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PubMed1994

Kenny-Caffe syndrome.

Kenny-Caffe Syndrome is rarely found. From 1966-1993 only 22 cases were reported worldwide. The author presented a case of Kenny-Caffe Syndrome who showed typical findings, i.e. short stature, small slender long bones with medullary stenosis, thickened cortex of the long bones, hypocalcemia with tetany at 1 month of age, hyperphosphatemia, hyperopia of both eyes and normal IQ. A review of the literature summarizing the clinical and laboratory findings of this syndrome is also presented.

Bone Diseases, Developmental↗

PubMed1995

Epidemiology of ametropia of U.S. Army recruits.

All people attempting to enlist in the U.S. Army must undergo a physical examination that requires a rudimentary vision screening. Those who pass the physical, upon reporting to basic training, are again evaluated and any treatment necessary to allow the recruits to function during their initial indoctrination is provided. Those who fail to see 20/20 O.D. and O.S. with their current spectacles fail the screening and are evaluated by an optometrist. If their condition is not disqualifying, appropriate correction is prescribed. We reviewed the records of all the recruits in a 1-month period who either required spectacles to see 20/20 or failed the screening at the 43rd AG BN (reception). Epidemiological evaluation revealed most to be either simple myopes or myopic astigmats. Hyperopia and hyperopic astigmatism accounted for the next most common diagnosis. Other conditions included anisometropia, antimetropia, amblyopia, keratoconus, and nystagmus. Examinations of these recruits were very limited, with dilated fundus evaluations being performed only when there was a high probability of a disqualifying condition. Therefore, it is unknown what retinal disease or degeneration may be present other than what would be visible with direct ophthalmoscopy.

Adolescent↗

PubMed1994

Hyperopic thermal keratoplasty procedure in a civilian air traffic controller.

Hyperopic thermal keratoplasty (HTK), also referred to as radial thermokeratoplasty, is one of several refractive surgery procedures in use to correct significant visual acuity problems. The current procedure was developed in the farmer Soviet Union, and was first performed in the U.S. in the early 1980's. The thermocoagulating unit used for the surgery is still considered an experimental device by the Food and Drug Administration, and as such requires a device exemption permit from that Agency for its use. The unit is used to coagulate corneal protein, which alters the shape of the cornea and hence its refractive power. No well-controlled series of patients followed over time exists to conclusively state the pros and cons of the procedure. Excimer laser surgery has been recently used as a substitute for the thermocoagulator, but experience is also limited. Lasers, nevertheless, show great promise for use in this procedure. While HTK has been shown to correct hyperopia, significant sequelae have been documented with the procedure; they have included unstable visual acuity, under- and overcorrection of acuity, damage to the cornea, and scarring. These sequelae may present a problem for individuals involved in aviation, where issues of visual acuity are critical. It is important to identify such individuals and monitor their vision status carefully prior to return to safety related duties.

Adult↗

PubMedDate not supplied

Soft toric lenses fitting for the ophthalmic technician.

1. Many ophthalmic technicians are familiar with fitting standard soft lenses that correct hyperopia and myopia. There is less confidence, however, in their proficiency with fitting soft toric lenses that correct astigmatism. 2. Performing accurate keratometry and refraction is an essential first step in fitting soft toric lenses. Familiarity with the different types of toric lenses is integral to an effective fit. 3. Knowledge of front and back surface toric lenses and their indications is of primary concern and allows for an effortless and successful fit.

Allied Health Personnel↗

PubMed1994

Ocular manifestations of Sotos syndrome.

BACKGROUND: Sotos syndrome (cerebral gigantism) is a congenital syndrome characterized by large body size for patient age, advanced bone age, and unusual facial characteristics with varying levels of cognitive, developmental and perceptual deficits. While more than 150 cases have been reported, only a single case report has been published in the ophthalmic literature. This study briefly reviews the pertinent aspects of this syndrome and reports on the medical, physical, developmental and ocular manifestations of 32 subjects. METHODS: Our patient population was obtained from several schools and colleges of optometry and private offices and clinics of optometrists and ophthalmologists. The Sotos Syndrome Support Association assisted in obtaining patients for this study as well. All children had been previously diagnosed as having SS. Commonly accepted methods for evaluating young, non-verbal, and/or handicapped children were used. RESULTS: Our findings indicate that moderate to high refractive error (hyperopia), nystagmus, and strabismus (esotropia) are commonly associated conditions of this syndrome. CONCLUSIONS: Since many of our subjects exhibited these amblyogenic precursors, a routine optometric vision evaluation should be an essential part of the individual educational and habilitation plan for all children with Sotos syndrome.

Abnormalities, Multiple↗

PubMedDate not supplied

[Mean-term variations of visual function of video display terminal operators: observations on 70 cases].

The aim of the study was to evaluate medium-term variations of visual functions in VDT operators and their possible relationship to VDT exposure. The clinical records of 70 VDT operators attending our outpatient service for periodical ergophthalmological evaluation were reviewed in order to evaluate the variation of some visual parameters after a two-years follow-up. These included refraction, phorias, fusional convergence and divergence, stereopsis. The group did not include subjects affected by hyperopia, large ametropias, or binocular vision disturbances and was divided into two subgroups: low exposure group (n = 20; < 4 hours/day) and high exposure group (n = 50; exposure > 4 hours/day). Asthenopia was frequent in both groups. Variation of refraction and binocular vision parameters were absent or rather limited in both exposure groups. This seems to indicate that in subjects without significant ophthalmological problems the risk of permanent functional damage is very low at medium-term.

Adult↗

PubMed1994

[Value of immersion B-scan ultrasonography in vitreo-retinal pathology].

Diagnosis immersion B Scan ultrasonography is very useful to study anterior segment lesions of the eye (angle of iris, anterior synechiae, iris and ciliary body tumors). We studied forty patients with posterior segment lesions of the eye with this technique. We think that it is useful to study anterior vitreous (cyclitic membranes, vitreoretinal relationships in front of ora serrata). It is useful to study the posterior segment of the eye with this immersion technique, in case of high hyperopia, microphthalmos, phtysis bulbi with retinal detachment and to evaluate acute vitreous hemorrhages, vitreous membranes in case of proliferation diabetic retinopathy, tractional retinal detachment and vitreoretinal adhesions. All the structures were better defined with the immersion technique than with the contact technique: with the immersion technique, these anterior structures are located close to the focus point of the probe (which is the case with the contact technique).

Eye Diseases↗

PubMed1993

[Anterior chamber dimensions in normal subjects on Kume Island, Okinawa].

The anterior chamber dimension and axial length were studied by photogrammetry and ultrasonography in 365 normal subjects over 21 years of age on Kume island, Okinawa. There was no difference between right and left eyes in the anterior chamber dimensions, corneal curvature, or axial length. Male subjects had a larger anterior chamber and longer axial length than female subjects. The volume, depth, and diameter of the anterior chamber diminished with age and degree of hyperopia. The axial length was related to the anterior chamber dimensions, corneal curvature, and degree of ametropia. The anterior chamber dimensions and axial length in subjects over 60 years of age on Kume island were significantly smaller than in normal subjects over 60 years in Tokyo.

Adult↗

PubMed1993

Possible errors in the measurement of retinal lesions.

PURPOSE: To determine the accuracy of the measurement of structure in the retina from fundus photographs. METHOD: A model eye was developed to measure the retinal image size of the Zeiss fundus camera. A x 10 microscope objective with a focal length of 16.41 mm was used together with a microscope graticule. RESULTS: Under emmetropic conditions the difference between the calculated and the measured magnification was 8.6%. The total change in magnification from myopia to hyperopia was -24.63% to +18.1%. When the camera position was altered with respect to the model eye by +/- 5 mm under myopic conditions the change in magnification was -4.5% and +6.8%. In the hyperopic condition the change was -5.6% to +4.6%. CONCLUSIONS: Measuring the size of structure in the retina from photographs may therefore prove to be inaccurate but in some circumstances determining the percentage change in size may prove more reliable.

Animals↗

PubMed1993

[Hereditary blepharophimosis with visual alterations].

We report a Mexican family with two members (mother and daughter) affected with blepharophimosis hereditary syndrome: ptosis of the eyelids, blepharospasm and epicanthus inversus. The daughter presented: hyperopia, astigmatism, hemispheric asymmetry, superficial mental deficiency and ovarian cyst. The mother with ophthalmological affectation, present too border line intellectual quotient. Clinical findings in this family illustrate autosomal dominant trait; differential diagnosis should be taken into account for genetic counselling.

Blepharophimosis↗

PubMed1993

Refractive state of aphakic and pseudophakic eyes of dogs.

Streak retinoscopy was performed by 5 ophthalmologists on 256 eyes (191 dogs) to determine their postoperative refractive state after cataract extraction. Aphakic and pseudophakic eyes that had been implanted with 1 of 5 intraocular lenses (IOL) with dioptric powers ranging from +14.5 to +38 diopters (D) were studied. By use of ANOVA, breed and body type of dog and individual performing refraction were found to have no detectable effect on final refractive state. Mean refractive state of aphakic eyes was +14.4 +/- 2.10 D. Mean refractive state for different IOL powers was as follows: +14.5 D IOL = +11.54 +/- 1.18 D (n = 13); +30 D IOL = +5.15 +/- 1.18 D (n = 105); +34.0 D IOL = +3.5 D (n = 1); +36 D IOL = +2.34 +/- 0.73 D 9 (n = 61); and +38 D IOL = +1.41 +/- 0.56 D (n = 28). Residual hyperopia ranged from +0.5 D to +2.5 D with +38 D IOL, and no eyes were myopic (overcorrected) by use of any of the IOL studied. Linear regression analysis of refractive state on IOL power for all dogs predicted that dioptric strength of +41.53 D was necessary to best approximate emmetropia for the population as a whole. Body type of the dog had only slight effect (< 1.0 D) on predicted optimal IOL power. Further linear regression analysis of the 7 breeds studied predicted variations from +39.62 to +43.14 D in IOL powers necessary to approximate emmetropia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Phototherapeutic keratectomy: long-term results in 166 eyes.

One hundred sixty-six eyes with corneal disease were treated with the excimer laser in order to ablate opacities, irregularities, or to improve wound healing. Postoperative follow up time was 15 months (range 6 to 28 months). An individual goal was set for each patient and 84% achieved the goal. The visual acuity change is given for each subgroup. Phototherapeutic keratectomy (PTK) was shown to be an advantageous surgical method, where the success is in the careful preoperative evaluation. One problem with the technique is the induced hyperopia.

Adult↗

PubMed1995

Ocular dysfunction associated with mental handicap.

The aim of this article is to show the main general and ocular characteristics of a group of 46 mentally handicapped people of different IQ and age who were provided with visual care. Many different syndromes and neurological alterations have been described in the literature. The case types and number of people studied for each condition attending our clinics were: syndromes: Down's (25), Soto (2), West (2), Rubinstein-Taybi (1), triple X (1); neurological conditions: cerebral palsy (8), microcephaly (5), hydrocephaly (2). In our study the ocular findings were high incidence of ametropies: 58.7% hyperopia, 21.7% myopia, 19.5% astigmatism and 28% strabismus.

Adolescent↗

PubMed1996

[Rapid eye fatigue--causes and therapy].

Tired eyes even after a short period of strain are well known as asthenopia. This term derives from a Greek expression meaning 'weak eye'. The following reasons are to be taken into account: uncorrected refractional errors such as hyperopia and astigmatism, accommodative and fusional defects and heterophoria, or combinations there of. With many cases of asthenopia the clinical symptomatology may resemble an organic eye disease or an affection of the brain [dry eye, Graves' disease, myasthenia, special form of essential blepharospasm, neurogenic latent eye muscle palsies, narcolepsy]. It is the aim of a precise patient's history to differentiate between functional and organic causes. By means of case reports and diagnostic tools, the development of symptomatology and the therapy are discussed.

Accommodation, Ocular↗

PubMed1995

Progressive hemifacial atrophy. A natural history study.

PURPOSE: To describe two very different natural history courses in 2 patients with hemifacial atrophy. Progressive hemifacial atrophy (Parry-Romberg syndrome, Romberg syndrome, PHA) is characterized by slowly progressive atrophy, frequently involving only one side of the face, primarily affecting the subcutaneous tissue and fat. The onset usually occurs during the first 2 decades of life. The cause and pathophysiology are unknown. Ophthalmic involvement is common, with progressive enophthalmos a frequent finding. Pupillary disturbances, heterochromia, uveitis, pigmentary disturbances of the ocular fundus, and restrictive strabismus have also been reported. Neurologic findings may be present, but the natural history and progression of ocular findings are often not described in the literature. METHODS: We studied the records and present findings of 2 patients with progressive hemifacial atrophy who were observed in our institution over a 10-year period. RESULTS: Both patients showed progression of ophthalmic findings, primarily on the affected side. One patient has had chronic uveitis with secondary cataract and glaucoma, in addition to retinal pigmentary changes. She also had a third-nerve paresis of the contralateral eye and mild seizure activity. The other patient had mild uveitis, some progression of unilateral retinal pigmentary changes, and a significant increase in hyperopia in the affected eye, in addition to hypotony at age 19 without a clear cause, but with secondary retinal and refractive changes. CONCLUSION: Ocular manifestations of progressive hemifacial atrophy are varied, but can progress from mild visual impairment to blindness.

Adult↗

PubMed1996

Morphological and biomorphometrical observations on laser thermal keratoplasty. Histological and biomorphometrical examination of the relationship between refractive change and the volume following Cr:Tm:Ho:YAG laser treatment.

Laser thermal keratoplasty (LTK) is currently under clinical trial for the correction of hyperopia and hyperopic astigmatism by means of collagen coagulation in the peripheral cornea. The purpose of our study was to optimize the ratio between the volume of damaged corneal stroma and the refractive effect so as to minimize potential side effects such as endothelial damage or induction of glare phenomena. We therefore performed histological and morphometrical examinations of enucleated pig eyes to determine the relationship between the coagulated stromal volume and the refractive change after LTK using a pulsed Cr:Tm:Ho:YAG laser (wavelength 2.12 microns) on enucleated pig eyes. The refractive change was documented with a Littman ophthalmometer. Morphometrical analysis was performed using polarized light microscopy of sirius red-stained specimens. This special stain separated the thermally changed stroma into a dark nonbirefringent center and a birefringent peripheral zone. The volume of both zones was positively correlated with the refractive change induced. The volume was in turn influenced by the choice of laser parameters. From the ratio of the volume to the refractive change it was found that pulse energies above 30 mJ let to an enlargement of the coagulation volume without increasing the refractive change effectively. The use of high pulse energies did not improve the effect of LTK but only increased the risk of unwanted side effects. However, an increase in the laser repetition rate at a constant pulse number per spot led to refractive changes with minimal coagulation volume. The highest relative refractive change was achieved with a dark central zone and a birefringent zone, each having a volume of about 50-80 x 10(-3) mm3.

Animals↗

PubMed1996

[Effects on visual functions following several hours' usage of a head mounted display].

We investigated the effects of viewing video movies with a head-mounted display (HMD) for 4 to 6 hours on visual functions such as refraction, visual acuity, and accommodation-vergence system. Two or three video movies were watched without any breaks by 13 normal volunteers (age: 22 approximately 40). Measurements were made of (1) objective and subjective refraction, (2) corrected visual acuity, (3) tonic level and step response of accommodation with a computer-assisted infrared optometer, and (4) near and far phorias and AC/A ratio. Significant transient myopia was found following 4 hours' viewing, but not following 6 hours' viewing. Scrutinizing individual data, myopia was consistently found in some subjects, and hyperopia in others. We presumed that many subjects might have been influenced by initial instrumental myopia when they adjusted the focus by using the mechanism built in the HMD. No significant change was observed in any other examination. However, there was a tendency for the AC/A ratio to change after a short time, and then to recover to its original value. Based on the results in this study, it appears that some changes in accommodation and vergence systems are caused by viewing video movies with the HMD. Although the amount of changes was within normal physiological variation in this study, the possibility still remains that usage for a longer time may lead to other changes in visual function. Care is also necessary when using the HMD in subjects with subclinical problems.

Accommodation, Ocular↗

PubMed1996

Crystalline lens parameters in infancy.

Despite the importance of lens power to ocular development, few data are available regarding infant crystalline lens parameters. Lens and corneal radii of curvature were measured in the horizontal meridian using a video-based keratophakometer, and refractive error was measured by cycloplegic retinoscopy in 19 out of 27 infants ranging in age from 3 to 18 months. The median refractive error was +1.50 D, and the median corneal power was 43.5 D. Using previously reported values for axial ocular dimensions, the median anterior and posterior lens radii of curvature were 8.7 and 5.6 mm, respectively, both substantially flatter than infant schematic eye values. The median equivalent refractive index of the lens was 1.49, considerably higher than previous reported schematic values for infants or children. There was a significant reduction in hyperopia with age (r = -0.47, P = 0.043), but no age-related trends in lens or corneal radii of curvature, suggesting that calculated values for lens power and equivalent index may undergo substantial decline with age during early childhood development as axial length increases. Most of the decrease in lens power (75%) may be due to decreases in equivalent index rather than to flattening of the surface radii of curvature. Videophakometry appears to be a feasible and useful technique for documenting the role of the crystalline lens in infant ocular development.

Anthropometry↗