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PubMed1996

Multihandicapped blind and partially sighted children in south Germany. I: Prevalence, impairments and ophthalmological findings.

Data on prevalence, impairments, neuropaediatric and ophthalmologic findings are reported in a population-based study of 239 multihandicapped blind and partially sighted children in South Germany born between 1981 and 1987. With a prevalence of 0.67 per 1000 live births this type of impairment was rare. However, most children in this series were very severely impaired with very low developmental age and several additional impairments. Most children had lesions of the visual pathways without significant involvement of the eyes. Ophthalmological and neuroradiological findings indicated that optic nerve atrophy and lesions of the posterior visual pathways frequently coexisted.

Birth Weight↗
PubMed1995

Ophthalmologic procedures in the emergency department--Part II: Routine evaluation procedures.

The emergency physician (EP) must be familiar with performance of ophthalmologic procedures for evaluation and treatment of a multitude of eye complaints. This article is the second of three articles addressing ophthalmologic procedures potentially of use by the EP. This article reviews the indications and the techniques for the following routine procedures: visual acuity testing, pupil dilatation, topical anesthesia use, and tonometry. Criteria for consultation also are addressed.

Anesthesia, Local↗
PubMed1995

Ophthalmologic procedures in the emergency department--Part III: Slit lamp use and foreign bodies.

The emergency physician (EP) must be familiar with carrying out ophthalmologic procedures for evaluation and treatment of a multitude of eye complaints. This article is the last of three articles addressing ophthalmologic procedures of use by the EP. This article reviews the indications and the techniques for slit lamp examination of the eye and techniques of foreign body removal. Criteria for consultation also are addressed.

Emergency Medicine↗
PubMed2005

Nordic research in ophthalmology.

Nordic ophthalmologists and vision scientists are active in many fields of eye research. This is most evident at the biannual Nordic Congress of Ophthalmology, most recently held in Malmö in June 2004. The authors here review some of the research in vision and ophthalmology presented at this meeting or published recently by Nordic scientists. This paper does not represent a comprehensive review of all Nordic research in the field, but attempts to give an overview of some of the activities underway in eye research in this part of the world.

Animals↗
PubMed1993

Computer-assisted instruction in emergency ophthalmological care.

The use of computer-assisted instruction in medical education has increased steadily in the last decade with the availability of personal computers. Many computer-assisted instruction programs train the user to handle various forms of disease or injury. Our intent was to provide medical students with more experience in managing ophthalmological emergencies, and we therefore designed a computerized teaching system for emergency ophthalmological care. The system makes it possible for inexperienced students to develop these skills, without jeopardizing the patient's health during training. Colour illustrations help teach the student to judge clinical signs. First, two classes of altogether 35 students used the teaching system. The students were shown to have gained significantly better knowledge of conditions which had been presented to them by the computerized teaching, than of conditions which had not been presented in this way. After having used the system, two other classes were asked about their attitudes towards this teaching modality. A majority regarded it as a valuable or very valuable addition to traditional methods of teaching. This type of instruction system may improve the quality of ophthalmic teaching without increasing teaching staff requirements.

Attitude of Health Personnel↗
PubMed1987

Public health ophthalmology.

Public health ophthalmology, often referred to as preventive or community ophthalmology, focuses on three community based activities: preventive, curative, and promotive. The pioneering work of Professor Barrie Jones in this field is recognised. Examples of each activity are provided, with emphasis on the developing world.

Adolescent↗
PubMed2003

Primary care and ophthalmology in the United Kingdom.

The National Health Service is now primary care led. There are different definitions for primary care and in this review they are analysed and related to ophthalmology to produce a working definition for ophthalmic primary care, summarised as the provision of first contact care for all ophthalmic conditions and follow up, preventive, and rehabilitative care of selected ophthalmic conditions, in a variety of settings, by a diverse workforce. The attributes of primary care are first contact, accessibility, continuity, longitudinality, comprehensiveness, coordination, equity, and accountability. The delivery of ophthalmic primary care should be governed by these and evaluated accordingly. The clinical content of primary care consists of the first presentation of disease, the management of minor illness and trauma, the recurrence of disease, the follow up and support of some chronic conditions, and the delivery of preventive health care. Planning for ophthalmic primary care needs to take service requirements of these categories of disease into account. Primary care research is abundant in ophthalmology but needs to be more structured and targeted. Ophthalmic primary care itself is urgently in need of recognition and formal adoption by the profession.

Community Health Services↗
PubMedDate not supplied

Results of an ophthalmologic screening programme for identification of cases with Anderson-Fabry disease.

PURPOSE: Anderson-Fabry disease is an inherited lysosomal storage disease with a broad and unspecific range of symptoms, a painful course of disease and early death. The recent development of new enzyme therapy emphasises the need for early diagnosis and treatment of undiagnosed patients. One of the affected organs of Anderson-Fabry disease is the eye. Cornea verticillata--corneal opacities and corneal dystrophy--as well as tortuositas vasorum can occur in an early stage of the disease affecting almost all hemizygous men and more than 70% of heterozygous women. In order to identify unknown cases with Anderson-Fabry disease, we carried out a screening programme contacting Austrian ophthalmologists. METHODS: All 658 Austrian ophthalmologists were asked to record patients with cornea verticillata as well as tortuositas vasorum--twice at an interval of 3 months. RESULTS: 33% of the contacted ophthalmologists replied, identifying 5 patients suspected of having Anderson-Fabry disease. After additional examinations including tests for enzyme activities Anderson-Fabry disease was confirmed in 1 man. CONCLUSION: We have identified 1 case with Anderson-Fabry disease through our ophthalmology screening programme among a population of approximately of 8 million. Ophthalmologic screening programmes for ocular manifestations typical of Anderson-Fabry disease are limited because of the moderate visual affection in these patients. Nevertheless, considering the limited options to detect such cases otherwise, ophthalmologists have a major responsibility to identify patients with Anderson-Fabry disease on routine examinations.

Austria↗
PubMed2006

Ophthalmologic manifestations of cutaneous conditions.

Many cutaneous conditions have associated ophthalmologic findings, which are important to recognize for both dermatologists and ophthalmologists. This review highlights some important ophthalmologic manifestations associated with neurocutaneous syndromes and inherited connective tissue diseases.

Connective Tissue Diseases↗
PubMed1992

Scheimpflug photography in clinical ophthalmology. A review.

The development of a slitlamp camera system based on the Scheimpflug principle with image analysis has been a major improvement in lens and cataract research. Since its introduction into ophthalmology by Brown and Niesel in the sixties of this century and further technical amelioration by Hockwin, Dragomirescu and Sasaki it has been applied in various experimental and clinical investigations. The purpose of this paper is to summarize and review the application of Scheimpflug photography in clinical ophthalmology and to show possibilities and indications for the use of the Scheimpflug technique in clinical studies.

Anthropometry↗
PubMed2003

Introduction to apoptosis in ophthalmology.

Apoptosis represents a mode of cellular death genetically programmed to maintain homeostasis of tissues. In specific pathologic circumstances, the death program may be activated by various environmental factors such as exposure to toxic substances or bacteria or deprivation of nutrients. From this point of view, apoptosis is considered the final event in several pathologies. In ophthalmology, experimental evidence has confirmed that apoptosis is a type of cellular death involved in various pathologic processes including glaucoma, retinitis pigmentosa, ischemic retinopathy, corneal reparative processes, cataract, and retinoblastoma. The aim of this article is to review the most recent results published in this field and to describe some of the molecular mechanisms responsible for the activation of the apoptotic program in some important ocular disorders. The understanding of such mechanisms could outline new therapeutic strategies for the prevention of cellular death in ophthalmology.

Animals↗
PubMed2003

The mechanisms of apoptosis in biology and medicine: a new focus for ophthalmology.

Defects in apoptosis (programmed cell death) have recently emerged as being closely involved in the pathogenesis of most ocular diseases and, therefore, apoptosis is now a topic of exponential interest in ophthalmology. This review summarizes recent works on mechanisms of apoptosis, from its initiation and modulation to the switching-on of its execution machinery. Interactions of cell death with cell division programs to orchestrate ontogenesis, aging, and adult life and their alterations in human diseases are pointed out. Two main apoptotic signaling pathways are identified: a death receptor-dependent (extrinsic) pathway and a mitochondrion-dependent (intrinsic) pathway. Mitochondrion harbors both antiapoptotic (Bcl-2, Bcl-XL) and apoptotic factors (Smac/Diablo, Apaf-1, cytochrome c). Its permeability transition pore (mPTP) is the main trigger of cell suicide. The process of mPTP opening, in association with extrusion to cytoplasm of a variety of apoptotic factors, is shown. Cytochrome c is one of these apoptotic factors. When expelled to cytoplasm, this double-faced respiratory chain component assembles with two other modules, Apaf-1 and procaspase 9, to form a protein complex--the apoptosome--that starts apoptosis execution. Another respiratory chain component, the CoQ10, is believed to counteract mPTP opening. What makes apoptosis particularly exciting for medicine is that its dysfunctions play a central role in the pathogenesis of several human diseases. For instance, excesses of apoptosis lead to cell loss that accompanies neurodegenerative diseases, whereas genetically determined defects of apoptosis lead to the deregulated cell proliferation typical of cancer. A variety of ophthalmologic diseases, such as post-keratectomy haze, corneal lesions, cataract, glaucoma, senile maculopathies, and genetic ocular pathologies, that underlie apoptosis dysfunctions are treated in detail in the other reviews of this issue.

Animals↗
PubMedDate not supplied

A pilot study of the use of objective structural clinical examinations for the assessment of ophthalmology education.

PURPOSE: A pilot study was carried out to evaluate the practicality, reliability, and validity of an objective structured clinical examination (OSCE) for assessing the clinical skills and abilities of specialists in ophthalmology. METHODS: Ten unfolded OSCE style, criterion referenced questions were asked to nine candidates to assess their clinical skills and abilities, as opposed to subject knowledge. Candidate and assessor reactions to the examination process were monitored and analyzed using participant observation and questionnaires administered immediately after the event. Relevant statistical techniques were applied to the results. RESULTS: A total of 89% of candidates passed the examination, with the pass boundary set at 70%. Candidates revealed themselves more successful in meeting clinical skill criteria (mean 77%) than clinical ability criteria (mean 72%). Candidates, assessors, and observers all expressed the view that the OSCE pilot had been a successful way of assessing clinical skills and abilities. CONCLUSIONS: OSCE style assessment is an effective and efficient means of assessing skills and abilities in clinical ophthalmology education.

Adult↗
PubMed1998

Vigabatrin-associated retinal cone system dysfunction: electroretinogram and ophthalmologic findings.

OBJECTIVE: To determine the sources of vigabatrin-associated visual disturbances in patients treated for epilepsy. BACKGROUND: Vigabatrin is an extremely effective antiepileptic drug that selectively increases brain gamma-aminobutyric acid (GABA). Several patients recently developed constricted visual fields during vigabatrin treatment in the United Kingdom, indicating the possibility of GABA-associated retinal dysfunction. METHODS: Patients with visual symptoms treated chronically with vigabatrin at our center underwent visual evoked potentials (VEP), electroretinograms (ERG), and visual field and ophthalmologic examinations. RESULTS: Four of 38 patients treated with vigabatrin developed visual symptoms 2 to 40 months after starting the drug. Two patients complained of constricted visual fields and two had blurred vision. ERG demonstrated evidence of bilateral retinal dysfunction consistent with reduced inner retinal cone response in all four patients. Oscillatory potential responses were lost, suggesting impairment of the highly GABAergic amacrine cells. Two of the patients had normal VEPs and minimal findings on clinical ophthalmology examinations despite abnormal ERGs. Abnormal examination findings were narrowed retinal arteries, surface wrinkling retinopathy, and abnormal macular reflexes. One patient also had reduced rod photoreceptor function in the more symptomatic left eye. CONCLUSIONS: Visual field constriction and blurring during vigabatrin therapy is associated with retinal cone system dysfunction. Visual symptoms may represent selective vulnerability of retinas of affected patients to GABAergic effects of vigabatrin. The prevalence and course of retinal changes associated with vigabatrin therapy are important to determine in a larger group of patients.

Adult↗
PubMed1997

Ophthalmologic examination in systemic toxicity studies: an overview.

The procedures of ophthalmologic examination used by the authors during systemic toxicity studies in laboratory animals are presented in this paper. The present international guidelines with respect to the requirements for ophthalmological examination are given in an overview. A list of proposed keywords is included which may be used in describing ocular changes.

Animals↗
PubMed2001

A cost study of teleconsultation for primary-care ophthalmology and dermatology.

Teleconsultations were performed between a health centre in a small Finnish town and a university hospital 55 km away. Telemedicine consultations were carried out with a total of 42 patients suffering from various eye and skin disorders. We evaluated the costs of the teleconsultations in the health centre and the conventional alternative of the patient travelling to the hospital. The cost of conventional consultations, which was not affected by the patient workload, was EU126 per patient for ophthalmology and EU143 per patient for dermatology. The cost of the teleconsultations per patient decreased as the number of patients increased. There were cost savings in relation to teleconsultations when the annual numbers of patients were more than 110 in ophthalmology and 92 in dermatology. Benefits and savings achieved through teleconsultations mainly consisted of reduced transportation costs and reduced paperwork both at the health centre and at the university hospital, as well as time savings for the patient. Another important benefit was improved medical education. The present study shows that teleconsultations can be performed in a cost-effective way in a relatively small health centre.

Cost-Benefit Analysis↗
PubMed1999

Evaluation of the first international teleconference in ophthalmology.

The First International Teleconference in Ophthalmology was held during March 1998 between five sites in the UK, USA, Greece and Malaysia. ISDN transmission at 128 kbit/s was used to reduce costs while maintaining the clarity of the presented material. Specialized lecture theatres were not available at all sites and conventional halls had to be adapted for videoconferencing. For this reason initial point-to-point testing was carried with Bristol to simplify problem solving. Thereafter, a multipoint bridge was used to connect all sites together. During the conference a number of individual presentations were given, all followed by extensive discussion periods. Special instructions were given beforehand on the production of slide material, with particular reference to font sizes and colour combinations. Full use was made of various presentation media, including slides, videos and live demonstrations. The conference was attended by over 500 delegates, all of whom were specialists in ophthalmology. The technology employed was ideal for teaching purposes. However, if used in a clinical field, it should be kept in mind that the choice of transmission rate makes certain features not easily apparent in images but they become clearer when pointed out by the presenter.

Computer Communication Networks↗
PubMed1994

Hyaluronic acid. A review of its pharmacology and use as a surgical aid in ophthalmology, and its therapeutic potential in joint disease and wound healing.

Hyaluronic acid is a naturally occurring polysaccharide with distinct physicochemical properties which underlie its application as a viscoelastic tool in ophthalmological surgery. In cataract surgery the role of hyaluronic acid in facilitating procedures and protecting the corneal endothelium is well established. Some benefit has also been gained with the use of hyaluronic acid in penetrating keratoplasty, trabeculectomy, retinal reattachment and trauma surgery, although its efficacy in these indications is less well-defined in the published literature. In addition to its lubricating and cushioning properties, demonstration of some in vitro anti-inflammatory activity and a possible disease-modifying effect for hyaluronic acid in animals has prompted its investigation as a treatment in osteoarthritis and, to a much lesser extent, in rheumatoid arthritis. Hyaluronic acid 20 mg, as weekly intra-articular injections for 3 to 7 weeks, improved knee pain and joint motion in patients with osteoarthritis. Although this occurred to a greater degree than with placebo in most comparisons, the effects of hyaluronic acid was similar to those of placebo in the largest trial. In the few available comparisons with other agents, hyaluronic acid appeared equivalent to methylprednisolone 40 mg (for 3 weeks) and to a single injection of triamcinolone 40 mg. Hyaluronic acid was distinguished from other therapies by providing a sustained effect after treatment discontinuation. Together with its very good tolerability profile, these properties justify further study of hyaluronic acid in patients with osteoarthritis. Some limited evidence of improvement in patients with rheumatoid arthritis, and a possible healing effect of hyaluronic acid on tympanic membrane perforations, represent additional areas of interest for future investigation. In summary, hyaluronic acid is a well-established adjunct to cataract surgery and may prove to be a promising option in the treatment of patients with osteoarthritis. Its very good tolerability provides further impetus for examination of its potential role in an extended scope of arthritic and ophthalmological indications, and in wound healing.

Adjuvants, Pharmaceutic↗