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Interventions for intermittent distance exotropia: review.
PURPOSE: Management decisions in intermittent distance exotropia vary and lack well-defined clinical guidelines. We undertook a systematic review in an attempt to clarify the effects of various surgical and nonsurgical treatments and to establish the significance of factors such as age with respect to outcome. The review was undertaken in collaboration with the Cochrane Eyes and Vision Group. METHODS: Electronic and manual searches were undertaken to identify randomised controlled trials of surgical or nonsurgical treatments for intermittent distance exotropia. We also contacted researchers active in this field for information about further published or unpublished studies. There were no language restrictions. Study abstracts identified from the searches were analysed independently by the two reviewers (SR and LG) and marked for inclusion, exclusion, or consideration. Reviewer analysis was compared and full papers for appropriate studies were requested. RESULTS: No randomised controlled trials were found that met our selection criteria. CONCLUSIONS: The current literature consists mainly of retrospective reviews. These are difficult to compare and analyse due to variations in definition, intervention criteria, and outcome measures. However, there appears to be an agreement that the nonsurgical treatment is more appropriate in small-angle deviations or as a supplement to surgery. Studies supporting both early and late surgical intervention were found, so the optimal timing of surgical intervention could not be concluded. There is a need for robust clinical trials to improve the evidence base for the management of this condition.
Abnormalities on the multifocal electroretinogram may precede clinical signs of hydroxychloroquine retino-toxicity.
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The natural history of Vigabatrin-associated visual field defects in patients electing to continue their medication.
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Colour blindness.
The physiology of colour vision is discussed; as is the way in which the human eye can detect various combinations of red, green and blue. Red-green colour blindness, with X-linked inheritance, is the most common, but other types are also considered. Methods of testing relating to the age of the child are reviewed. The use of colours in teaching is widespread, but there is controversy over the difficulties this may cause a colour blind child. A review of the literature does not reveal much information on this, and any problems that do arise are likely to be individual to the child, and to depend on such factors as overall intelligence, the attitude of the teacher, and the personality of the child. There is not doubt that it is essential to recognise colour vision defects when it comes to choosing a career, and that tests must be done during secondary schooling, but in order to avoid some affected children being disadvantaged there is enough evidence to support testing at school entry.
Visual impairment in adult people with intellectual disability: literature review.
The present paper reviews studies on the prevalence of visual impairment (VI) in adults with intellectual disability (ID). Every publication describes an alarming prevalence of blindness and VI. Cataract and keratoconus were common. Many cases of poor distance vision were treatable by ordinary spherical or astigmatic glasses, but few people had had such prescriptions. Elderly residents in community and institutional care often did not receive glasses for near vision. Professional assessments disclosed higher prevalences of VI than questionnaires mailed to the care personnel. The prevalence of VI increased dramatically with the severity of ID and with age. Regular professional assessment of eye disorders, visual acuity and refraction are warranted in residents in both hospital and community care.
Refractive surgery and diplopia.
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Diabetic retinopathy: yet another reason for a comprehensive eye-care programme for Australian Aborigines and Torres Strait Islanders.
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Swedish school nurses' view of school health care utilization, causes and management of recurrent headaches among school children.
The present survey was addressed to a representative, nationwide sample of Swedish school nurses and 174 (69%) responded. They were asked about their views on: (i) the most usual problems for students that prompt attendance at school nurses' offices; (ii) the causes and management of school children's headaches and (iii) the school nurses' own education with respect to headaches. Headaches were reported to be one of the most common problems among adolescents visiting the school nurses' offices and tension-type headaches were regarded as a more serious school health problem, compared with migraine. Various stressors such as family and peer problems were regarded as important causes of recurrent headaches. In addition, the school nurses mentioned too little physical activity, sleep problems and poor eating habits as related factors, in particular among students with tension-type headaches. Common management approaches used by the school nurses were to provide information about headaches or supportive discussion, recommend follow-up visits, perform vision tests and refer students to a school physician. About one-fifth to one-third of the school nurses often gave analgesic medication to students because of headaches, most commonly used were paracetamol followed by various NSAIDs. Most of the school nurses regarded relaxation training as an "effective or very effective" treatment for both migraine and tension-type headaches, whereas palliative and prophylactic drug treatments were seen as more effective for migraine. It is suggested that school nurses, who often provide the first line of treatment for school children and adolescents with recurrent headaches, also should administer a cost-effective treatment such as relaxation training in school settings, where many of the headache episodes occur. However, school nurses also need to be properly trained to ensure quality in delivering such treatment approaches.
Interfacing the Shin-Nippon autorefractor SRW-5000 with a personal computer.
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Detection of uveal melanoma by optometrists in the United Kingdom.
In the United Kingdom, most uveal melanomas are detected by optometrists. Prospectively collected data on patients with uveal melanoma presenting to optometrists were analysed retrospectively to determine: (a) the proportion of patients who were asymptomatic at the time of tumour detection, (b) the proportion of symptomatic patients reporting that their tumour was missed at their initial presentation and (c) the clinical features related to immediate tumour detection. The 223 patients had a mean age of 59.7 years, a mean tumour diameter of 11.3 mm and a mean tumour thickness of 4.6 mm. Symptoms were present in 122 patients (55%) and were associated with large tumour size (p < 0.0001) and male gender (p = 0.003), with more males tending to have a large tumour (p = 0.004). Seventy-nine percent of symptomatic patients reported that their tumour was detected at their first visit. Failure of tumour detection in symptomatic patients was associated with absence of tumour extension posterior to equator (p < 0.0001).
Where is the vision for fall prevention?
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[Job profile of the eyes of police executive power officials].
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[Diabetic retinopathy and associated risk factors in type-1 and type-2 diabetics in the Upper Palatinate].
BACKGROUND AND OBJECTIVE: Diabetic retinopathy is the main cause of blindness in industrial countries. This study was undertaken to determine the prevalence of diabetic retinopathy and risk indicators among volunteers in a rural district in Bavaria, Germany. PATIENTS AND METHODS: Using a mobile survey unit, we investigated 627 diabetic volunteers (275 women, 352 men, mean age 64.5 +/- 12.5 yr) in 23 cities and villages. One retinal Polaroid photo was taken per eye, using a non-mydriatic camera (Canon CR4-45 NM). RESULTS: In 60 subjects (9.6%) retinal photographs were not assessable. Among the remaining 567 patients (76 type-1 diabetes, HbA1c 7.3 +/- 1.2% and 491 type-2 diabetes, HbA1c 7.7 +/- 1.5%) in 72.3% no retinopathy was found (57.9% type-1 diabetes/74.5% type-2 diabetes). Non-proliferative retinopathy was diagnosed in 22% (38.2%/19.6) and proliferative retinopathy in 5.6% (3.9%/5.9%). Photocoagulation scars were present in 6.1% (11.7%/5.3%) and macular oedema in 11.8% (14.1%/11.6%). In 6.1% (5.3%/6.6%) of patients visual acuity was less than 0.1 in at least one eye. The degree of retinopathy was found to be related to the duration of diabetes mellitus, age at onset, glycaemic control (HbA1c), blood pressure and symptoms of neuropathy. CONCLUSIONS: The prevalence of retinopathy of 22.0% in the study group was found to be low for non-proliferative diabetic retinopathy, perhaps due to the methods used and/or good or acceptable glycaemic control measured as HbA1c.
Visual outcome in children with congenital hemiplegia: correlation with MRI findings.
Fourteen children with congenital hemiplegia were studied with a detailed assessment of various aspects of vision (linear acuity, stereopsis, visual fields) and MRI. The aim of this study was to evaluate the effect of a congenital lesion on visual function. The results showed a very high incidence (78%) of children who had abnormal results on at least one of the visual tests. Visual abnormalities were not correlated with the clinical severity of hemiplegia or with a specific pattern of lesion on MRI. Similarly no constant association could be found between visual structures (optic radiations and primary visual cortex) and visual function. Finally, our results would suggest that all the children with congenital hemiplegia need to be investigated irrespective of the clinical severity or of the type or the extent of the lesion. This would help to identify children with minor visual abnormalities which can affect everyday life performance.
[Driving behavior of patients before cataract operation--is an unlimited driver's license justifiable? Results of an analysis of 1,124 patients of the ophthalmology department of a central hospital].
BACKGROUND: The aim of the study was to evaluate the driving habits and patterns of those patients, who underwent cataract-surgery during a one year period at the Landesaugenklinik Salzburg and to compare the preoperative visual acuity with the legal requirements in effect in Austria. MATERIALS AND METHODS: The best-corrected visual acuity prior to surgery and the individual driving customs were noted on a detailed questionnaire. RESULTS: A minimum of 5.6% of the overall number of patients with cataract (not taking visual field defects into account) were driving a motor vehicle with a visual acuity not sufficient to meet current legal requirements. Considering only those drivers licence holders that admitted to still driving a motor vehicle it can be concluded that 26% have a legally unsatisfactory visual acuity. As between 28,000 and 31,000 cataract-operations are performed yearly in Austria, this study seems to clearly indicate that at least 1,600 of these persons--regardless of an additional visual field defect--are illegally driving a motor vehicle. It can be additionally concluded that the number of undetected cases is significantly higher. CONCLUSIONS: It therefore seems appropriate to call for a mandatory eye exam by a qualified ophthalmologist of all persons holding a driving licence, possibly beginning at the age of 60. The license issued thereafter should be valid for an age-related period of time only.
[Ophthalmoscopic evaluation of ocular fixation in children up to 2 years old].
BACKGROUND: The examination of fixation on the fundus oculi is one of the main points in the diagnosis of amblyopia. Therefore it is necessary to describe the fixation ability and to clarify at what age children can fixate foveally and at what age this examination can be carried out, considering not only physiological aspects, but also co-operation reasons. PATIENT AND METHODS: Fixation on the fundus oculi was examined in 111 children aged between 1 and 25 months with the ophthalmoscop-star. This examination was carried out in 64 cases by a second and in 15 cases by a third examiner on the same day. RESULTS: During the first 3 months of age children cannot fixate foveally, one can observe instead, a kind of scatter at the posterior pole in a diameter of about 5 degrees. In the course of the 4, and 5, month of age foveal fixation develops. Repeated examinations of the same child on the same day by a 2, and 3, examiner reveal a very high rate of accordance (78%) of their results. CONCLUSIONS: The examination of fixation on the fundus can be carried out at 4 to 5 months of age. At that age one can differentiate quite reliable between a foveal and eccentric fixation as well as scatter at the posterior pole. The rate of accordance 78% with this fixation examination by several examiners shows that same reliability of this examination carried out in school children and adults. Comparing this result with fixation examination carried out with the Haidinger brushes then one must calculate with a fault rate of about 20% when examining with the ophthalmoscope, considering that the examination with Haidinger brushes as a reference examination.
[A new photographic method for measuring squint angles in infants and small children].
A new photographic method for measuring squint angles in children and infants is presented. A photographic picture is taken from the subject, using a camera with the three flashes bulle. One flashbulle is placed vertically over the lens, two other flashbulles are placed symmetrically in an angle of 10 degrees beside the middle flash. Six reflections can be seen on the photographic picture in each pupil. (1. and 4. Purkinje Sanson Images of each light source.) The horizontal distance of two reflections is determined by the distance of the flashguns. If the reflection lines in both eyes are symmetrical, there is no squint. If there is a shift, it can be measured on the slide and by using a simple formula the squint angle can be calculated. The accuracy of the method is between 2 and 3 degrees.