Showing papers in "Acta Ophthalmologica Scandinavica in 2001"

The therapeutic effects of retinal laser treatment and vitrectomy. A theory based on oxygen and vascular physiology.

Abstract: The physiologic mechanism of photocoagulation can been seen in the following steps. The physical light energy is absorbed in the melanin of the retinal pigment epithelium. The adjacent photoreceptors are destroyed and are replaced by a glial scar and the oxygen consumption of the outer retina is reduced. Oxygen that normally diffuses from the choriocapillaris into the retina can now diffuse through the laser scars in the photoreceptor layer without being consumed in the mitochondria of the photoreceptors. This oxygen flux reaches the inner retina to relieve inner retinal hypoxia and raise the oxygen tension. As a result, the retinal arteries constrict and the bloodflow decreases. Hypoxia relief reduces production of growth factors such as VEGF and neovascularization is reduced or stopped. Vasoconstriction increases arteriolar resistance, decreases hydrostatic pressure in capillaries and venules and reduces edema formation according to Starling's law. Vitrectomy also improves retinal oxygenation by allowing oxygen and other nutrients to be transported in water currents in the vitreous cavity from well oxygenated to ischemic areas of the retina. Vitrectomy and retinal photocoagulation both improve retinal oxygenation and both reduce diabetic macular edema and retinal neovascularization.

Visual screening of Swedish children: An ophthalmological evaluation

Abstract: The aim of this thesis was to assess the vision screening system and ocular status in Sweden of today, yesterday and tomorrow and to compare the prevalence of ocular disease before and after screening and treatment with special focus on amblyopiaScreening has been defmed by the United States Commission of Chronic Illness (1957) as "the presumptive identification of unrecognized disease or defect by the application oftests, examinations or other procedures, which can be rapidly applied Screening tests sort out apparently well persons who probably have a disease from those who probably do not" The screening system for eye disorders was introduced in the whole country in the beginning of 1970 and has not been evaluated in a greater area and for a longer period Neither has an evaluation been done according to WHO's instructions Amblyopia is the most common cause to visual impairment in one eye The visual system is developing mostly in the first years of life and it is important to treat amblyopia in early childhood The three first papers are retrospective studies and the fourth a prospective study The study group in the first and second paper consisted of all children born 1982 in three Swedish cities from newborn until the age of 10 years The children have been tested eight to nine times at the Child Health Care Centres and in school during this time The sensitivity and specificity of visual screening were 92% and 97% respectively The prevalence of ametropia was 77%, strabismus 31%, amblyopia ≤ 7 29% and organic lesions 02% We compared the prevalence of amblyopia today with the time before screening was introduced in Sweden This comparison shows that serious amblyopia has been reduced about 10 times with screening and treatmentLoss of vision in the non-amblyopic eye was investigated by studying patients with amblyopia at four visual rehabilitation centres Approximately 12% of the people with amblyopia ≤ 03 will eventually become visually handicapped due to lesions in the better eyeDespite visual screening and treatment there are some children left with residual amblyopia We investigated ways to improve the system by lowering the age for visual acuity examination from 4 to 3 years and at the same time two vision charts were compared We found that the testability rate for 3-year-olds was almost the same for the Lea Symbol chart and the HVOT chart (828% and 848% respectively) Testability was about 10% higher at 4 years The positive predictive value was lower at 3 years (58%) than has previously been found at 4 years (72%)Conclusion: In these studies we have found that screening is justified for the following reasons: visual screening is efficient in terms of sensitivity and specificity and many important ocular conditions are detected in this process; the prevalence of serious amblyopia is greatly reduced by screening and treatment; loss of vision in the non-amblyopic eye is a significant problem, which can be greatly reduced by screening and treatment, thereby saving expenses for the societyThe following has been found regarding the design of visual screening: visual acuity testing is efficient in detecting visual disorders from 4 years and up; visual acuity can be tested at 3 years, but with lower positive predictive value; the most widely used charts in Sweden and internationally, the HVOT chart and the Lea Symbols chart perform equally well in visual acuity testing of 3-year-old and 4-year-old children

Exfoliation (pseudoexfoliation) syndrome: toward a new understanding. Proceedings of the First International Think Tank.

Abstract: . Exfoliation (pseudoexfoliation; PEX) syndrome is the single most common identifiable cause of open-angle glaucoma, however, very few investigators are engaged in basic research on this disease. To stimulate the field, the First International Think Tank on Exfoliation Syndrome was held in New York in July 1999, comprising clinicians and scientists. This report is a summary of the proceedings of this meeting.

An intervention trial on efficacy of atropine and multi-focal glasses in controlling myopic progression.

Abstract: . Purpose: This randomized clinical trial assessed the treatment effects of atropine and/or multi-focal lenses in decreasing the progression rate of myopia in children. Methods: Two hundred and twenty-seven schoolchildren with myopia, aged from 6 to 13 years, who were stratified based on gender, age and the initial amount of myopia were randomly assigned to three treatment groups: 0.5% atropine with multi-focal glasses, multi-focal glasses, and single vision spectacles. Each subject was followed for at least eighteen months. These results report on the 188 patients available for the follow-up. Results: The mean progression of myopia in atropine with multi-focal glasses group (0.41 D) was significantly less than the multi-focal (1.19 D) and single vision group (1.40 D) (p<0.0001). But no significant difference was noted between the last two groups (p=0.44). The progression of myopia was significantly correlated with the increases of axial length (r=0.65, p=0.0001), but not with the changes of corneal power (r=−0.09), anterior chamber depth (r=−0.023), lens thickness (r=−0.08), or intra-ocular pressure (r=−0.008). Conclusion: The 0.5% atropine with multi-focal lenses can slow down the progression rate of myopia. However, multi-focal lenses alone showed no difference in effect compared to control.

Refractive error and glaucoma.

Abstract: . Purpose: To study the association between refractive error, glaucoma damage and IOP in a large population. Methods: We examined 32,918 citizens of the city of Malmo, Sweden, 57–79 years of age, searching for individuals with undetected glaucoma. Refraction was measured with autorefractors. Glaucoma damage was defined as reproducible visual field defects with the Humphrey Full Threshold 24–2 program. Results: Glaucoma prevalence was clearly associated with refractive state, increasing gradually with increasing myopia. This was seen both in males and females and persisted over the full age range. Glaucoma was significantly more common in myopic than in hyperopic eyes with low IOP readings (p=0.024). The overrepresentation of glaucoma in myopic eyes declined with increasing IOP and no relationship was observed in eyes with IOP ≥31 mmHg. Conclusion: In this large population, the prevalence of glaucoma increased with increasing myopia. The association between myopia and glaucoma was strong at lower IOP levels, and weakened gradually with increasing IOP. Our findings indicate that myopia is an important risk factor for glaucoma and particularly for normal tension glaucoma.

Epidemiology of endogenous uveitis in north-eastern Italy. Analysis of 655 new cases.

Abstract: Purpose: To report the results of a retrospective analysis among endogenous uveitis patients in the north-eastern area of Italy. Methods: The authors reviewed a series of 655 new cases treated between October 1986 and December 1993. The incidence of endogenous uveitis was calculated based on a 100,000 patient population. Results: The average incidence was 11.40/100,000. The majority of patients were between the ages of 20 and 70 years (74.43%). A probable diagnosis was determined in 55.57% of cases; anterior uveitis was diagnosed in 58.01% of cases, posterior uveitis in 26.11%, panuveitis in 12.98%, and intermediate uveitis in 2.9% of cases. The authors observed recurrences in 25.49% of cases. While the first cases are almost equally distributed in the various months, the recurrences seem to be significantly more frequent in the cold (from November to February; mean air temperature∞8ae) and transitional months (October and from March to May; mean air temperature from 8ae Ct o 18aeC) than in the warm months (from June to September; mean air temperature ‐18aeC). Respectively p‰0.003 and p‰0.029. Conclusion: The incidence in this series is lower than in other European and American studies. Despite the high rate of idiopathic cases in this study, the authors support that the presentation of single case experiences may allow improved multi-centric analysis and a greater understanding of the epidemiology of uveitis.

The impact of glaucoma on the quality of life of patients in Norway. I. Results from a self-administered questionnaire.

Abstract: . Purpose: To evaluate the feelings and experiences of patients living with glaucoma. Methods: A questionnaire was delivered to patients willing to take part, at a regular visit to their ophthalmologist, for filling in anonymously at home. A total of 589 questionnaires were returned. Results: More than 80% reported negative emotions on learning that they had glaucoma, one-third were afraid of going blind. Half the patients had no visual problem at all, 14% complained of poor or very poor vision. This proportion increased with age. One-fourth of the patients on topical medication experienced adverse effects of moderate or high degree. About half the patients being treated with laser or surgery felt their situation had improved afterwards. Nine-tenths of the individuals were satisfied with the information and care given, although their knowledge about glaucoma was rather incomplete. One-fifth missed information, mainly on causes, treatment and prognosis of the disease. The younger patients were more anxious and inquiring, reported more side effects and were less satisfied than the older patients. The women were in general more dissatisfied than the men. Conclusion: Giving a patient a diagnosis of glaucoma influences his quality of life negatively. Only half of our patients experienced any visual difficulties, whereas one-fourth reported adverse reactions due to the therapy. Most of the patients were very satisfied with the information and care given. Ophthalmologists in private practice are quite central in the management and care of the glaucoma patients in a medical setting like ours.

The prevalence and causes of bilateral and unilateral blindness in an elderly urban Danish population. The Copenhagen City Eye Study.

Abstract: . Purpose: To study the prevalence and causes of bilateral and unilateral blindness in an elderly urban Danish population. Methods: Data originated from a Danish epidemiologic cross-sectional random sample population eye survey conducted during the years 1986–1988. The population consisted of 1,000 inhabitants aged 60 to 80 years in Copenhagen. The participants underwent an extensive ophthalmologic examination. A participation rate of 96.9% was achieved. Any blindness was defined as best-corrected visual acuity (VA) worse than 0.05 (the WHO criteria) and VA of 0.1 or worse (the National criteria (NC) of blindness). Results: The prevalence rates of bilateral and unilateral blindness were, respectively, 0.53% and 3.38% according to WHO, but 1.06% and 4.44% using NC. Bilateral blindness rose significantly with age (p=0.02). According to NC, age-related macular degeneration (AMD) was the leading cause of bilateral blindness, accounting for 60% of all blind persons. Glaucoma, myopic macular degeneration, cataract and retinitis pigmentosa were jointly the second most common cause, each accounting for 10% of all bilaterally blind persons. Diabetic retinopathy was not a cause of bilateral blindness. Amblyopia was the most frequent, AMD the second most frequent, and diabetic retinopathy was among the third most common cause of unilateral blindness accounting for, respectively, 28.60%, 16.66% and 9.52% of all unilateral blindness. Conclusions: Blindness was associated with increasing age. A calculation indicates that among Danes aged 60 to 80 years 7,736 are bilaterally blind and 35,503 suffer from unilateral blindness. This study highlights AMD as the most important cause.

Risk factors for corneal graft failure and rejection in penetrating keratoplasty

Abstract: Purpose To evaluate risk factors for graft failure and allograft rejection after penetrating keratoplasty (PK). Methods We retrospectively studied clinical results of PKs in terms of graft survival and rejection-free graft survival rates. PKs were done on 271 eyes between 1987 and 1997. Clinical results were analyzed by Kaplan-Meier's life table method and the log-rank test. Relative risks and adjusted survival probabilities for each value of the factor were compared with the risk for a specified reference value. Results The overall rates of graft survival and rejection-free graft survival in 10 years after PK were 79.3% and 77.9%, respectively. Higher relative risk of graft failure was associated with corneal vascularization (relative risk for within one quadrant = 1.67, two quadrants = 2.37, three or more quadrants = 3.39), regraft (relative risk for one failed previously graft = 2.08, two or more failed previously graft = 2.65), aphakia (relative risk = 2.17) or pseudophakia (relative risk = 3.02), presence of anterior synechia (relative risk = 2.91), presence of posterior synechia (relative risk = 2.56), long (more than 85 minutes) operation time (relative risk = 2.20), and older (more than 50 years) recipient age (relative risk = 2.38). Higher relative risk of rejection was associated with corneal vascularization (relative risk for within one quadrant = 2.35, two quadrants = 2.03, three or more quadrants = 2.63), long (more than 85 minutes) operation time (relative risk = 1.47), and younger (less than 60 years) donor age (relative risk = 2.10). There was no association between graft failure or allograft rejection and graft size or suture technique, respectively. Conclusion The risk factors for graft failure after PK were corneal vascularization, regraft, aphakia or pseudophakia, presence of anterior synechia, presence of posterior synechia, long operation time, and older recipient age. The risk factors after PK for allograft rejection were corneal vascularization, long operation time, and younger donor age.

The exfoliation syndrome in cognitive impairment of cerebrovascular or Alzheimer's type.

Abstract: The prevalence of exfoliation syndrome was studied in 39 patients suffering from dementia and cognitive impairment; a positive finding of exfoliation was detected in 11/39 of these patients. A comparison with an age-matched population survey showed that the prevalence of ocular exfoliation and the relative risk were significantly elevated. These results suggested that lesions related to the exfoliative process might be located also in the brain of patients suffering from dementia and cognitive impairment.

Ocular and orbital cysticercosis.

Abstract: . Purpose: To study the demographic factors, clinical diagnosis, results of investigation, modalities of treatment and their outcome in ocular and extraocular cysticercosis. Method: A total of 20 patients were recruited for the study. Ultrasonography and computed tomography were done for all the patients. Serial ultrasound was obtained in patients receiving medical treatment. Therapy was individualized according to the location of the cyst. Results: The commonest clinical presentation was proptosis (9 of 20) with restriction of ocular movements, followed by subconjunctival cyst, subretinal cyst, papilloedema, atypical optic neuritis, lid nodule and intraretinal cyst. Ultrasonography was comparable with computed tomographic scan for detection of scolex. Two of the twenty patients had associated cysts in the brain parenchyma. Medical or surgical therapy as indicated, had a satisfactory outcome. Conclusion: Cysticerci can lodge themselves in any part of the ocular and extra ocular tissue. Associated brain parenchyma involvement is quite rare. The clinical presentation, treatment and outcome mainly depends on the location of the cyst.

Visual acuity, residual amblyopia and ocular pathology in a screened population of 12-13-year-old children in Sweden.

Abstract: . Purpose: To establish the distribution of visual acuity and the prevalence of residual amblyopia and other ocular disorders in a vision-screened population group of 12–13-year-old children. Methods: In total 1046 children were examined in a field study in Sweden. The examination included visual acuity, stereopsis, cover testing, red reflex, refractive retinoscopy and examination of the posterior pole. In selected cases VEP was also performed. Results: Visual acuity ≥1.0 in at least one eye was present in 98% of cases. Residual amblyopia (≤0.5) was found in 1.1% of the population. Manifest strabismus was found in 2.7%. There were only a small number of ocular opacities and posterior pole abnormalities. Ocular albinism was found in 7 cases. In 15 children the cause of subnormal VA was unexplained. Conclusion: Results for visual acuity, residual amblyopia and other ocular disorders are very similar to previous Nordic, vision-screened populations.

Quantitative assessment of retinal thickness in diabetic patients with and without clinically significant macular edema using optical coherence tomography

Abstract: PURPOSE: To assess patients with diabetic macular edema quantitatively using optical coherence tomography (OCT). METHODS: OCT was performed in 14 eyes with diabetic retinopathy and ophthalmoscopic evidence of clinically significant macular edema (CSME) and in 19 diabetic eyes without CSME. Retinal thickness was computed from the tomograms at fovea and other 36 locations throughout the macula. RESULTS: The mean +/- standard deviation foveal thickness was 255.6 +/- 138.9 microm in eyes with CSME, and 174.6 +/- 38.2 microm in eyes without CSME (p = 0.051). Within 2000 microm of the center of the macula, eyes with CSME had significantly thicker retina in the inferior quadrant than those without CSME (p < 0.01). The foveal thickness was correlated with logMAR visual acuity (gamma = 0.68, p < 0.01). OCT identified sponge-like retinal swelling and/or cystoid macular edema in 11 (58%) eyes without CSME, and in 12 (86%) eyes with CSME. CONCLUSIONS: Criteria of CSME seem to be insufficient in really identifying macular edema. OCT may be more sensitive than a clinical examination in assessing diabetic macular edema and is a quantitative tool for documenting changes in macular thickening.

Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma.

Abstract: Purpose: To study the effect of phacoemulsification and intraocular lens implantation (PHACO IOL) on intraocular pressure (IOP) and glaucoma medication in open-angle glaucoma (OAG) eyes. Methods: 38 open-angle glaucoma (OAG) eyes with cataract underwent phacoemulsification and intraocular lens implantation (PHACO IOL) performed by one surgeon (RJU). None of the patients had prior intraocular surgery. Surgery was performed by scleral incision on 37% and by clear corneal incision on 63%. Patients were re-examined on the first postoperative day, after one week, 4 months, and in 29 cases 1‐3.7 (mean 2.8) years after the operation. Results: The mean preoperative IOP was 18.4”3.3 mmHg with a mean of 1.7 glaucoma medications. On the first postoperative day, the mean IOP rose to 28.2”12.5 mmHg. IOP fl30 mmHg occurred in 39.5% of the eyes. After one week, IOP had returned to the preoperative level. After 4 months, IOP had further decreased to 16.1”3.8 mmHg (p‰0.0027). After a mean follow-up of 1‐3.7 (mean 2.8) years, the average postoperative IOP was 15.1”2.9 mmHg, being significantly (p‰0.001) lower than the preoperative IOP with 86% of the patients having a mean of 1.6 drugs on average. The type of incision (scleral vs. corneal) did not affect the postoperative IOP level. Using the criteria of Bigger and Becker (1971) the long-term IOP control after PHACO-IOL surgery was improved or unchanged in 86% and worse in 14% of the preoperatively well-controlled OAG eyes. Conclusions: In OAG eyes PHACO IOL is associated with a significant decrease in IOP with less medication up to 1‐3.7 (mean 2.8) years.

Long-term follow-up of idiopathic central serous chorioretinopathy without laser.

Abstract: . Purpose: The purpose of this study was to observe the varied types of manifestations in the fundus of patients with idiopathic central serous chorioretinopathy (ICSC) without laser treatment and also to assess the ultimate visual outcome in such cases in a long-term follow-up ranging from 7 to 23 years. Methods: This study is confined to 5 selected cases of ICSC which fairly represent the different types of late stage manifestations of the disease in the fundus. Case records from our hospital, as well as available records of previous treatment elsewhere were reviewed. A complete ophthalmological examination, routine laboratory investigations and fluorescein fundus angiography (FFA) were repeated in each case on the day of final evaluation. Results: Pigmentary disturbances in the macular area resembling to some extent age-related macular degeneration (AMD), extensive retinal pigment epithelial (RPE) atrophy and macular haemorrhage have been observed in the fundus of the reviewed cases. Conclusions: ICSC runs an unpredictable course and there are no definitive clinical clues to predict its ultimate outcome. Recurrence of the condition is a possibility for a considerable period of time.

Strabismus and binocular function in children with Down syndrome. A population-based, longitudinal study.

Abstract: . Purpose: We have performed a population-based, longitudinal study on strabismus in children with Down syndrome. The aims of the study were to examine the frequency and type of strabismus, the age at onset, and the binocular potential. Methods: An unselected population of 60 children with Down syndrome born 1988–1999 was followed with repeated examinations. Mean follow-up time was 55±23 months (range 24–115). The alignment of the eyes was examined using Hirschberg corneal reflex test and cover test for near fixation. To evaluate binocular function, Titmus House Fly Test and Lang’s stereo test were used. Results: Twenty-five patients (42%) had strabismus (21 esotropias, two exodeviations and two vertical deviations). Only one case of infantile esotropia was found, the other esotropias were acquired forms. The mean age at “onset” (e.g. when strabismus was first noticed) was 54±35 months. In the acquired esotropia group (n=20), 15 (75%) were associated with hypermetropia (mean spherical equivalent +4.3±1.7 D). Seventeen of the strabismic patients had an accommodation weakness. Eleven of the strabismus patients gave a clearly positive response to one or both stereotests. Conclusions: The majority of the Down syndrome children with strabismus have an acquired esotropia and hence a potential for binocularity. Hypermetropia and accommodation weakness are probably important factors in esotropia in Down syndrome patients.

Short wavelength automated perimetry.

Abstract: Short Wavelength Automated Perimetry (SWAP) utilizes a blue stimulus to preferentially stimulate the blue cones and a high luminance yellow background to adapt the green and red cones and to saturate, simultaneously, the activity of the rods. This review describes the theoretical aspects of SWAP, highlights current limitations associated with the technique and discusses potential clinical applications. Compared to white-on-white (W-W) perimetry, SWAP is limited clinically by: greater variability associated with the estimation of threshold, ocular media absorption, increased examination duration and an additional learning effect. Comparative studies of SWAP and W-W perimetry have generally been undertaken on small cohorts of patients. The conclusions are frequently unconvincing due to limitations for SWAP in the delineation of abnormality and of progressive field loss. SWAP is almost certainly able to identify glaucomatous visual field loss in advance of that by W-W perimetry although the incidence of progressive field loss is similar between the two techniques. Increasing evidence suggests that functional abnormality with SWAP is preceded by structural abnormality of the optic nerve head and/or the retinal nerve fibre layer. SWAP appears to be beneficial in the detection of diabetic macular oedema and possibly in some neuro-ophthalmic disorders.

Rieger syndrome is associated with PAX6 deletion

Abstract: . Purpose: Rieger syndrome is an autosomal dominant condition defined by anterior segment dysgenesis in combination with facial, dental, skeletal and umbilical abnormalities. To date Rieger syndrome has been associated with mutations in the PITX2 gene at chromosome 4q25 and a second locus has been found at chromosome 13q14. Methods: We describe a Rieger syndrome case with all the typical dysmorphic features and the molecular genetic finding by use of FISH analysis of the PAX6 gene. Results: An eight-year-old girl had iris stroma hypoplasia, corectopia and iridogoniodysgenesis. She had an underdeveloped premaxilla and a congenital absence of nine teeth in the maxilla. The front teeth in the mandible were peg-shaped and all teeth were small. There was failure of involution of the periumbilical skin. FISH analysis using probes for the PAX6 gene showed a small deletion for the PAX6 gene on one homologue of chromosome 11. Conclusion: Rieger syndrome can – in addition to PITX2 gene mutations and abnormalities at chromosome 13q14 – be associated with PAX6 gene abnormalities.

An evaluation of the retinal nerve fiber layer thickness by scanning laser polarimetry in individuals with dementia of the Alzheimer type.

Abstract: . Purpose: To determine, using scanning laser polarimetry, whether or not the retinal nerve fiber layer (RNFL) is altered in dementia of the Alzheimer type (DAT). Methods: Thirty individuals with mild to moderate DAT and 30 healthy age-matched controls participated in the study. Fundus images were acquired with a Nerve Fiber Analyzer. RNFL thickness measurements were obtained under an ellipse located 1.75 disc diameter from the optic nerve head (ONH) center. Results: No differences in RNFL thickness were observed between DAT and healthy subjects. The regional distribution of RNFL thickness was similar between the two test groups, with the RNFL being thickest in the superior and inferior retinal segments relative to the nasal and temporal regions. Conclusions: Our data indicate that the RNFL is not altered in DAT, at least in the earlier stages of the disease.

Ocular perfusion and age-related macular degeneration.

Abstract: . Purpose: To review the role of ocular perfusion in the pathophysiology of age-related macular degeneration (AMD), the leading cause of irreversible blindness in the industrialized world. Methods: Medline search of the literature published in English or with English abstracts from 1966 to 2000 was performed using various combinations of relevant key words. Results: Vascular defects have been identified in both nonexudative and exudative AMD patients using fluorescein angiographic methods, laser Doppler flowmetry, indocyanine green angiography, and color Doppler imaging. Conclusion: Although these studies lend some support to the vascular pathogenesis of AMD, it is not possible to determine if the choroidal perfusion abnormalities play a causative role in nonexudative AMD, if they are simply an association with another primary alteration, such as a primary RPE defect or a genetic defect at the photoreceptor level, or if they are more strongly associated with one particular form of this heterogeneous disease. Further study is warranted.

The impact of glaucoma on the quality of life of patients in Norway. II. Patient response correlated to objective data.

Abstract: Purpose To elucidate the relationship between the visual difficulties reported by patients treated for glaucoma and their objective functional damage, and to evaluate the reliability of the patient responses Methods Questionnaires concerning quality of life filled in at home by 589 patients treated for chronic open angle glaucoma were correlated to corresponding questionnaires returned from their ophthalmologists Results Few of our patients had a visual field damage judged to be of functional significance There was a weak to moderate association between both visual field defects and decreased visual acuity and self-reported visual difficulties A high proportion of the patients had normal binocular visual field and a stable disease, raising the suspicion that some of them were treated for ocular hypertension The agreement between the responses from the patients and the ophthalmologists concerning the topical treatment was good, regarding treatment duration and other diseases of the patients the agreement was moderate Conclusion The association between subjective visual disability and presence of visual field defects was weak to moderate in our patients treated for glaucoma, and this association was further weakened by adjusting for visual acuity Some patients might be treated unnecessarily, and a favourable prognosis might be given to most of them The reliability of the patients in general was good

External beam irradiation therapy for choroidal haemangiomas. Visual and anatomical results after a dose of 20 to 25 Gy.

Abstract: Purpose: To evaluate the visual and anatomic results of radiation therapy in ten patients with choroidal haemangiomas Methods: Nine patients with circumscribed choroidal haemangiomas and one with diffuse choroidal haemangioma have been reviewed retrospectively They were treated by lens-sparing external beam radiation therapy (20‐24 Gy) (9 eyes) and plaque brachytherapy (25 Gy) (1 eye), respectively Results: The visual acuity improved by two lines or more in 8 of 10 eyes No eyes showed deterioration of visual acuity In all cases the retinal detachment showed complete resolution A regression in tumour thickness was observed in all cases, and a reduction of anisometropia in cases with submacular infiltration by the tumour During follow-up (04‐88 years) there were no signs of radiation cataract, retinopathy or optic neuropathy Conclusions: External beam radiation (20‐25 Gy) is a reasonable alternative for treatment of symptomatic choroidal haemangiomas

Biometric measurements of the eyes in teenagers and young adults with Down syndrome.

Abstract: Purpose: To examine ocular biometric variables in subjects with Down syndrome. Methods: In a population-based study we have compared ocular biometric variables in a group of 47 individuals with Down syndrome (20.0”3.9 years) with 51 control subjects (21.0”4.6 years). Results: A thinner cornea (0.48”0.04 mm vs. 0.55”0.03 mm, p∞0.001) and higher keratometry values (46.39”1.95 D vs. 43.41”1.40 D, p∞0.001) were found in the Down syndrome group than in the control group. Oblique astigmatism was commonly found in the Down syndrome individuals, showing a strong right-left specificity (right eyes’ axes in the 135ae-meridian, left eyes’ axes in the 45ae-meridian). The lens was thinner (3.27”0.29 mm vs. 3.49”0.20 mm) and the calculated lens power was weaker (17.70”2.36 D vs. 19.48”1.24 D) in the Down syndrome group than in the control group (p∞0.001 in both cases). Conclusions: Thinning of the corneal stroma may account for the steeper cornea and the high frequency of astigmatism in Down syndrome due to lower corneal rigidity. It may also be of etiological importance to the increased incidence of keratoconus in Down syndrome.

Angiolymphoid hyperplasia with eosinophilia should not be confused with Kimura's disease.

Abstract: . Purpose: To emphasize the differences between angiolymphoid hyperplasia with eosinophilia (ALHE) and Kimura’s disease (KD), two entities often confused in the ophthalmic literature. Methods: Case report of a subcutaneous mass in the periocular region of a 45-year old woman and a MEDLINE review of the ophthalmic and non-ophthalmic literature on ALHE and KD. Results: The clinical and histopathological findings of the present case were consistent with ALHE, but not with KD. A survey of the current ophthalmic literature indicates that these two designations are still often used synonymously, despite that non-ophthalmic papers now separate ALHE from KD. Conclusion: The clinical and histopathological features of ALHE are most often distinctly different from KD and these entities should be clearly separated in the ophthalmic literature.

Visual impairment in adult people with moderate, severe, and profound intellectual disability

Abstract: PURPOSE To assess visual impairment in adults with intellectual disability after de-institutionalisation. PATIENTS The county has a population of 385 483 persons of 18 years and older; 961 were moderately, severely or profoundly intellectually impaired (ID), 837 of them (87 %) participated in the investigation. METHODS Visual acuity, VA: Osterberg picture charts and reduced copies for near vision could be used in 71% of the patients. Teller preferential looking procedure was applied to people who were unable to cooperate with the picture charts. When examined with picture wall chart VA 0.3-> or =0.10) was found in 10.8%, severe low vision in 1.2% (VA or =0.05), and blindness (VA +1.50 was found in 151 of 710 subjects (21%), and spectacles were used by 106 (15%); myopia <-1.0 was present in 213 individuals (30%), 95 persons (13%) had lenses <-1.0. CONCLUSION Resettled adult people with intellectual disability have a high prevalence of treatable visual impairment. A structured scheme of referral to optometric and ophthalmological care is essential if these people are to be given the care to which they are entitled.

Effect of localized defocus on detection thresholds for different sized targets in the fovea and periphery

Abstract: . Purpose: Previous studies of optical blur in perimetry have measured the effect of foveal refractive error on peripheral perimetric detection thresholds. Since peripheral refractive error can be significantly different from that of the fovea we wished to remove the ambiguity of previous results by correcting the actual peripheral refractive error first before adding blur. Methods: We measured detection thresholds in the fovea and at 30 degrees in the horizontal temporal field in two trained observers. Peripheral refractive error was determined at each location and thresholds measured at the same locations for stimuli ranging in size from 0.2 to 6.4 degrees and refractive errors between ±4.00 diopters. Results: Foveal thresholds increased immediately with increasing refractive error, particularly for smaller stimulus sizes. At 30 degrees, thresholds for smaller stimuli were less affected by defocus initially and then increased more sharply. Larger stimuli were relatively unaffected by defocus such that when stimulus size reached 1.6 degrees there was little or no increase in threshold for refractive error between ±4.00 diopters. Conclusions: Peripheral refractive error, largely forgotten by perimetrists, has a significant effect on performance, particularly for smaller stimuli. Differences in foveal vs peripheral viewing can be explained by differences in ganglion cell receptive field sizes.

The effect of early steroid treatment after PRK on clinical and refractive outcomes.

Abstract: Purpose: To evaluate the effects of steroid treatment administered in the first days after excimer laser keratectomy (PRK) on re-epithelialization time, postoperative pain, haze and refractive outcome. Methods: A randomised, double masked trial was carried out on two groups of patients (40 patients each), who underwent PRK. Group A (steroid group) received 0.1% fluorometholone acetate whereas group B (NSAID group) received 0.5% ketorolac tromethamine until re-epithelialization was completed. Subsequently, all 80 patients received the same steroid treatment: 0.1% fluorometholone acetate for myopic corrections up to »5 D, or dexamethasone for myopic corrections exceeding ‐5 D. Both drugs were tapered off over approximately 3 months. Follow-up examinations were planned at 1, 3, 6, 12 months after surgery. Results: Re-epithelialization was completed after three days, without any significant difference between groups. A higher hyperopic shift was shown in the steroid group and a more severe regression was reported in the NSAID group (p∞0.001). Haze was significantly reduced in the steroid group (p‰0.005), especially for myopic corrections over » 5D( p‰0.015). Pain was significantly reduced in the NSAID group (p‰0.002). Conclusion: Steroid eyedrops administered in the first days after PRK did not affect re-epithelialization time. Moreover, a modulation of the inflammatory response in this period appears to reduce haze and myopic regression in high myopic patients.

Pseudoexfoliation syndrome in eyes with ischemic central retinal vein occlusion. A histopathologic and electron microscopic study.

Abstract: . Purpose: To determine histopathologically the prevalence of pseudoexfoliation (PEX) material in eyes enucleated secondary to ischemic central retinal vein occlusion (CRVO) and to evaluate eyes with PEX material in the anterior segment and CRVO ultrastructurally for PEX deposits in the vicinity of central retinal vessels. These deposits could explain an association of CRVO and PEX. Methods: All surgically enucleated eyes with secondary angle closure glaucoma due to rubeotic iris secondary to ischemic CRVO (1981–1998) available were re-analyzed light microscopically for the presence of PEX in the anterior segment (n=120; 76.9±8.5 years [range: 51–91]). Eyes with PEX in the anterior segment and available optic nerve cross sections were examined by electron microscopy for PEX material in the retrolaminar (n=7) and intralaminar central retinal vessels (n=3). All eyes surgically enucleated because of malignant melanoma of the choroid aged 70 years and older (1981–1998) with sections available served as age-matched controls (n=107; 76.4±5 years [range: 70–91]). Results: PEX material was present light microscopically in the anterior segment in 12 of 120 eyes with CRVO (10%) compared to 2 of 107 age-matched eyes with choroidal malignant melanoma (1.9%; p<0.05). Electron microscopically, neither structural alterations of the vessel wall nor PEX deposits were found in association with central retinal vessels both in the intra- and retrolaminar areas in any of the 7 eyes with PEX in the anterior segment and CRVO analyzed. Conclusions: Histopathologically, PEX is significantly more common in eyes enucleated secondary to CRVO compared to eyes enucleated because of an intraocular tumor. This most likely is due to the secondary open angle glaucoma in eyes with PEX as a known risk factor for CRVO. According to the small number of optic nerves analyzed here, there seems to be no morphologically evident PEX vasculopathy in the central retinal vessels both within and immediately behind the lamina cribrosa in eyes with PEX in the anterior segment and CRVO potentially causing retinal venous thrombosis.

Cortical lens opacification in Iceland. Risk factor analysis -- Reykjavik Eye Study.

Abstract: . Purpose: Cortical lens opacification has been associated with outdoor exposure and UV radiation more than other types of lens opacification. We studied risk factors for cortical lens opacification only, the most common as well as the earliest age related change we observe in the lens. Methods: 1,045 persons, 583 females and 462 males, 50 years and older, underwent a detailed eye examination and answered a questionnaire. Participants with cortical lens opacification grade I, totalling 374 persons, were assigned to case-control study I, and to case-control study II those with cortical lens opacification grades II and III, totalling 82 subjects. 378 age and sex matched persons served as controls. Results: Those who spent more than 4 hours/day outside on weekdays, in their 20’s–30’s and 40’s–50’s respectively, were found to have increased risk of moderate to severe cortical lens opacification. Thus the relative risk for grades II & III, was 2.80 (95% CI 1.01–7.80) and 2.91 (95% CI 1.13–9.62) respectively. Ageing and systemic cortical steroids use were also found to be risk factors. Conclusion: Outdoor exposure appears to be associated with increased risk of moderate to severe cortical lens opacification. Ageing is, however, the main risk factor.