reduction was -10.10 +/- 1.39 diopters for myopia and +4.75 +/- 0.50 diopters for hyperopia. The mean achieved refractive error reduction at 12 months for myopia was -10.56 +/- 3.00 diopters and for hyperopia was +4.08 +/- 0.8 diopters. Corneal haze at 12 months was minimal. Uncorrected visual acuity improved by 2 or more lines in 6 (75%) of the eight children able to perform psychophysical acuity tests. Best spectacle-corrected visual acuity improved by 2 lines in 3 (38%) of patients. Stereopsis improved in 3 (33%) of nine patients. CONCLUSIONS: Pediatric PRK can be safely performed for anisometropia. The refractive error response in children appears to be similar to that of adults with comparable refractive errors. Visual acuity and stereopsis improved despite several children being outside the standard age of visual plasticity. Photorefractive keratectomy may play a role in the management of anisometropia in selected pediatric patients.

Amblyopia↗
PubMed2004

The effect of off-the-visual-axis retinoscopy on objective refractive measurement.

PURPOSE: To determine the effect of off-axis retinoscopy on objective refractive measurement. DESIGN: Prospective experimental study. METHODS: Eight volunteers underwent cycloplegic retinoscopy of their right eye on-the-visual-axis, and 5, 10, 15, and 20 degrees off-the-visual-axis in adduction. A single masked examiner performed all retinoscopy with random order of the patient and axis refracted. RESULTS: The average spherical retinoscopic value at 0, 5,10,15, and 20 degrees of off-axis alignment was -0.40, -0.90, -1.00, -1.38, and -1.80 diopters, respectively. The average spherical equivalent retinoscopic value obtained for each of the above positions of eye alignment was -0.02, -0.59, -0.45, -0.64, and -0.98 diopters, respectively. The induced cylinder power increased by an average of 3% for each degree of off-axis retinoscopy, though the axis of the cylinder was not predictable. CONCLUSION: Objective refractive measurement by retinoscopy is significantly altered by off-the visual-axis retinoscopy. The induced error may be clinically important even with small degrees of eccentricity.

Adult↗
PubMed2004

Optic disk and retinal characteristics in myopic children.

PURPOSE: To examine the baseline retina and optic disk characteristics in children. DESIGN: Cross-sectional study. METHODS: Subjects included 679 subjects with myopia and 100 with emmetropia, aged 8 to 13 years. Digital retina imaging and cycloplegic autorefraction were conducted to look for signs of retinal degeneration. Other outcome measures were vertical and horizontal cup-to-disk (CD) ratios, CD area ratio, parapapillary atrophy (PPA)-to-disk area ratio, and disk rotational angle. RESULTS: The prevalence of lattice degeneration was 0.15% (95% confidence interval: 0.008-1.00). No other retinal abnormalities were detected. Increased PPA-to-disk area ratio was associated with increased axial length, increased myopia severity, and increasing age. Cup-to-disk ratios were smaller in subjects with myopia compared with those with emmetropia, but this did not correlate with severity of myopia. In subjects with severe myopia, the upper pole of the disk was rotated away from the fovea but to lesser extent than in those with emmetropia or milder myopia. CONCLUSIONS: Apart from PPA, degenerative features were not commonly found in this study.

Adolescent↗
PubMed2005

Visual prognosis of amblyopia associated with myelinated retinal nerve fibers.

PURPOSE: To investigate the visual prognosis of amblyopia associated with anisomyopia and myelinated nerve fibers. DESIGN: Retrospective noncomparative case series. METHODS: Twelve children with amblyopia associated with anisomyopia and myelinated nerve fibers were treated with spectacle correction after cycloplegic refraction and occlusion therapy for amblyopia. Their visual acuity was measured at each visit to the clinic. The patients were divided into three groups according to their final visual acuity, and statistical analyses were performed to evaluate the differences among these groups in terms of the initial age, spherical equivalent, anisometropia, the area of myelination, final age, and follow-up period. RESULTS: The mean refractive error of the 12 children in spherical equivalents was -8.16 diopters (range -1.50 to approximately -13.00 diopters). The mean age at the initiation of therapy was 4.2 years (range 2.1 to 8.6) and the mean follow-up period was 2.6 years (range 0.5 to 5.1). After the occlusion treatment, visual acuity improved to 20/30 in four patients, and to 20/60 in one patient. In the remaining six patients, visual acuity remained at 20/200 or worse. The amount of anisometropia and the area of myelination were significantly different between the group with a final visual acuity of 20/40 or better and the group with a final visual acuity of worse than 20/200. CONCLUSION: The visual acuity of about one third of the amblyopes with myelinated nerve fibers improved to 20/30. The prognostic factors for the visual improvement were the amount of anisometropia and the area of myelination.

Amblyopia↗
PubMed2005

Accuracy of the Lang II stereotest in screening for binocular disorders in 6-year-old children.

PURPOSE: To assess the accuracy of the Lang II stereotest in screening for strabismus, amblyopia, and anisometropia in 6-year-old children. DESIGN: Cross-sectional population-based study. METHODS: The Sydney Myopia Study examined 1765 6-year-old children (78.9% of eligible) who were identified by random cluster sampling of 34 schools in Sydney, Australia. Sensitivity and specificity of the Lang II stereotest was determined by best stereoacuity. Cycloplegic autorefraction, assessment of visual acuity, and ocular motility were conducted. RESULTS: Test sensitivity ranged from 21.4% for anisometropia (> or =1.0 diopter) to 31.3% for amblyopia. The detection rate for new cases of amblyopia ranged from 20% to 40%; the detection rate for new cases of strabismus was 30%. Specificity was >98% in all three conditions. Children with false-negative results included newly diagnosed cases of strabismus (14 of 25 children) or amblyopia (5 of 12 children). CONCLUSION: The Lang II stereotest, when used alone, has very limited value as a screening test of binocular dysfunction.

Amblyopia↗