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Soft lenses are used continuously for a prolonged period as a corneal protective device following unique under-lid surgery for ptosis correction. Until this procedure was employed, this excellent surgical technique had been all but abandoned.
Visual problems may be due to an inadequate illumination. In this article some recommendations are presented with regard to the illumination in the dental office. Prior to this, a description of some technical terms such as lux and candela is presented. Some light sources may be dangerous for the eye if used for a longer period of time. Mechanical damage to the eyes and infection by hard and large particles of the aerosol may be serious. Spectacles and air suction devices are therefore a necessity. Lastly, some attention is given to working with monitors of personal computers.
PURPOSE: To assess the degree of corneal diameter shrinkage induced by Q-switched mid-infrared laser corneal trephination for penetrating keratoplasty in an experimental model. METHODS: Corneal trephination was performed in 80 enucleated porcine eyes fixed in a holder centered on an automated globe rotation device, by Q-switched (2.94 microm) Er:YAG laser along open masks. Four types of masks were used to protect the underlying corneal tissue: metal masks (donor and recipient) and ceramic masks (donor and recipient). Two spot diameters (0.65 mm and 0.96 mm) were combined with two energy settings (40 mJ/pulse and 50 mJ/pulse) for each of the masks used. Repetition rate was fixed at 5 Hz. Diameters of donor buttons/recipient beds (horizontal and vertical) were measured immediately after the trephination and compared to the given mask size. RESULTS: Minimum corneal shrinkage was found in the recipient metal mask group (mean +/- SD=0.3+/-0.4%) with 50 mJ pulse energy and 0.65 mm spot diameter (in the horizontal diameter), while the maximum shrinkage (5.3+/-2.8%) was found in the donor metal mask group with 50 mJ pulse energy and 0.96 mm spot diameter. Corneal shrinkage was less pronounced in recipient beds than in donor buttons (P<0.01). The differences in shrinkage between the use of ceramic and metal masks were insignificant (P>0.05). Mean induced corneal diameter discrepancies between the donor button and the recipient bed (with metal and ceramic masks) were 2.5% and 2.5% in vertical diameter and 3.4% and 2.4% in horizontal diameter. CONCLUSIONS: The Q-switched Er:YAG laser experimental corneal trephination for penetrating keratoplasty may induce minor degrees of corneal diameter shrinkage in donor buttons and recipient openings. Oversizing of donor masks by 0.25-0.35 mm (i.e. 3-4% of graft size) may be a valid option to avoid refractive consequences.
The frequent use of heavy eyeglasses by the angiographer has resulted in significant discomfort due to "sliding glasses." Described is the optical push device, which allows the angiographer to adjust eyeglasses comfortably while maintaining sterility.
This study investigated the hypothesis that eye color is related to permanent threshold shift. Hearing levels and eye color determinations (gray, blue, hazel, and brown) were obtained for 100 industrial employees. Discriminant function analyses were utilized to attempt to establish linear combinations of variables that would identify group membership (i.e., eye color) correctly. Linear combinations of variables were not effective in delineating group membership. Probabililty statistics were then utilized to evaluate the probability of the determined relationships. These results indicated predictive accuracy of 69% for blue-eyed workers and 59% for brown-eyed workers.
In a randomized trial comparing a modified oxygen headbox with conventional eye patches for protecting the eyes of newborn infants undergoing phototherapy, the use of the headbox did not interfere with phototherapy treatment and was preferred by the nursing staff, as shown by an opinion survey. This, plus our previously reported finding that the headbox was associated with less eye infection, less periorbital skin irritation and less accidental exposure of the eyes due to displacement of the protective devices, suggests that the headbox provides a convenient and inexpensive alternative method of eye protection. The device may be particularly useful in busy and under-staffed neonatal units where vigilant eye care of infants undergoing phototherapy may be difficult.
BACKGROUND: Laser eye protection has been designed to protect operators and patients from severe eye injuries. OBJECTIVE: To describe two cases in which lasers used for cutaneous therapy may have been associated with the induction of vitreous floaters, a subacute eye injury, in physicians operating these devices, and to review the theoretical feasibility of such injuries, prior reports of the same, and strategies for minimizing risk. METHODS: Report of two cases and review of the literature. RESULTS: Given the circumstantial evidence, it is possible that subacute vitreous injuries may be sustained by the operators of dermatologic lasers. Ex vivo experiments and previous case reports have demonstrated the possibility of laser-induced vitreous injury, including changes in vitreous conformation and vitreous hemorrhage, in the absence of permanent retinal deficits. It may be speculated that vitreous floaters are a milder manifestation of such subacute injuries. CONCLUSION: To the extent that vitreous floaters can multiply and presage the onset of severe retinal injury, the risk of their induction by dermatologic lasers should be minimized. Simple strategies and further research can help achieve this goal.
BACKGROUND: Despite the potential for eye injury, most hockey players in the National Hockey League do not use a protective face shield. We examined the effect of a hockey visor and sports goggle on visual function to see whether visual impediment is a substantial factor in the resistance to use of protective eyewear. METHODS: We measured Snellen visual acuity, Ishihara colour vision and contrast sensitivity and performed Humphrey central 30 degrees and peripheral 30 degrees to 60 degrees threshold perimetry in eight volunteers (10 eyes) with and without a sports goggle and a hockey visor (half face shield). Subjects with normal acuity and normal confrontation fields who did not require presbyopic correction at near were enrolled. Five subjects (10 eyes) had further testing with threshold perimetry of the temporal crescent. The order in which the tests were performed (no mask first, visor first or goggle first) was alternated between subjects. RESULTS: There was no difference in Snellen acuity or Ishihara colour vision, and no statistically significant difference in contrast sensitivity or foveal threshold with or without protective eyewear. The visor caused a statistically significant decrease in the central 30 degrees mean deviation index compared to no mask (p = 0.001), but the goggle did not. Each of the peripheral quadrant threshold totals was significantly decreased with the visor compared with no mask (p < 0.05). The 30 degrees to 60 degrees temporal field was better preserved with the goggle than with the visor, but the nasal peripheral field was worse with the goggle than with the visor. Both the visor and the goggle caused a statistically significant decrease of more than 4 decibels in the temporal crescent threshold (p = 0.000). INTERPRETATION: Protective eyewear does not adversely affect Snellen acuity, contrast sensitivity, Ishihara colour vision or foveal threshold. The central 30 degrees field of vision is not affected by the sports goggle and is minimally depressed by the hockey visor. The goggle better preserves the temporal midperipheral field, but, unlike the visor, the goggle caused a monocular nasal lens rim scotoma. Both devices caused a depression of more than 4 dB of the far temporal field beyond 60 degrees (temporal crescent).
Thirty-seven cases of ocular injury incurred while persons were playing racquetball were found in reviewing records of 1,071 emergency room patients in a three-month period. These can be divided into ball-induced and racquet-induced injuries. Fifteen ball-induced injuries occurred, ranging from a corneal abrasion to vitreous hemorrhage, in a patient with sickle cell retinopathy. Twenty-two cases of racquet-induced brow lacerations that occurred when the player struck his (or her) own forehead with the racquet were found. During the same interval, five tennis-related ocular injuries were observed. Ocular safety devices are strongly recommended to help prevent racquetball injuries.
PURPOSE: To investigate the extent and type of as well as the circumstances connected with, ocular injuries caused by pyrotechnical products in the Western region of Sweden (1 750 000 inhabitants). METHODS: A three-year prospective observational study was carried out to register, interview and follow-up all patients with ocular injuries caused by fireworks. The patients were reported by all ophthalmologists in the area. RESULTS: 52 patients (72 injured eyes) were reported, 49 males and 3 females. 39 of 52 (75%) were younger than 18 years. 15 patients (including the three females) were bystanders. The injuries ranged from conjunctivitis to complete loss of the eye. The pyrotechnical device had been manipulated or misused in 19 (37%) of the 52 accidents. Seriousness of injury could not be correlated to type of device or to whether the injured person was active in launching the firework or not. 20 (38%) of the 52 patients had permanent damage to the eye. CONCLUSION: Ocular injuries from fireworks remain a problem. Preventive measures such as protective glasses and legislation are being discussed.
A report of 20 cases of solar retinopathy associated with watching an eclipse of the sun is presented. Visual prognosis was generally good and most patients had good vision at the end of six months. Paramacular scotomata, image distortion and macular changes were, however, still present in the majority of patients. Transmission of energy through various protective devices was measured with a fluxmeter. The finding of retinal damage after exposure of even short duration through protective devices that reduce the incident irradiance of the sun up to 5,000 times indicates that the damage observed may be other than thermal in nature. It is concluded that no safe method for directly viewing a solar eclipse is generally available, and that the public, especially schoolchildren and their children, should be better acquainted with this hazard.
Lasers have several unique properties that allow for the production of intensely powerful beams of light. These same properties also carry significant hazards for those not familiar with their safe use. If misdirected, laser beams can produce blindness or full-thickness cutaneous burns. Dry surgical gauze and drapes can ignite with sufficient exposure to laser energy, and treatment of infected tissue can generate a plume that poses a biohazard risk to the physician and staff as well. In order to use these powerful devices most effectively and safely, the physician should understand the basics of laser safety and be able to implement practical methods of operation.
Five patients with ocular trauma due to elastic cords with attached metal or plastic hooks were evaluated over a 13-month period. Injuries included hyphema, angle recession, lens subluxation, choroidal rupture, vitreous hemorrhage, retinal detachment, and scleral rupture. Two patients suffered penetrating ocular injuries, and three patients had final visual acuities of 20/200 or less. This series emphasizes the potential severity of ocular injury due to these commonly used devices and reiterates a modification in design that might decrease the likelihood of accidental trauma from elastic cords.
Experiments on photic damage to the retinas of rats with hereditary retinal dystrophy and some tentative clinical evidence on human patients suggest that, in human retinitis pigmentosa, one could try to protect the retina and especially the rods from bright light in an attempt to delay the retinal degeneration and to prolong the period of useful vision. Several theoretical criteria have been proposed for protection of RP patients from possible photic retinal damage. Observing these criteria, Adrian developed a brownish ophthalmic filter which absorbs the short wavelengths preferentially, thus protecting the rods primarily. Whether or not use of these filters will be efficacious has yet to be determined and will require careful experimentation and the accumulation of clinical experience. Several brown ophthalmic filters also have been tested against the criteria for a protective device. The NoIR Amber 7% plastic glasses satisfy these criteria quite well and thus can be considered as a substitute for the Adrian lens. The characteristics of the two types of filters are compared. Experience with different methods of protection may show whether it is better to attempt to delay degeneration of both retinas simultaneously by decreasing their illuminations with filters or to exclude light completely from one eye in an attempt to preserve it while the other eye degenerates in the usual course of the disease. In any event, given the present state of knowledge, it seems to be appropriate, especially in the early stages of the disease, to suggest that RP patients protect their retinas from excessive light.
This study compared the effectiveness of the ITT Night Vision Viewer with the Wide Angle Mobility Lamp (WAML) as low-vision mobility devices for people experiencing night blindness due to retinitis pigmentosa (RP). Both engineering bench testing and functional evaluations were used in the assessments. Engineering evaluations were conducted for (1) consistency of the manufacturer's specifications, (2) ergonomic characteristics, (3) modifications of devices, and (4) pedestrian safety issues. Twenty-seven patients with RP conducted rehabilitation evaluations with each device that included both clinical and functional tests. Both devices improved nighttime travel for people with night blindness as compared with nighttime travel with no device. Overall, the WAML provided better travel efficiency-equivalent to that measured in daytime. Recommendations have been developed on ergonomic factors for both devices. Although some participants preferred the ITT Night Vision Viewer, overall most participants performed better with the WAML.
The objectives of this study were to determine the distribution of different sports-related eye injuries and to identify injury types to enable recommendations to be made about the use of protective eyewear. The study population comprises all 565 eye trauma patients examined at the Ophthalmology Emergency Clinic of the Helsinki University Central Hospital over a 6-month period. Data were collected from patient histories and questionnaires. In addition, three severe floorball eye injury cases are presented. Of the 565 eye traumas, 94 (17%) were sports related. Of these, 42 (45%) were associated with floorball. Countrywide, in Finland, estimated over 300 (+95% CI 228-415) floorball eye injuries occur annually. The mean age of floorball patients was 22 years. The most common finding (55%) in sports injury patients was hyphema. Clinically severe eye injuries during this period accounted for one-fourth of all cases. During the study period, no eye injury was found in an organized junior ice hockey, where facial protection is mandatory. Floorball is estimated to belong to the highest risk group in sports, and thus, the use of protective eyewear is strongly recommended. We conclude that national floorball federations should make protective eyewear mandatory.
LASER is an acronym for Light Amplification by Stimulated Emission of Radiation. Since the first working laser was demonstrated in 1960 the laser has evolved from being viewed as a weapon, courtesy of the film industry, to its current position as a commonplace medical device within the healthcare industry. As perioperative staff we have become very familiar with the therapeutic use of this device. It is my experience however that, just occasionally, we are guilty of the old adage 'familiarity breeds contempt'. We must remember that the very same features which make lasers so useful in healthcare may also represent major health hazards to patients, staff and others.
Watching directly at the sun without appropriate protection, particularly during a solar eclipse, can cause severe retinal injuries. On 11 August 1999, a total solar eclipse crossed France. The Direction Générale de la Santé implemented a prevention strategy. A formal agreement was developed with manufacturers and importers of protective glasses and more than 30 million glasses, conformed with safety standards, were distributed in France. Information campaign reach the whole population in France. In order to evaluate the impact of this campaign, The National Institute of Public Health in France implemented a nation-wide surveillance of ocular complications related to the eclipse. Information on patients was collected using a standardised questionnaire. The questionnaire was sent to the 5,600 private and public sector ophthalmologists practising in France and to five hundred hospital emergency units. A total of 147 patients were reported to have had a retinal injury associated with viewing the eclipse. Seventeen cases were severe (visual acuity < 2/10th) of whom 7 had bilateral injury. Forty-four per cent of patients were aged 15 to 29 years and 46% viewed the eclipse in three regions in the south of France which were sunny on 11th August. One hundred and six patients (67% aged 30 years and more) presented with keratitis. Thirty-six per cent occurred in 2 northern regions of France, which were overcast on the day. A hundred patients watched the whole eclipse without any protection, 74 reported to have removed their EC glasses, and 32 used non-appropriate devices. Only 4 patients presenting with retinal injury reported having used the EC glasses the whole time whilst viewing the eclipse. France is the only country in Europe to have implemented an exhaustive prospective surveillance of ocular injuries related to the solar eclipse. According to current data, the quality and availability of EC glasses did not contribute significantly to ocular injuries. Clinical and epidemiological studies are being conducted in order to further document the evolution of patients presenting with retinal injuries, the circumstances of observation, and their comprehension of preventive messages.