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At least 19 recordsLinked to original sources
PubMed1998

Acyclovir for the prevention of recurrent herpes simplex virus eye disease. Herpetic Eye Disease Study Group.

BACKGROUND: Long-term treatment with antiviral agents has been shown to prevent recurrences of genital and orofacial herpes simplex virus (HSV) disease, but it is uncertain whether prophylactic treatment can prevent recurrences of ocular HSV disease. METHODS: We randomly assigned 703 immunocompetent patients who had had ocular HSV disease within the preceding year to receive 400 mg of acyclovir or placebo orally twice daily. The study outcomes were the rates of development of ocular or nonocular HSV disease during a 12-month treatment period and a 6-month observation period. RESULTS: The cumulative probability of a recurrence of any type of ocular HSV disease during the 12-month treatment period was 19 percent in the acyclovir group and 32 percent in the placebo group (P<0.001). Among the 337 patients with a history of stromal keratitis, the most common serious form of ocular HSV disease, the cumulative probability of recurrent stromal keratitis was 14 percent in the acyclovir group and 28 percent in the placebo group (P=0.005). The cumulative probability of a recurrence of nonocular (primarily orofacial) HSV disease was also lower in the acyclovir group than in the placebo group (19 percent vs. 36 percent, P<0.001). There was no rebound in the rate of HSV disease in the six months after treatment with acyclovir was stopped. CONCLUSIONS: After the resolution of ocular HSV disease, 12 months of treatment with acyclovir reduces the rate of recurrent ocular HSV disease and orofacial HSV disease. Long-term antiviral prophylaxis is most important for patients with a history of HSV stromal keratitis, since it can prevent additional episodes and potential loss of vision.

Acyclovir↗
PubMed2000

Design of Physicians' Health Study II--a randomized trial of beta-carotene, vitamins E and C, and multivitamins, in prevention of cancer, cardiovascular disease, and eye disease, and review of results of completed trials.

PURPOSE: To assess the balance of benefits and risks of supplementation with beta-carotene, vitamin E, vitamin C, and multivitamins on cancer, cardiovascular (CVD), and eye diseases. DESIGN: Physicians' Health Study II (PHS II) is a randomized, double-blind, placebo-controlled trial enrolling 15,000 willing and eligible physicians aged 55 years and older. PHS II will utilize a 2 x 2 x 2 x 2 factorial design to test alternate day beta-carotene, alternate day vitamin E, daily vitamin C, and a daily multivitamin, in the prevention of total and prostate cancer, CVD, and the age-related eye diseases, cataract and macular degeneration. PRIOR RESULTS: The final results of the recently completed Physicians' Health Study I (PHS I), a randomized, double-blind, placebo-controlled trial in 22,071 healthy US male physicians, indicated that beta-carotene supplementation (50 mg on alternate days) had no significant benefit or harm on cancer or CVD during more than 12 years of treatment and follow-up. In regards to cancer, there were possible benefits on total and prostate cancer in those with low baseline levels assigned to beta-carotene, a finding compatible with the Chinese Cancer Prevention Study for combined treatment with beta-carotene, vitamin E, and selenium in a poorly nourished population. Further, with respect to CVD, there were apparent benefits of beta-carotene supplementation on subsequent vascular events among a small subgroup of 333 men with prior angina or revascularization. The currently available data from randomized trials of primary prevention are sparse and inconsistent for vitamin E and non-existent for vitamin C and multivitamins. For eye diseases, namely cataract and age-related macular degeneration, there are no completed large-scale randomized trials of antioxidant vitamins. CONCLUSIONS: PHS II is unique in several respects. PHS II is the only primary prevention trial in apparently healthy men testing the balance of benefits and risks of vitamin E on cancer and CVD. In addition, PHS II is the only primary prevention trial in apparently healthy men to test the balance of benefits and risks of vitamin C, multivitamins, as well as any single antioxidant vitamin, alone and in combination, on cancer, CVD, and eye diseases. Finally, PHS II is the only trial testing a priori the hypotheses that beta-carotene and vitamin E may reduce the risks of prostate cancer. Thus, PHS II will add unique as well as importantly relevant and complementary information to the totality of evidence from other completed and ongoing large-scale randomized trials on the balance of benefits and risks of beta-carotene, vitamin E, vitamin C, and multivitamins alone and in combination on prevention of cancer, CVD and eye diseases.

Aged↗
PubMed2000

Risk factors associated with age-related macular degeneration. A case-control study in the age-related eye disease study: Age-Related Eye Disease Study Report Number 3.

OBJECTIVE: To investigate possible risk factors for age-related macular degeneration (AMD) in participants in the Age-Related Eye Disease Study (AREDS). DESIGN: Case-control study. PARTICIPANTS: Of the 4757 persons enrolled in AREDS, 4519 persons aged 60 to 80 years were included in this study. The lesions associated with AMD ranged from absent in both eyes to advanced in one eye. MAIN OUTCOME MEASURES: Stereoscopic color fundus photographs of the macula were used to place participants into one of five groups, based on the frequency and severity of lesions associated with AMD. Participants with fewer than 15 small drusen served as the control group. RESULTS: Staged model building techniques were used to compare each of the four case groups with the control group. Increased age was a consistent finding of all four of the case groups compared with the control group, and all the following associations were age adjusted. Persons with either intermediate drusen, extensive small drusen, or the pigment abnormalities associated with AMD (group 2) were more likely to be female, more likely to have a history of arthritis, and less likely to have a history of angina. Persons with one or more large drusen or extensive intermediate drusen (group 3) were more likely to use hydrochlorothiazide diuretics and more likely to have arthritis. Hypertension, hyperopia, presence of lens opacities, and white race were also found more frequently in this group as well as in persons with neovascular AMD (group 5). Only persons in group 5 were more likely to have an increased body mass index, whereas persons with geographic atrophy (group 4) as well as those in groups 3 and 5 were more likely to have completed fewer years in school or to be smokers. Those with geographic atrophy were also more likely to use thyroid hormones and antacids. CONCLUSIONS: Our findings for smoking and hypertension, which have been noted in previous studies, suggest that two important public health recommendations, the avoidance of smoking and the prevention of hypertension, may reduce the risk of developing AMD. Other associations, such as those for hyperopia, lens opacities, less education, female gender, increased body mass index, and white race, which have been noted in other studies, are also seen in the AREDS population. The increased use of thyroid hormones and antacids in persons with geographic atrophy and the increased likelihood of arthritis or hydrochlorothiazide use in persons with one or more large drusen or extensive intermediate drusen have not been previously reported and need additional investigation.

Aged↗
PubMed1999

Thyroid eye disease.

Thyroid eye disease is the most common cause of unilateral and bilateral proptosis in adults. It occurs most frequently in women aged 30 to 50 years. Clinical features include eyelid retraction, periorbital edema, conjunctival injection and chemosis, proptosis, extraocular muscle restriction, exposure keratopathy, and optic nerve compromise. Thyroid eye disease differs from idiopathic orbital myositis in that the latter is characterized by a more acute onset, more severe pain, and a rapid response to systemic corticosteroid therapy. Echography and computed tomography in thyroid eye disease reveal enlarged extraocular muscle bellies with relative sparing of the tendons. Despite evidence of an immune-mediated cause, the precise pathophysiologic mechanisms of thyroid eye disease remain unknown.

Age Distribution↗
PubMed1995

Sensitivity and specificity of photography and direct ophthalmoscopy in screening for sight threatening eye disease: the Liverpool Diabetic Eye Study.

OBJECTIVE: To evaluate different methods for community based screening for sight threatening diabetic eye disease. DESIGN: Prospective study. SETTING: Mobile screening unit visiting inner city community clinics; hospital assessment clinic (tertiary centre). SUBJECTS: 395 diabetic patients registered with four general practices in an inner city location. INTERVENTIONS: Community based photography with mydriasis and direct ophthalmoscopy through dilated pupils by an experienced ophthalmologist, both compared with reference standard of slit lamp biomicroscopy by a consultant specialist in medical retinal disease. MAIN OUTCOME MEASURES: Sensitivity and specificity of screening method and prevalence of sight threatening diabetic eye disease (moderate preproliferative retinopathy, circinate maculopathy, exudate within 1 disc diameter of fixation, other diabetes related eye disease). RESULTS: 358 subjects underwent photography, 326 attended hospital clinic for ophthalmoscopy, and six were ungradable on photographs and biomicroscopy, leaving 320 for analysis. Of these 295 (91%) attended clinic within four months of photography. Sensitivity of detection of eye disease by photography was 89% (95% confidence interval 80% to 98%), significantly better than for direct ophthalmoscopy (65% (51% to 79%)). Analysis of patients with false negative results indicated possible improvement of photographic sensitivity to 93% by addition of stereoscopic macular pair photographs. Specificity of detection of sight threatening eye disease was 86% (82% to 90%) for photography and 97% (95% to 99%) for direct ophthalmoscopy. CONCLUSIONS: Since high sensitivity is essential for an effective screening programme, a photographic method should be considered as preferred option in national, community based screening programmes. Even in the hands of an experienced ophthalmologist, direct ophthalmoscopy is limited by weaknesses inherent to the instrument.

Ambulatory Care↗
PubMed2001

B-cell autoepitopes on the acetylcholinesterase-homologous region of human thyroglobulin: association with Graves' disease and thyroid eye disease.

OBJECTIVE: Thyroglobulin (Tg) is a large autoantigen involved in autoimmune thyroid diseases. Tg epitopes have, so far, been identified within large peptides. In the present study, we used small synthetic peptides to finely map serological epitopes on the highly immunogenic C-terminal region of Tg. Homology of this region to acetylcholinesterase (AChE) has been implicated in the pathogenesis of thyroid eye disease (TED) through cross-reactive antibodies. METHODS: We tested total IgG purified from four pilot Graves' disease (GD) sera reactive with both Tg and AChE and from three healthy controls, for reactivity against overlapping 20mer peptides (pin synthesis) covering the sequence 2171-2748 of human Tg. Antibody-reactive peptides were subsequently synthesized by a solid-phase technique for confirmation with a large number of sera: 99 GD, 32 Hashimoto's thyroiditis (HT) and 45 healthy controls. RESULTS: Peptides TgP15, TgP26 and TgP41 (amino acids 2339-2358, 2471-2490 and 2651-2670 respectively) were found to be targets of autoantibodies on intact Tg, recognized by a statistically significant proportion of GD sera (22.2%, 35.4% and 30.3% respectively), compared with HT (0%, 15.6% and 6.3% respectively) and healthy controls (0%, 4.4% and 4.4% respectively). The majority of GD sera (56.6%) were positive for at least one of the three peptides. In GD, TgP26 reactivity was found to be associated with TED (48.6% with TED versus 25.5% without TED, P<0.05). CONCLUSION: Some epitopes on the C-terminal region of Tg are associated with GD. A subset of Tg-reactive autoantibodies, directed to this region, is associated with TED and may be involved in the development of the disease.

Acetylcholinesterase↗
PubMed1988

Immunosuppressant therapy of thyroid eye disease.

Thyroid eye disease is attributed to an autoimmune process where both cellular and humoral immunity play a role. In this report, after a short introduction dealing with immunopathogenesis of the disease, immunosuppressant therapy is discussed. Treatment with glucocorticoids (as the standard substance), nonsteroid immunosuppressants (azathioprine, cyclophosphamide, lately cyclosporin) and with the immunomodulatory substance ciamexone is reviewed. Retroorbital irradiation as a "local" immunosuppressive method and plasmapheresis are also discussed. While systemic glucocorticoids and to a lesser extent orbital radiotherapy are routinely administered for severe Graves' ophthalmopathy, nonsteroid immunosuppressants and plasmapheresis are not yet part of the established treatment of thyroid eye disease. Their use should currently remain confined to controlled studies.

Graves Disease↗
PubMed1994

Blindness in different types of eye disease. A study based on the records of the Department of Eye Diseases in the Medical University, Plovdiv for the period 1982-1991.

Between 1982 and 1991, inclusive, a total of 13718 patients were treated in the Department of Eye Diseases in Plovdiv University of Medicine. Cataract patients formed the most numerous group (19.71%), followed by those with diseases of the retina (9.53%), glaucoma (7.95%), uveitis (4.9%), diseases of the cornea (3.86%), malignant tumors of the eyelids and the eyeball (2.29%) and diseases of the optic nerve (1.54%). Of these 13718 patients, 1727 (12.58%) had monocular and binocular vision below 0.08. The patients with visual acuity from 0 to 0.03 were 1330 (9.69%). Nosologically, they were distributed as follows: glacoma-422 (3.07%), eye traumas-281 (2.04%), diseases of the retina-270 (1.96%), diseases of the cornea-89 (0.64%), cataract-80 (0.58%), uveitis-77 (0.56%), malignant tumors of the eyelids and the eyeball-66 (0.48%), and diseases of the optic nerve-45 (0.32%). Glaucoma was found to be the most common cause of blindness among the patients treated in the Department of Eye Diseases, followed by eye traumas and disease of the retina. The importance of the vascular factor in inducing blindness is undeniably great. It is the underlying cause of the open-angle glaucoma, the diseases of the retina and the optic nerve.

Blindness↗
PubMed2000

Oral acyclovir for herpes simplex virus eye disease: effect on prevention of epithelial keratitis and stromal keratitis. Herpetic Eye Disease Study Group.

OBJECTIVES: To investigate the effect of oral acyclovir therapy for recurrences of herpes simplex virus (HSV) epithelial keratitis and stromal keratitis and to determine if certain patients derive differential benefit. DESIGN: This randomized, double-masked clinical trial enrolled 703 immunocompetent patients with prior HSV eye disease within the preceding year; assigned 357 patients to receive oral acyclovir, 800 mg/d, and 346 to receive placebo; and followed up patients during a 12-month treatment period for the development of HSV eye disease. RESULTS: The cumulative probability of a recurrence of any type of ocular HSV disease during the 1-year treatment period was 19% in the acyclovir group compared with 32% in the placebo group. Sixteen patients in the acyclovir group and 30 in the placebo group had more than 1 recurrence. A benefit was seen for preventing both epithelial keratitis (rate ratio, 0.62; 95% confidence interval, 0.39-0.97) and stromal keratitis (rate ratio, 0. 57; 95% confidence interval, 0.36-0.89). Although a relative benefit of treatment on preventing any type of recurrence was present in most subgroups, the magnitude of absolute benefit was greatest among patients with the highest number of prior episodes of ocular HSV disease. The benefit in preventing stromal keratitis was seen solely among patients with a history of stromal keratitis. CONCLUSIONS: Long-term suppressive oral acyclovir therapy reduces the rate of recurrent HSV epithelial keratitis and stromal keratitis. Acyclovir's benefit is greatest for patients who have experienced prior HSV stromal keratitis. Arch Ophthalmol. 2000;118:1030-1036

Acyclovir↗
PubMed2000

Managing eye disease in primary care. Part 1. How to screen for occult disease.

Proper eye screening is the first step in detection of occult eye disease in asymptomatic patients. Knowing which patients are at high risk and should be referred for a comprehensive eye examination is the key. In part 1 of this three-part article, Dr Shields explains how to identify high-risk patients and offers practical pointers for performing visual acuity measurements and other necessary testing in children. A list of resources on vision care for both patients and physicians is also included.

Adolescent↗