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PubMedDate not supplied

[Eye conditions as features of Down's syndrome in patients over 40 years of age].

AIMS: The purpose of this study was to determine the refractive status and ocular health of a group of patients with Down's syndrome, all over the age of 40, with possible involvement of Alzheimer's disease (AD). We also aimed to compare the results obtained from sufferers and non-sufferers of the disease. PATIENTS AND METHODS: We examined 49 patients, between 40 and 62 years of age. The visual examination consisted in visual acuity (VA) measurement, binocularity test, ocular motility, retinoscopy, ocular health and subjective examination. RESULTS: Of the 49 patients studied, 24.5% were diagnosed as suffering from AD and were treated accordingly; 4% of the patients diagnosed as suffering from the disease were unable to go on with the treatment for a number of different reasons and 8.2% were at the limit of being diagnosed. 68.7% of the patients presented VA in long distance sight below 0.5 and 48% had values below 0.4 in near sight. Results showed 61.4% myopias, 45.8% astigmatisms and 23% hyperopias. 31.2% of the patients showed signs of needing prescription regarding near sight. 66.7% presented strabismus and altered motility. The main pathologies found were: 59.4% of crystalline opacities, 25% nystagmus, 13.5% interventions due to cataracts, and 6.2% keratoconus, among others. CONCLUSIONS: Diagnosis of AD is a very complex task in this population due to the heterogeneity of the level of retardation, the presence of concomitant psychiatric diseases and associated sensory problems. Findings confirm the high incidence among this population of ametropias and pathologies, especially cataracts, and VA values outside the functional limits both in far and near sightedness. No significant differences were found among patients who had been diagnosed and those who had not been diagnosed as suffering from AD.

Adult↗
PubMed2004

[Cataract surgery in biphakia patients].

INTRODUCTION: Although the IOL implantation was used initially just for cataract surgery, in the last period IOLs are used in treating myopia more than -12D and hyperopia more than +4D, in phakic eyes, when the indications of excimer laser are limited. OBSERVATION: We present the case of a 40 years old patient with the diagnosis: biphakia, complicated cataract and high myopia in both eyes. VA-RE = 2/50 cc, VA-LE = 3/50 cc, IOP-RE:15 mmHg, IOP-LE:16 mmHg. We performed, in two separate surgeries, the explantation of the intraocular lens, then the extraction of the opacified crystalline lens through the same incision and the implantation of an AcrySof foldable lens with an adequate power, in the bag. We discuss the causes of cataract formation in eyes with posterior chamber phakic intraocular lens, the choice of the IOL power, the incision for explantation and implantation, and the intraoperative technical difficulties. CONCLUSIONS: The association of phakic IOLs and cataract represents a new challenge to the ophthalmic surgeon, taking into account that these IOLs are becoming more and more popular to correct high refractive errors.

Adult↗
PubMed2004

[The analysis of refractive error in children and adolescents from 6-15 years of age based on 1000 examinations in two major Polish regions].

PURPOSE: The aim of this study is to present the results of screening examinations of refractive errors, taken on 1002 of school children ranging from 6 to 15 years of age. MATERIAL AND METHODS: As the result of Internet screening visual acuity and color perception tests named "I can see..." in 10,021 children from randomly chosen schools in Poland in the year 2002, the group of 1002 children was chosen. In this group, the subjective and objective refractive error examination was taken as well as the visual acuity test, color perception with the use of Ishihara tables and full ophthalmologic examination. RESULTS: Average visual acuity was RE: 0.72 (SD +/- 0.31) and LE: 0.72 (SD +/- 0.31). The prevalence of emmetropia was 34%. In the examined group myopia in 17%, hyperopia in 20%, astigmatism in 5.5% of children was found, and in 24.5% of patients complex errors occur such as myopic and hyperopic astigmatism.

Adolescent↗
PubMed2004

Early predict the outcomes of refractive accommodative esotropia by initial presentations.

BACKGROUND: The differential diagnosis between fully and partially refractive accommodative esotropia (Ac-ET) depends on outcomes after intervention with refraction correction. Whether the differences exist in terms of initial clinical features between these two variants has not been fully explored. METHODS: Children between the ages of 6 months and 8 years with esotropia and spherical equivalent greater than +3.00 (D) were included in this study. After wearing diopters glasses for at least 2 years, children were classified according to the indexed criteria into the fully Ac-ET group (group A, N=28) partially Ac-ET (group or the B, N=17). Six clinical parameters, including age at onset, age at first visit, visual acuity, refractive error, angle of esodeviation, and presence or absence of inferior oblique overaction at initial presentation were compared between these two groups. RESULTS: The angle of esodeviation (31.4+/-11.6 PD vs. 42.6+/-12.6 PD, p = 0.004) was significantly different between the fully and partially Ac-ET groups, while refraction (+5.79+/-1.84 D vs. +4.79+/-1.40 D, p = 0.062) had borderline significance. On the contrary, the age at onset (2.35+/-1.74 yrs vs. 2.01+/-1.96 yrs, p=0.539), age at first visit (3.51+/-1.36 yrs vs. 3.01+/-1.70 yrs, p =0.285), inferior oblique overaction (32% vs. 47%, p =0.317), and visual acuity before (LogMAR: 0.40+/-0.25 vs. LogMAR: 0.34+/-0.25, p =0.544) and after treatment (LogMAR: 0.057+/-0.079 vs. LogMAR: 0.051+/-0.19, p = 0.088) were similar in the two groups. CONCLUSIONS: Children with a smaller angle of esodeviation and higher hyperopia were more likely belonging to fully Ac-ET, which can be treated with glasses without the need of surgical intervention. Early detection and early treatment of accommodative esotropia are needed to prevent strabismus and amblyopia.

Accommodation, Ocular↗
PubMed2005

[The prevalence and its effective factors of primary angle-closure glaucoma in defined populations of rural and urban in Beijing].

OBJECTIVE: To investigate the prevalence of primary angle-closure glaucoma (PACG) of urban and rural residents in Beijing, China. A quantitative comparison was made based on the data collected from this epidemiological survey. We also identify some of the most typical risk factors associated with PACG. METHODS: Glaucomatous screening examination was applied to specific age group populations (aged 40 and older) in the defined district of Beijing and its remote rural county, from June to October, 2001. There are 4451 subjects in all, 1980 rural subjects and 2471 urban subjects, 1939 males and 2512 females. The screen and diagnostic methods used in this survey included van Herick methods and gonioscopy examination to estimate the peripheral depth of the anterior chamber, visual acuity, intraocular pressure, refraction status, stereoscopic fundus photography, and threshold-related visual field tests. Subjects regarded as suspected glaucoma and glaucoma patients are reexamined with standard glaucomatous examination. RESULTS: The response rate of rural and urban population is 79.6% (1980/2488), 87.1% (2471/2836), respectively. The prevalence of PACG (in aged 40 years or older population) resulted from this survey was 1.2% (95% CI 0.9% - 1.5%). However, the prevalence was different between urban and rural residents, 1.1% (95% CI 0.8% - 1.4%) vs. 1.6% (95% CI 1.2% - 2.0%). The prevalence of PACG in female was more than that in male, 1.7% (95% CI 1.3% - 2.1%) vs.0.8% (95% CI 0.5% - 1.1%). A drastic increase in prevalence of PACG with age increase was identified in both survey sites, however, this increase in rural subjects (aged 60-69 years group) occurred ten years earlier than those from urban subjects (aged more than 70 years group). Compared to urban residents, rural residents showed higher prevalence of unilateral low vision (39.3% vs. 20.6%) and blindness (28.6% vs. 14.7%). This survey also confirmed that, as people aging, refraction status became hyperopia, the depth of peripheral anterior chamber became narrow. In the different age groups, female and male groups, the changes of refraction status and the depth of peripheral anterior chamber paralleled the prevalence of PACG. CONCLUSIONS: The prevalence of PACG was obviously different in different groups. This could due to several factors including gender, age, change of refraction status and chamber angle as well.

Adult↗
PubMed2004

[Correction of refractive errors in children with contact lenses].

PURPOSE: To appreciate the indications, complications and visual outcomes in the correction of refractive errors with contact lenses at children. MATERIAL AND METHOD: We studied 15 eyes from nine kids. The times prescription included: history (motivation of wearing contact lenses), ocular refraction (with cycloplegia), best corrected visual acuity, keratometry, the corneal diameter, slit lamp examination, the selection of contact lens and follow up. RESULTS: The age of patients varied between several months to twelve years. The refractive errors in which we used contact lenses were: aphakia--6 eyes, myopia--6 eyes, hyperopia--3 eyes. The types of contact lenses were for permanent use--8 eyes and discontinuity use--7 eyes. We didn't have any major complication. The best corrected visual acuity with contact lenses was: 0.1-0.3 at 4 eyes, 0.4-0.6 at 2 eyes and one at 7 eyes. CONCLUSIONS: (1) Contact lenses represent the optimal correction of anisometropia after congenital or traumatic cataract operation in children. (2) The quality of vision obtained with contact lenses represents an important factor in the prevention and treatment of amblyopia.

Child↗
PubMed2005

Screening for amblyopia in preverbal children with photoscreening photographs: IV. Interobserver variability in photograph grading: origin and method of reduction.

BACKGROUND: Earlier detection of childhood vision disorders is a prominent goal of vision screening. The Medical Technology and Innovation (MTI) PhotoScreener addresses this objective. Use of this camera does not require verbal feedback and may be administered early in a child's development. Decreasing the variability in photograph grading results will boost the utility of any photoscreening system. This report aims to understand and to decrease intra- and inter-observer variability in grading photoscreening photographs. METHODS: We dissected the photograph grading process and quantified the intra- and inter-observer agreement using intraclass plot correlation coefficients. We evaluated the outcome of a two grader verification system vs. adjudicated measurements with Receiver Operator Characteristic (ROC) curves. PARTICIPANTS: Data on 955 children under 5 years of age, normal except for refractive error, each with complete photoscreening and eye examination data, culled from two previous studies. MAIN OUTCOME MEASURES: Intra- and inter-observer agreement in measuring bright crescent dimensions and pupillary diameters. Sensitivity and specificity of detection of hyperopia. RESULTS: Measurements of bright crescents are associated with greater variability than are measurements of pupillary diameters. Recognition and omission of light "rim" measurements from photograph grading will result in superior inter-observer agreement. Photograph independent errors increase variability and may be corrected by remeasurement. A verification system in which the most discrepant 5% of measurements are redone results in ROC curves similar to adjudicated dimension. CONCLUSIONS: We conclude: 1) two novices grading photographs can do as well as one expert in most cases; 2) the proposed grading methodology has undergone statistical validation and can be used in other areas of ophthalmology and medicine; and 3) inter-observer variability, one of the limitations of photoscreening photograph grading, can be reduced. For 95% of the photographs, two novices achieve similar true positive and true negative values with or without adjudication.

Amblyopia↗
PubMed2005

Ophthalmologic abnormalities in high school students with mental retardation in Taiwan.

BACKGROUND AND PURPOSE: Visual and ocular disorders are common in mental retardation (MR), and can influence sensory-motor development and learning. This study investigated visual and ocular abnormalities in a population of high school students with MR. METHODS: All students with MR in their first year at a special education high school who underwent ophthalmic examinations in December 2001 were included. Data were collected by retrospective review of hospital records and student health records. RESULTS: A total of 68 students with MR, including 45 males and 23 females, completed ophthalmologic examinations. Abnormal ophthalmologic findings in these 68 students (15-23 years old) included astigmatism (74.4%), myopia (53.7%), amblyopia (29.3%), exodeviation (23.5%), anisometropia (22.0%), blepharoconjunctivitis (20.6%), hyperopia (18.2%), cataract (13.2%) and suspected glaucoma (11.8%). Amblyopia was mainly attributed by refractive errors and strabismus. Myopia was less prevalent than in the general population of the same age in Taiwan, but astigmatism and anisometropia were more prevalent. More than one-third of the exodeviations were large-angle exotropia. The presence and type of cataract were highly associated with Down's syndrome. CONCLUSION: The prevalence of visual and ocular disorders in teenage and young-adult students with MR is high. Because these disorders can be detrimental to learning, early and regular ophthalmic examinations of children with MR are mandatory, with particular attention to screening for refractive error, amblyopia, strabismus and cataract and treatment of these conditions when identified.

Adolescent↗
PubMed2005

[Advantages and disadvantages of contact lenses in the correction of ametropia].

PURPOSE: The purpose is to appreciate the benefits and the drawbacks in the correction of the refractive errors with contact lenses comparative to the glasses, to see their indications, general contraindications, their specific features. MATERIAL AND METHOD: This is a retrospective study on a group of 100 patients that were consulted during a period between years 2003 and 2004 in the Optimed Clinic of Ophthalmology. RESULTS: The patient's age varied between seven to sixty years, most of them between twenty and thirty years. Women formed the largest group most of the patients lived in the cities. The refractive errors in which we used contact lenses were: myopia, astigmatism, hyperopia, keratoconus. Soft lenses were used more then hard lenses. Only 25 of our patients developed some complications, especially corneal complications. CONCLUSIONS: 1. The contact lenses represent an optimal solution in the correction of refractive errors, especially in young patients. 2. The quality of vision obtained with contact lenses is superior comparative to glasses. 3. Most of their complications can be treated without marks.

Adolescent↗
PubMed2005

Occurrence of refractive errors among students who before the age of two grew up under the influence of light emitted by incandescent or fluorescent lamps.

PURPOSE: The aim of the study was to determine whether the development of refractive errors could be associated with exposure to light emitted by incandescent or fluorescent lamps. MATERIAL AND METHODS: 3636 students were examined (1638 boys and 1998 girls, aged 6-18 years, mean age 12.1, SD 3.4). The examination included skiascopy with cycloplegia. Myopia was defined as refractive error < or = -0.5 D, hyperopia as refractive error > or = +1.5 D, astigmatism as refractive error > 0.5 DC. Anisometropia was diagnosed when the difference in the refraction of both eyes was > 1.0 D. The parents of all the students examined completed a questionnaire on the child's light exposure before the age oftwo. Data were analyzed statistically with the chi2 test. P values of less than 0.05 were considered statistically significant. RESULTS: It was observed that sleeping until the age of two in a room with a light turned on is associated with an increase in the occurrence of anisometropia (p < 0.02) as well as with a reduction in the prevalence of emmetropia (p < 0.05). It was also found that light emitted by fluorescent lamps leads to more frequent occurrence of astigmatism (p < 0.01).

Adolescent↗
PubMed2006

[Dissociated horizontal deviation--a diagnostic problem in strabismus].

Dissociated horizontal deviation (DHD) is one of the four components of the dissociated strabismus complex which also includes dissociated vertical deviation, dissociated torsional deviation and manifest-latent or latent nystagmus. These dissociated deviations may co-exist with concomitant strabismus (exotropia, esotropia, hyperopia). Sometimes it is difficult to make the difference between dissociated and non-dissociated component of the deviation. We report 3 cases of strabismus and DHD with special emphasis on the diagnostic difficulties and the therapeutic possibility. A careful clinical examination with additional measurement tests makes the difference between DHD and associated tropias. The reversed fixation test is a decisive test for the diagnosis of DHD. The therapeutic approach depends on the type of DHD (uni or bilateral, latent or manifest), the magnitude of the deviation, the fixation behavior and the association of the DHD with exotropia, esotropia or orthotropia.

Adolescent↗
PubMed2006

The yield and challenges of charitable state-wide photoscreening.

INTRODUCTION: State-wide cooperative programs for pediatric vision screening utilizing the MTI photoscreener and centralized interpretation were established in Alaska (The Alaska Blind Child Discovery, ABCD) and in Tennessee (Tennessee Lions Outreach). METHODS: Details of setup, implementation and interpretation of the state-wide MTI photoscreening programs are compared through 2002. The absolute numbers of children screened and the breakdown in interpretation categories are presented. RESULTS: ABCD screened 14,000 children while Tennessee Lions screened 100,800. Similarities between ABCD and Tennessee programs were funded by Lions Clubs and other charitable and public health organizations, community screening and each had coordinated centralized image interpretation and notification. The programs differed by clinic focus (Tennessee Lions organized pre-schools while ABCD used village and community health fairs and schools), parent notification (Tennessee Lions communicated through pre- schools and ABCD mailed directly to parents), and image interpretation (Tennessee used VOIC age-based and pupil-size crescents while ABCD used "delta-center crescent"). Predictive value positive was 73% for Tennessee and 89% for ABCD. Tennessee achieved better followup on referrals after a specific coordinator was employed. Image interpretation breakdown for ABCD: Tennessee Lions Outreach were anisometropia (29%:34%), high hyperopia (33%:16%), astigmatism (18%:30%), strabismus (7%:15%), myopia (5%:2%), cataract (0.7%:0.2%). Two state-wide programs detected 3216 amblyopic children at a charity borne-cost of 1.5 million dollars. If the parents persisted with appropriate amblyopia therapy, the expected societal value was estimated at 17 million dollars. Lacking societal mandate and funding, these concerted charitable efforts only achieved a community penetration rate of 10% to 14%. CONCLUSION: National adoption of preschool vision screening by a method with similar or even better validity and cost effectiveness as MTI photoscreening, ideally in the pediatric medical home, is warranted.

Alaska↗
PubMedDate not supplied

Emmetropization in accommodative esotropia: an update and review.

Many children with accommodative esotropia are able to successfully discontinue spectacle wear, while others require spectacle correction into adulthood. Parents often ask about the likelihood of glasses being required on a long-term basis and whether use of spectacles will cause dependency. Most infants are hyperopic and gradually become emmetropic. The extent to which accommodation and spectacle use affect this process is still debated. However, certain characteristics, such as degree of hyperopia, can help predict long-term spectacle requirement.

Accommodation, Ocular↗
PubMed2006

[Refractive surgery: a solution for elimination of glasses?].

Refractive surgery corresponds to all surgical methods designed for correction of refractive errors called ametropia (myopia, hyperopia, astigmatism and presbyopia). This area in ophthalmology, recently opened, is in continuous progress concerning techniques of treatment and also of diagnosis. These innovations allowed spectacular performances making possible the corrections of all refractive defaults. Two main categories can be distinguished depending on the corneal or intraocular location of the surgery. The first group includes incisions, excimer photoablation, laser thermokeratoplasty and intrastromal segments. The second group represents implantation of intraocular lens in front of natural lens (phakic IOL) or taking the place of the lens after its removal (pseudophakic IOLs).

Algorithms↗
PubMed2006

[The use of accommodative lenses for surgical correction of the presbyopia using the Prelex method].

The authors refer about their experience with the surgical correction of the presbyopia by means of the Prelex (presbyopic lens exchange) method. Patients, who underwent this type of refractive surgery procedure to decrease their dependency on glasses correction for far as well as for near vision (12 patients, 23 eyes) and 1 young female patient (2 eyes) with juvenile cataract and high hyperopia, were included in the study. The average age at the time of the surgery was 51.0 +/- 5.5 years (range, 19-77 years). The average follow up period of the whole group of patients is 9.8 months (range, 1-13 months). Depending on the type of the lens implanted, the group was divided into subgroup A with the accommodative lens 1 CU produced by Human Optics Company implanted, and subgroup B with the accommodative lens Kellan TetraFlex KH 3500 produced by LensTec Company implanted. The subgroup A consists of 8 patients (15 eyes) with the average preoperative refractive error +2.35 +/- 3.45 diopters. The average uncorrected visual acuity of this group was 0.24 +/- 0.18, and the average best-corrected visual acuity was 0.77 +/- 0.22 at the time before the surgery. The average glasses correction for near was +4.1 dioptres, and the uncorrected vision for near was Jaeger's table Nr. (J) 13. The B subgroup consists of 5 patients (10 eyes). The average preoperative refractive error was +2.23 +/- 0.93 diopters. The average value of the uncorrected visual acuity before the surgery was 0.43 +/- 0.28, and the average corrected visual acuity was 0.82 +/- 0.25. The average value of the glasses correction for near was +5.25 and uncorrected vision for near J 13. The final average postoperative error at the time of the last visit was in the A subgroup +0.06 +/- 1.17 dioptres. The average uncorrected visual acuity was 0.69 +/- 0.24, and the average best-corrected visual acuity 0.96 +/- 0.12. The average vision of the patients of this subgroup for near was J 3. In the B subgroup we found at the last visit the average final value of the postoperative refractive error -0.2 +/- 0.72 dioptres. The average uncorrected visual acuity 0.57 +/- 0.22 and the average corrected visual acuity 0.95 +/- 0.12. Average uncorrected vision for near was J 5. We did not notice any serious per- or postoperative complication of this procedure.

Accommodation, Ocular↗
PubMed2006

A new autosomal recessive syndrome consisting of posterior microphthalmos, retinitis pigmentosa, foveoschisis, and optic disc drusen is caused by a MFRP gene mutation.

PURPOSE: To describe the clinical and genetic characteristics of a new ophthalmic syndrome, which consists of posterior microphthalmos, retinitis pigmentosa, foveoschisis, and optic disc drusen, that segregates as an autosomal recessive trait in a family with four affected siblings. The membrane-type frizzled-related protein (MFRP) and CEH10 homeodomain-containing homolog (CHX10) genes, previously implicated in autosomal recessive forms of nanophthalmos/microphthalmos, were analyzed as candidate genes for this novel disease. METHODS: Complete ophthalmologic examinations were performed in four affected siblings and their parents. Ophthalmologic manifestations, fundus photographs, ultrasonographic (US) assessment, electroretinography (ERG), fluorescein retinal angiography (FA), Goldmann kinetic perimetry (GKP), and optical coherence tomography (OCT), as well as mutational status of MFRP and CHX10 genes in genomic DNA. RESULTS: In all affected siblings, ophthalmologic examination demonstrated normal horizontal corneal diameters and high hyperopia; funduscopy, ERG, and FA evidenced a progressive retinal dystrophy compatible with retinitis pigmentosa; A- and B-mode ultrasonography revealed decreased axial eye length and optic disc drusen; OCT showed localized macular retinoschisis. MFRP molecular analysis disclosed a one base pair insertion in exon 5 (c.498_499insC) in all affected individuals, a mutation that predicts a truncated protein (P165fsX198). Both parents were heterozygous for this mutation. CONCLUSIONS: A distinct autosomal recessive ophthalmic syndrome characterized by microphthalmos, retinitis pigmentosa, foveoschisis, and optic disc drusen is described. We demonstrated that this clinical association is caused by a mutation in MFRP, a gene previously implicated in isolated nanophthalmos. Our data indicate that defects in MFRP could be responsible for syndromic forms of microphthalmos/retinal degeneration and that this gene is necessary for photoreceptor maintenance.

Adult↗
PubMed1991

Vision screening of an adolescent inner city population: a high failure rate and low compliance on follow-up care.

625 inner city high school students were screened. Some 45.8% of this sample were designated as special education students. The referral rate was 52.3% for all students screened. Detailed failure rate by group and category are reported. Special education students had a higher incidence of uncorrected hyperopia and binocular dysfunction. Intervention strategies to improve a poor compliance rate for follow-up care are discussed.

Adolescent↗
PubMed1991

[Intermittent exotropia associated with accommodative esotropia].

Intermittent exotropia associated with accommodative esotropia is a rare particular type of strabismus. 8 cases of XT-ET were presented here. The clinical features of them were summarized as follows: 1. The age of onset was early. 2. The initial symptom was esotropia, exotropia was observed by doctor. 3. The most patients (6/8) associated high or medium hyperopia. 4. The AC/A rate were normal or lower than normal. 5. The angle of deviation varied with the examination, exotropia 30 degrees-15 degrees<-->orthophoria<-->esotropia 15 degrees-30 degrees. 6. The esotropia can be corrected with spectacles. The visual-vestibular interaction examination for eye movement were examined in 3 cases, but have no regular expression yet. Finally, the incidence (0.4%, 8/21 58) and treatment for this disease were discussed.

Accommodation, Ocular↗