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[Color vision in glaucoma].

This article is a general view of evaluated acquired color vision defects in the early stages of primary glaucoma and in patients at risk for glaucoma. The articles published until now indicates a decrease in color discriminating sensitivity in the short wavelength part of the visible spectrum in patients with glaucoma as well as in patients with ocular hypertension. It has been found a positive correlation between the blue-yellow color vision defects and the perimetric changes in the glaucomatous eyes. Blue-yellow color vision testing with the anomaloscope may serve as an additional test in the early diagnosis of glaucoma but the absence of dyschromatopsia does not exclude the disease.

Color Perception↗

[Analysis of the clinical effectiveness of vitrum vision in the tired eye syndrome and senile macular degeneration].

The paper evaluates the clinical effectiveness of Vitrum Vision ("Unifarm") that contains a complex of carotenoids, vitamins, and trace elements, which is adapted to ocular tissue metabolic features, in the tired eye syndrome and senile macular degeneration. The use of Vitrum Vision in patients with the tired eye syndrome improved the basic parameters of photosensitivity and increased the reserve of relative accommodation and in those with myopia enhanced uncorrectable visual acuity, ameliorated the magnitude of subjective visual and ocular symptoms, and increased the duration of a visual load until sensations of eye tiredness appeared. The administration of the drug in all clinical forms of senile macular degeneration increased visual acuity, improved the basic parameters of photosensitivity, enhanced the functional activity of neurons in the central portions of the retina (as shown by electrophysiological studies) while that in the subretinal neovascular membrane diminished retinal edema, improved the patients' general condition, far vision, and increased comfort on reading.

Accommodation, Ocular↗

Prevention of facial fractures from night vision goggle impact.

Facial bone fractures in the military can result from direct loading of night vision goggles on the orbital region. Facial fracture research has shown that increasing the area over which the load is applied increases the load tolerance. The purpose of this study is to apply this concept to reducing the risk of facial bone fracture from night vision goggle impacts. The effectiveness of countermeasures in prevention of orbital fracture was evaluated using a vertical drop tower with two impact velocities of 2.6 m/s and 3.6 m/s. The countermeasure used was a rigid plastic custom face shield made from a plaster impression of each head. In addition to two human cadaver subjects, one male and one female, tests were completed on a Hybrid III 50th percentile dummy head. Three impacts to the dummy headform included no countermeasure, safety glasses, and a custom face shield. These tests yielded peak loads of 8700 N, 7500 N, and 5640 N respectively. Using the female subject, impacts were preformed successively until injury occurred. These two impacts to the subject wearing a custom face shield resulted in peak loads of 4025 N and 5158 N. The highest load corresponds to an impact velocity of 3.6 m/s and a nasal bone fracture. Two impacts to the male subject with a custom face shield resulted in peak loads of 4554 N and 5101 N with no injury. The final impact to the male subject had a peak load of 2010 N with complete orbital fracture due to the absence of a countermeasure. From these tests it is shown that facial fracture risk from night vision goggle impact can be reduced using a contoured rigid face shield.

Aged↗

Translating visions into realities.

The overall vision and the building concept. The overall vision with individual buildings that have focal points for the related medical treatment may seem to increase both investment and operational cost, especially in the period until the total hospital is finished (2014). The slogan "Better services at lower cost" is probably a vision that will prove to be hard to fulfil. But the patients will probably be the long-term winners with single rooms with bathroom, high standards of service, good architecture and a pleasant environment. The challenge will be to get the necessary funding for running the hospital. The planning process and project management Many interviewees indicate how difficult it is to combine many functions and requirements in one building concept. Different architectural, technical, functional and economic interests will often cause conflict. The project organisation HBMN was organised outside the administration of both STOLAV and HMN. A closer connection and better co-operation with STOLAV may have resulted in more influence from the medical employees. It is probably fair to anticipate that the medical employees would have felt more ownership of the process and thus be more satisfied with the concept and the result. On the other hand the organisation of the project outside the hospital administration may have contributed to better control and more professional management of the construction project. The management for planning and building (technical programme, environmental programme, aesthetical The need for control on site was probably underestimated. For STOLAV technical department (TD) the building process has been time-consuming by giving support, making controls and preparing the take-over phase. But during this process they have become better trained to run and operate the new centres. The commissioning phase has been a challenging time. There were generally more changes, supplementation and claims than anticipated. The investment costs are nearly on budget, but the concept will have a negative effect on the running costs of the hospital. The budgets for running both the old and new hospital until phase 2 is finished have not been calculated properly and can reduce the level of ambition in the further process. The moving in phase was a little postponed for some of the centres. Only the laboratory centre has moved in on time. It was realised immediately that the buildings services had not been tested out and adjusted properly. In addition it was acknowledged that there should have been a better training programme for the new organisation before moving in. This situation was extremely challenging for the medical employees. With experience from building phase 1, HBMN decided to change the contract model for building phase 2 to a partnering process. That means higher involvement of suppliers and subcontractors with a goal to improve both quality and efficiency. A greater involvement of all participants is needed to share the risk but also reduce costs.

Efficiency, Organizational↗

[Blurred vision after instillation of topical carbonic anhydrase inhibitor].

PURPOSE: The aim of this study was to compare brinzolamide with dorzolamide in regard to blurred vision after instillation. We also compared saline with two topical carbonic anhydrase inhibitor drugs. SUBJECTS AND METHODS: The study population comprised 21 healthy volunteers whose best corrected visual acuity was 1.0 or better. Brinzolamide 1% or dorzolamide 1% was applied to one eye the contralateral eye was exposed to the other drug. At 30 sec after instillation, visual acuity was measured every 30 sec until best visual acuity was recovered. Because visual acuity can fluctuate widely with blinking, subjects blinked for 5 sec before visual acuity measurement. As control, we applied saline alone to both eyes of 14 subjects and measured the change in visual acuity in the same way. Subjective sensations in each eye were recorded after measurement. RESULTS: Average visual acuity every 30 sec for 5 min was 0.41, 0.56, 0.68, 0.86, 0.87, 0.96, 1.04, 1.08, 1.11, and 1.12 after dorzolamide instillation, and 0.28, 0.42, 0.60, 0.69, 0.81, 0.91, 0.93, 0.99, 1.06, and 1.10 after brinzolamide instillation. In contrast, the average visual acuity after saline instillation for 2 min was 1.09, 1.13, 1.16 and 1.16. Of the 21 subjects, 15 (71.4%) felt moderate or severe irritation when dorzolamide was instilled; 2 (9.5%) felt moderate or severe irritation when brinzolamide was instilled. CONCLUSIONS: Both brinzolamide and dorzolamide caused significantly prolonged blurring of vision, from 30 sec to 2 or 3 min after instillation, as compared with saline only. The average visual acuity after brinzolamide instillation was lower than after dorzolamide for 5 min after instillation, although there was no significant difference. Judging from the subjects' sensations, it is suggested that with dorzolamide the prolonged blurred vision was due to reflex tearing from irritation, as explained above, whereas with brinzolamide it was due to opaque tears on the ocular surface.

Administration, Topical↗

Mission statements and vision documents in medical practices.

Thoughtful, carefully constructed mission statements and vision documents serve both to signal the purpose of a medical practice to the public and other professional colleagues, and to keep the practice's providers focused on its key purposes. Practice culture is the primary driver ofmission and vision. We clarify the differences between mission statements and vision documents, and offer guidelines to aid in constructing them.

Documentation↗

Effect of light adaptation on the orientation acuity of human cone vision.

At the detection threshold, a line orientation is identified by the accuracy of 15-20 deg. Deviations from this rule are observed for short lines presented on a dim background. We checked up for one possible source of deviation: the substitution for foveal cone vision by peripheral rod vision. Long wavelength (red) light was used for the test line. In a control experiment such light did not stimulate rods. The test line was 4 min of arc long. It was presented for 20 ms on a white background of 1 or 1000 trolands and was viewed foveally. In a 2-alternative forced-choice experiment the psychometric functions for detection and orientation identification (vertical v. horizontal) were compared. In another experiment, the line was presented randomly in one of 18 orientations in the range 0-180 deg and the subject was asked to determine the orientation. In both experiments orientation perception was impaired at the dim background in comparison with the results at the bright background. This suggests that light-adaptational changes of the mechanisms responsible for orientation perception exist within the photopic vision.

Adaptation, Ocular↗

[Diagnostic value of fibrolaparoscopy and direct-vision peritoneal biopsy in atypical tuberculous peritonitis].

Fifty-three cases of atypical tuberculous peritonitis were diagnosed by Machida FLA-8 fibrolaparoscope and direct-vision peritoneal biopsy in our hospital during the last few years. The misdiagnosis rate of this disease is very high. The rate of accurate clinical diagnosis was only 39.6% in patients of this study, while 60.4% was misdiagnosed as other diseases, such as cirrhosis, chronic hepatitis, hepatic carcinoma ovarian cyst etc. In addition, many patients with other diseases were misdiagnosed as tuberculous peritonitis by clinical consideration, for instance, 56 cases who were diagnosed or doubted as tuberculous peritonitis by clinical consideration were diagnosed as other diseases by laparoscopy and liver and peritoneal biopsy under direct-vision. Among them chronic hepatitis accounted for 32 cases, peritoneal carcinoma 11 cases, cirrhosis 7 cases, normal peritoneum, liver, gall bladder and spleen 6 cases. Therefore, the patient who is presumptively diagnosed as tuberculous peritonitis by clinical consideration should have laparoscopy and direct-vision peritoneal biopsy performed.

Adolescent↗

High dose corticosteroids for treatment of vision loss due to indirect injury to the optic nerve.

Thirty-six patients with vision loss due to indirect injury to the optic nerve were retrospectively studied. Twenty-one had been acutely treated with high-dose intravenous dexamethasone and 15 had not. The visual acuity of 62% of the treated patients and of 33% of the untreated patients improved. This difference was not statistically significant. However, of those patients whose vision did improve, the vision of those on steroids began to improve earlier (P less than .05).

Adolescent↗

The classic and the romantic vision in psychoanalysis.

Psychoanalysis is characterized by a tension to be found in intellectual history at least since the eighteenth century. The classic vision of man is that of distrust of the idiosyncratic and subjective and the emphasis on the need for objectivity and rationality. In psychoanalysis this is reflected in the attitude of benevolent suspicion which seeks the traces of the pleasure principle in order to allow maturation. It is exemplified here through Freud's work. The romantic vision sees man as essentially striving for full selfhood, and mental suffering is the result of the thwarting influence of the environment. Kohut, who is taken to exemplify this vision, takes an attitude in which he seeks for the healthy striving behind the seemingly ill and perverse. He emphasizes the human need for idealization as a normal phenomenon. The tension between classicism and romanticism expresses itself in clinical problems no less than in theory. It is argued that this tension is not to be resolved, as it reflects the tension between the human ability and need for full experience and the capacity for self reflection which is essential to maturity and wisdom.

Attitude↗

Compatibility of the aviation night vision imaging systems and the aging aviator.

With the advent of the night vision goggle (NVG) mission requirements in the United States Army, the reserve components began training with the second generation (AN/PVS-5 & AN/PVS-5A) systems. These systems prohibit the wear of spectacles by the aviator. Certain modifications on some systems allowed for spectacle wear. However, there still exists a 5-h day filter training minimum in which the full NVG with facemask and cushion must be worn without spectacles. The NVG system corrects up to +2.00 diopters of hyperopia and up to -6.00 diopters of myopia, but only +/- 1.00 diopter of astigmatism. A survey of the reserve component (USAR and NG) aviators in the Southwest was conducted to establish the relative incompatibility of the NVG system among an aviator population older than the active component aviators. All medical record custodians received questionnaires and the flight surgeon followed up replies by telephone or on-site visits. We screened a total of 127 aviator records. The aviator's average age was 39.5 years; 65.3% had 20/20 vision and were emmetropes. Of those that wore spectacles, 82.4% had hyperopia or myopia correctable by the built-in optical adjustments contained in the NVG. The other 17.6%, who had vision that exceeded the correction factors built into the NVG, consisted of astigmats with greater than 2.00 diopters of cylinder. Nearly 20% of the aviators who wore corrective lenses exceeded the corrective limits of the goggles that they used. Further, pilots had no specific prescreening instruction. With the development of more sophisticated aviation optics. Three options exist: modify visual standards, allow contact lens wear, or design future systems to be compatible with spectacles.

Adult↗

Functional development of geniculocortical pathways in normal and amblyopic vision.

The geniculocortical pathways of many mammals, including primates, are largely comprised of two neuron types. These are known as X and Y cells. Their functional significance in unclear, but the following highly speculative hypothesis is suggested. Y cells, because of their broad sensitivity to the crucial lower spatial frequencies as well as to the higher ones, are involved in a basic analysis of form vision. X cells, because of their fairly selective sensitivity to higher spatial frequencies, add to this certain details (i.e. enhanced acuity, etc.). If an animal develops with ametropia, Y cells should be adequately stimulated and as the lower spatial frequencies remain undistorted many Y cells would develop and reasonable form vision with milk amblyopia would result. Only X cells would be greatly affected by such an environment. However, if the animal develops with cataracts or is reared in an environment which abolishes all spatial frequencies, then neither X nor Y cells will develop. This would result in poor form vision and a deep amblyopia. Many of these phenomena have been observed in experimental studies of cats. The present relevance for clinical problems of this suggested functional dichotomy for X and Y cells is at best tenuous, and it is offered merely as a working hypothesis for future studies.

Amblyopia↗

Effects of immediate introduction of indirect vision on performance and posture.

When students are taught psychomotor skills in the mandibular arch and transfer to the maxillary arch, there is a continued desire to depend upon direct vision, which results in early acquisition of poor postural habits. This study examined differences in psychomotor performance between dental students beginning with direct and indirect vision exercises. The investigation was conducted in a preclinical Performance Simulation Laboratory that allowed a high degree of accuracy in the evaluation of operator posture. No significant differences in performance were found between the groups. Within group variances indicated that there was a more uniform transition from maxillary to mandibular preparations than from the lower to upper arch preparations. Analysis of the postural data showed no significant relationship to the quality of cavity preparation, but indicated that student posture was better for the arch in which they first learned. The study was unable to substantiate the assumption that mirror management is better taught after direct vision skills are learned.

Clinical Competence↗

[An electronic visual aid using a luminance amplifier in night vision disorders].

The efficiency of a light amplifier system for the improvement of night vision has been tested on 30 normal subjects and on subjects suffering from night blindness including 36 patients with pigmentary retinopathy, 18 myopic patients with night blindness and 12 patients with senile cataracts. In all cases, the scotopic vision presented a great improvement and it reached up to half of photopic vision. The use of the light amplifier would certainly provide a considerable improvement for subjects suffering from night blindness and mostly for those suffering from pigmentary retinopathy. But two conditions are necessary for this: miniaturization of the device and absence of major macular lesions in the patient.

Cataract↗

The theophylline method of the Abbott "Vision" analyzer evaluated.

We evaluated the analytical performance of the Abbott "Vision" analyzer for theophylline measurement. The within-day precision (CV) was 1.8% and 3.1% at theophylline concentrations of 15.2 and 25.2 mg/L, respectively; between-day precision was 3.5% and 4.8% at 14.9 and 24.4 mg/L, respectively. Bilirubin (143 mg/L) and triglyceride (7.4 g/L) did not interfere, but hemoglobin caused lower values for apparent theophylline, the magnitude of the decrease being proportional to the hemoglobin concentration. At the cutoff concentration of 1 g/L programmed into the instrument by the manufacturer, hemoglobin reduced the theophylline value by less than 10%. Results by the Vision method (y) compared well with those by the "TDX" procedure (x): r = 0.98, y = 0.978x - 0.270 mg/L. The Vision method gave comparable theophylline values for serum, plasma, and whole-blood samples. We also validated analytically and clinically that capillary blood samples collected by finger stick can be used interchangeably with blood samples collected by venipuncture for monitoring theophylline therapy.

Autoanalysis↗

Different rates and amounts of vision function recovery during orthoptic therapy in an older strabismic amblyope.

Orthoptic therapy was instituted in an 11-year-old patient having deep amblyopia, constant small-angle esotropia with anomalous retinal correspondence, and a past history of minimal success with such therapy. This combination of factors pointed toward a poor prognosis for substantial recovery of vision function. Rate of recovery of several monocular and binocular vision functions was monitored during the course of 18 months of intensive orthoptic therapy. Results showed marked improvement in several monocular vision functions, suggesting presence of considerable residual neural plasticity of multiple sites in the visual pathways of this older amblyope.

Accommodation, Ocular↗

Guidelines for an occupational vision program.

The need for and development of an effective occupational vision program is discussed. The role of the optometrist as an occupational vision consultant is outlined and specific guidelines for the provision of in-plant and in-office vision services are provided. Requirements of the OSHAct are summarized and specific problem areas related to industrial safety eyewear are also discussed.

Contact Lenses↗

A vision screening of a Down's syndrome population.

A vision screening of 55 (24 male, 31 female) Down's syndrome children was done by SUNY vision training residents. In the past, similar screenings have been done with older children. The children in this study ranged in age from 2 years, 2 months, to 8 years, 5 months. The median age was about 3.5 years. This study will enable vision care practitioners to be more aware of visual conditions in this population which have a greater incidence than the normal population.

Child↗