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PubMed2001

Distant cancer effects on standardised testing of peripheral vision.

BACKGROUND: Profound central-retinal visual losses have been a major presenting factor reported in cancer and melanoma associated retinopathies (CAR, MAR). However, it is well established that standardised tests of peripheral retinal function are often the most sensitive detectors of early eye disease. This is a preliminary investigation of the responsiveness of the peripheral retina to "distant" (non-eye or CNS) cancers using easily obtained standardised tests. METHODS: The design is a single blind study where test results are compared with published norms and a small age matched control group. Of 120 ambulatory cancer outpatients who were interviewed at routine follow up examinations, 111 volunteered and admitted a range of mild visual changes. 25 cancer patients completed all tests of peripheral vision function and a clinical screening. There were seven control subjects of the same age range. RESULTS: 98% (49 of 50) of eyes from the patient cohort were judged clinically normal following examinations which emphasised the central retina, fundus appearance, and static fields. On testing which emphasised the visual periphery, 46 (92%) eyes showed one or more quantitative abnormalities >2 SD from the age adjusted norm means. These abnormalities clustered mainly about dark adaptation (rod cell) sensitivity (31, 62% of measured sites), the blue sensitive retinal cells (17, 34% of measured eyes), and the oscillatory component (OP) of the electroretinogram (23, 46% of measured eyes). One control eye (7%) showed a significant dark adaptation abnormality and ERG reduction. There was no identifiable interaction between chemotherapy mode and the cancer associated retinal deficits (CARD). Antiretinal antibodies were found in sera from most patients and controls. CONCLUSION: CARD is common in the retinal periphery of many cancer patients, and is distinct from rare CAR, MAR central-retinal responses. CARD has numerous potential clinical uses which justify expanded research with more defined large samples.

Adaptation, Ocular↗
PubMed1997

Impaired vision in the elderly: a preventable condition.

BACKGROUND: Vision is thought to deteriorate with age as a number of factors in later life endanger eyesight. Assessment of the visual acuity of the elderly and identification of endangering factors help in detecting those with impaired vision which in turn impairs daily activities. OBJECTIVE: This study measured the visual acuity of the senior citizens and identified those with impaired vision. The probable contributing factors for impaired vision were studied with the aim of preventing visual impairment. METHOD: The study was part of a screening campaign for elderly glaucoma in the community. A convenience sample of ambulatory senior citizens from stratified localities had their visual acuity measured with a standard Snellen's chart. The test was repeated with pinholes if the visual acuity was less than 0.5. Those without improvement after pinhole were considered as having impaired vision. People with elevated intraocular pressure by the Pulsair were selected for examination by an ophthalmologist for ocular pathology. RESULTS: For the ambulatory population aged > or = 65 the mean visual acuity of either eye before pinhole was 0.3. Nearly 72% had impaired vision (visual acuity not corrected above 0.5 with pinhole). There was a significant association between this impairment and female sex, history of diabetes mellitus or glaucoma, cataract, and infrequent eye examination. CONCLUSION: Impaired vision is highly prevalent in the elderly ambulatory population, a condition which is preventable by tight surveillance of predisposing factors and regular simple measurement of visual acuity. The primary care setting is most suitable for these activities.

Age Distribution↗
PubMedDate not supplied

Assessment of stereopsis in rhesus monkeys using visual evoked potentials.

Rhesus monkeys can have deficiencies in stereo vision, making it necessary to screen monkey subjects intended for single cell studies of stereo-based depth processing. We measured VEPs in two monkeys using a dynamic random-dot display in which a stereo-defined checkerboard reversed in depth. Monkeys fixated upon a small dot during stimulus presentation. One monkey showed clear evoked potentials in response to changes in disparity that were similar to those obtained in human subjects, using an identical stimulus paradigm. Controls with presentations of the monocular stimulus sequences (in which no depth reversal can be perceived) yielded no or much weaker VEPs. In the other animal, however, there was no difference in evoked potential between the two conditions. These electrophysiological findings closely match the performance of these same two subjects in a disparity discrimination task in which they were previously trained. We conclude that VEPs using this type of stimulus display can be used to screen monkeys for single cell or behavioral studies of stereopsis.

Animals↗
PubMed1997

Retinal changes associated with tamoxifen treatment for breast cancer.

PURPOSE: This study was undertaken to estimate the incidence of retinal changes and determine the prevalence of ocular toxicity associated with tamoxifen treatment in a breast cancer population. METHODS: The study was based on a population cross-sectional survey, including 290 patients taking tamoxifen from 6 months to 12 years; 274 patients were analysed. The main outcome measures were the incidence of retinal changes and visual impairment. RESULTS: The incidence of retinal changes was 0.9% (3 of 274 patients). All 3 patients were asymptomatic. The length of tamoxifen treatment ranged from 39 months to 120 months in the affected patients, with cumulative tamoxifen doses ranging from 23.7 g to 73 g. CONCLUSIONS: Retinopathy in patients receiving low doses of tamoxifen is rare and, in our study, did not result in changes in visual acuity. We found no retinopathy in patients receiving tamoxifen within the first 3 years of treatment or in patients receiving a total tamoxifen dosage of less than 23.7 g. Although retinopathy can occur in a tamoxifen-treated population, its low incidence and an associated good prognosis for vision does not merit special screening for this problem.

Aged↗
PubMed1994

An overview of the progression of diabetic retinopathy with treatment recommendations.

The American Academy of Ophthalmology and the National Eye Institute's national eye health care program's goals are to eliminate preventable blindness as a sequala of diabetes by the year 2000. To successfully implement the program, there needs to be a collaborative effort between primary care providers and ophthalmologists. The various primary health care providers treat approximately 80% of the diabetic population and are therefore in an excellent position to screen patients at risk for vision threatening problems and arrange for timely ophthalmic referral. This article provides an overview of the progression of diabetic retinopathy, the latest research findings and the recommendations for treatment and eye care guidelines set forth by the American Academy of Ophthalmology and the American Diabetes Association. Patient education, early recognition of asymptomatic ocular manifestations, and timely referral and treatment are the keys to prevent blindness.

Diabetic Retinopathy↗
PubMed1998

Development of a magnocellular function in good and poor primary school-age readers.

BACKGROUND: Abnormal functioning of the transient visual pathway (the M-pathway) has been implicated in specific reading disability (SRD). The aim of this study is to examine the contrast thresholds for flicker-defined form discrimination in primary school children, and to compare its development with reading and mentation development as a means of identifying children at risk of SRD. METHODS: One hundred eighty-seven children (aged 4 to 13 years) and 22 adults (aged 18 to 45 years) were assessed for contrast sensitivity to an illusory, flicker contrast-defined form (the letter 'E')--a task which was designed to rely to a large extent on magnocellular pathway function. Reading age (Neale Analysis of Reading) and mental age (Raven's Coloured Progressive Matrices) were assessed in the children, who had been previously screened for clinically normal binocular vision and refractive anomalies. RESULTS: The ability of primary school-age children to discriminate the orientation of the low contrast flickered letters (from a choice of 4) showed a significant improvement from kindergarten (ages 4 to 6 years) to grade 3 (ages 8 to 10 years) and older age groups. No significant difference was found between good and disabled readers (at least 1-year lag in reading readiness for the kindergarten group and 2-year lag in reading performance for 8 to 10 and 10 to 12-year-olds). CONCLUSIONS: It appears that there is a developmental improvement in perceptual capacity for tasks attributed to magnocellular function, which plateaus at the age of about 8 to 10 years. However, despite the reported reduction of magnocellular function in specific reading disabled children, no significant difference in contrast threshold for flicker-defined letter discrimination was found between good and poor readers.

Adolescent↗
PubMed2004

The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial.

OBJECTIVES: To test whether Stepping On, a multifaceted community-based program using a small-group learning environment, is effective in reducing falls in at-risk people living at home. DESIGN: A randomized trial with subjects followed for 14 months. SETTING: The interventions were conducted in community venues, with a follow-up home visit. PARTICIPANTS: Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling. INTERVENTION: The Stepping On program aims to improve fall self-efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower-limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two-hour sessions were conducted weekly for 7 weeks, with a follow-up occupational therapy home visit. MEASUREMENTS: The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant. RESULTS: The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50-0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community-residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17-0.59). CONCLUSION: The results of this study renew attention to the idea that cognitive-behavioral learning in a small-group environment can reduce falls. Stepping On offers a successful fall-prevention option.

Accidental Falls↗
PubMed1999

Home schooled children: a pediatric perspective.

To explore the attitudes and self-assessed knowledge of pediatricians regarding home schooling and determine whether practices provide preventive services typically rendered by the school system, we surveyed pediatricians in Wisconsin and Maryland (high versus low rates of home schooling, respectively). Of the 598 (53%) responding, only 18% supported home schooling. They judged home-schooled children to perform at an average (58%) or below average (12%) level on standardized tests and regarded them to be less mature than their peers (51%). These opinions differ from studies published in the educational literature. Many practitioners do not perform routine vision (18%) or hearing (83%) screens or monitor for overdue immunizations (71%). As pediatricians and child advocates, we need to become more knowledgeable about home schooling and provide preventive services for these children.

Child↗
PubMed1983

The effectiveness of auxiliary prescription labels: a pilot study.

Affixed auxiliary prescription labels are widely used in the practice of pharmacy because they supposedly provide the patient with pertinent information that is not contained within the prescription signature. Yet, whether the labels are effective is not known, nor is it known whether the label's elements, such as color, form, and logo, affect perception of the written text. Sound scientific analyses of these questions are limited. Therefore, a pilot study involving a series of experiments was designed to determine whether individual perception of pertinent information is affected by the use of affixed auxiliary prescription labels. The second objective of this study was to evaluate how color and logo differences affected perception of the label's written text. Participants were selected for the experiments after being screened for color blindness, corrected vision, and, in some cases, previous pharmacy employment. Subjects viewed labels affixed to prescription vials via a two-channel tachistoscope. The tachistoscopic methodology measured perception, and its accuracy was verified through a forced-choice instrument. Results from the pilot study were threefold: (1) a sound scientific analysis found affixed auxiliary labels to be effective, (2) significant variance could be attributed to both individual and subject differences, and (3) the unique effects of color and logo could not be determined.

Adult↗
PubMedDate not supplied

A simple screening test for color matching in dentistry.

This study compared a simple and readily available shade guide color-matching test with the general industry standard test for color discrimination. This study indicates that a simple screening test for color defective vision and color discrimination skills in dentistry can be performed by matching two Vita-Lumin shade guides. Those dental office personnel who score a low number of matches in the Vita test (that is, seven or fewer correct matches) should have additional color discrimination testing and refer shade matching to other personnel with higher scores.

Adult↗
PubMed1990

Normative data for the standard pseudoisochromatic plates--Part 2.

The Standard Pseudoisochromatic Plates--Part 2 are designed as a screening test for acquired color vision deficiencies. In order to control for age-related changes in color vision, it is necessary to establish norms for this test. Results from this study suggest that, disregarding one figure on the first test plate, one or more blue-yellow errors indicate a blue-yellow color vision defect for patients between 20 and 60 years, whereas two or more blue-yellow errors are indicative of a blue-yellow color vision defect for patients under 20 years and over 60 years. For modified red-green test figures, one or more errors are suggestive of a red-green defect for patients under 60 years, whereas two or more errors indicate red-green vision defect for patients over 60 years. Asking patients to judge which figure is more distinct on each test plate is not useful in comparing responses between patients.

Adolescent↗
PubMed1989

[An epidemiologic study of glaucoma in Shunyi County, Beijing].

An epidemiologic survey of glaucoma was conducted Feb.--July, 1985, in Shunyi County of Beijing, revealing that the prevalence of glaucoma was 0.60%, which consisted of angle closure glaucoma 0.41%, and open angle glaucoma 0.11%. The prevalence of primary glaucoma was 1.40% in persons over 40 years of age, accounting for 9.28% of the blind and 16.67% of the low-visioned. The methodology for glaucoma screening was discussed.

Adolescent↗
PubMed1997

A study of ocular morbidity among elderly population in a rural area of central India.

A cross-sectional study was conducted in five randomly selected villages in Wardha district of Maharashtra state to study the magnitude and factors related to the prevalence of ocular diseases among the elderly population. A total of 903 persons above 50 years were screened. The prevalence of low vision was 32% while that of blindness was 12.2%. Ocular morbidity rate was 1.21 lesions per elderly person and it increased significantly with increasing age (p < 0.001). Ocular diseases were found to be more prevalent among males, low socio-economic status group and landless labourers (p < 0.001). There was a high prevalence of refractive errors (40.8%), cataract (40.4%), aphakia (11.1%) followed by pterygium (5.2%), glaucoma (3.1%) and corneal opacities (3%). Prevalence of diseases of the lens and iris increased significantly with increasing age (p < 0.001). There is a need to evolve strategies for reducing the burden of ocular diseases and improve geriatric eye health under the existing infrastructure of health care delivery in our country.

Aged↗
PubMed2005

[Diabetic retinopathy. Current opinion on pathophysiology, diagnostics and therapy].

Diabetic eye disease affects quality of life for patients with diabetes by decreasing visual acuity and increasing the risk of blindness. In the course of diabetic retinopathy (DR) the loss of capillary integrity, microaneurysm formation, and ischemia is observed, which in turn drives the progression of DR. The macular edema is the result of fluid accumulation in the retina secondary to capillary leakage and/or microaneurysms. This contributes to loss of vision in DR. There is substantial evidence that control over metabolic factors can effectively prevent the development and progression of DR. For many patients who fail to achieve the optimal level of metabolic control the standard care should include the early detection and timely treatment of DR. Laser photocoagulation therapy, and vitrectomy are invasive methods, recommended to treat only the late stages of disease. A number of pharmacological agents that could slow the progression of DR in earlier stages are now being tested. It is likely that at least one of these agents, will be effective in reducing the progression of DR and the associated vision loss. With the introduction of these drugs in the coming years, there will be a need for improved screening and monitoring of patients with DR. New technologies are giving patients more access to optimal screening and may make this a more achievable goal.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Recommendations for the school health physical examination in Lebanon.

School health developed gradually over the years; starting with efforts to keep contagion out of schools to global programs of comprehensive services. One of its components, school medicine, covers screening examinations, record maintenance, emergency care, immunization monitoring and health counseling. This paper proposes the essential health activities to be performed during a screening school examination in Lebanon. The recommendations are based on a combination of international literature review of evidence and the existence of Lebanese epidemiological reports identifying specific problems. Vaccination record review, tuberculin testing, vision, hearing, dental and skin disorders screening procedures are proposed as essential activities of the school physical examination.

Child↗
PubMed1994

Computer-aided mammographic screening for spiculated lesions.

PURPOSE: To study the use of a computer vision method as a second reader for the detection of spiculated lesions on screening mammograms. MATERIALS AND METHODS: An algorithmic computer process for the detection of spiculated lesions on digitized screen-film mammograms was applied to 85 four-view clinical cases: 36 cases with cancer proved by means of biopsy and 49 cases with negative findings at examination and follow-up. The computer detections were printed as film with added outlines that indicated the suspected cancers. Four radiologists screened the 85 cases twice, once without and once with the computer reports as ancillary films. RESULTS: The algorithm alone achieved 100% sensitivity, with a specificity of 82%. The computer reports increased the average radiologist sensitivity by 9.7% (P = .005), moving from 80.6% to 90.3%, with no decrease in average specificity. CONCLUSION: The study demonstrated that computer analysis of mammograms can provide a substantial and statistically significant increase in radiologist screening efficacy.

Algorithms↗