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D B Granet

Publications and source records attributed to D B Granet.

12 recordsLinked to original sources
PubMed2001

Marked variability amongst pediatric ophthalmologists in designating the diagnostic gaze position angles in ocular motility evaluations.

BACKGROUND: Management of strabismus relies on accurate evaluation of binocular alignment in standard gaze positions. In 1962, Stuart & Burian noted that, without adopting a standard routine, "measurements of various patients could not be compared, and there will be considerable difference in measurement from one examination to another and by different examiners" (1). Diagnostic position gaze angles are not routinely measured. Is this important? SUBJECTS AND METHODS: Subjects were 82 volunteer experts recruited from attendees at the 1998 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) scientific meeting. One author served as examinee for all testing. The actual head posture was measured for the expert designated primary position, right and left gazes, head tilts and up- and downgazes using the CROM device. The examinee fixated at a six meter distance accommodative target. Examiners were asked to mimic their office routine. Eighty-two subjects ranging from 29 to 69 years of age, consisting of 24 females and 58 males were recruited. Sixty-nine were pediatric ophthalmologists, 7 orthoptists, 4 international members and 2 members in training. Eight subjects also underwent re-testing. Years in practice averaged 11.5. RESULTS: Range of head posture measurements: For "Horizontal Gaze": 10 to 50 degrees; For "Vertical Gaze": 4 to 58 degrees; For "Head Tilts": 20 to 50 degrees. There was no substantial difference between initial and repeat measurements. CONCLUSION: There is a surprisingly high degree of variability amongst expert observers in defining standard gaze positions. These results may explain some of the inconsistent outcomes noted in the strabismus literature. The implication for transferring data from publication to practice and in designing multicentered protocols is concerning. Without defining and maintaining a standard for binocular alignment measurements, comparison between studies and examiners is not possible.

Adult↗
PubMed1993

The visual-evoked response in infants with central visual impairment.

We studied ten children with central visual impairment with a known neurologic defect and an abnormal visual-evoked response who had results of repeat electrophysiologic testing evaluated at the Children's Hospital of Philadelphia from December 1989 through July 1991. Central visual impairment is defined as poor visual function with a normal anterior visual pathway. Age at first examination ranged from 5 to 48 months with a followup of two to 31 months. Repeat visual-evoked response testing showed improvement in seven patients and no change in three. Grating acuity as measured by the Teller acuity card procedure, performed in nine of ten patients, improved in seven, showed no change in one, and declined in one. We found a potentially favorable prognosis for those infants with central visual impairment, despite an initially abnormal visual-evoked response. We used a clinical approach to this disorder to improve diagnostic categorization and prognostic capabilities in central visual impairment.

Brain Diseases↗
PubMedDate not supplied

The intraoperative oculocardiac reflex as a predictor of postoperative vaso-vagal responses during adjustable suture surgery.

Adjustable suture surgery has become a popular method of strabismus correction in those cases in which results are less predictable, such as reoperations, thyroid ophthalmopathy, and blind eyes. Complications related to adjustable strabismus surgery are, in general, no different than those related to standard surgical techniques. We noticed a subgroup of patients who experienced significant vaso-vagal responses (V-VR) during postoperative adjustment and sought to discover a method of identifying these patients prior to adjustment. Sixty patients were studied prospectively from July 1991 to July 1992. All patients had surgery under general anesthesia and were adjusted 24 hours later. A positive oculocardiac reflex (OCR) occurred when a 10% or greater intraoperative change in heart rate was associated with traction on an extraocular muscle. A positive V-VR postoperatively consisted of one or more subjective findings (dizziness, light-headedness, nausea, or body temperature changes), and two or more objective findings (10% or greater change in heart rate, hypotension, pallor, diaphoresis, vomiting, disorientation, or loss of consciousness). Variables studied for predictive value included OCR, age, sex, strabismus type, previous surgery, muscle adjusted, and systemic disease. Twenty-five patients (41.6%) had a positive V-VR during adjustment. Twenty-seven patients (45%) had a positive OCR. Eighty-five percent of patients with a positive OCR and 9% of patients with a negative OCR had a positive V-VR. Younger patients were also more likely to have a positive V-VR. A positive intraoperative OCR under general anesthesia during strabismus surgery is highly predictive of a postoperative V-VR during planned adjustment.

Adolescent↗
PubMedDate not supplied

The use of hyaluronic acid during adjustable suture surgery.

We prospectively studied the force required to move an extraocular muscle after adjustable suture surgery with and without the perioperative use of hyaluronic acid (Healon). The 15 muscles that received hyaluronic acid averaged 15.0 g of force to move the muscle 2.0 mm which was significantly different than the average force of 36.15 g required for the 13 control muscles. The decreased force required to adjust the muscle along with potential antiinflammatory properties of hyaluronic acid make this a useful adjunct during adjustable suture surgery.

Humans↗
PubMedDate not supplied

A new objective digital computerized vision screening system.

PURPOSE: Fewer than 40% of children in the crucial younger-than-4 age group are evaluated for visual problems by pediatricians. This is due to impracticality from either a clinical or practice efficiency standpoint. Current photoscreening methods require trained readers and suffer from significant subjectivity and interobserver variability. We report a cross-sectional, double-masked study using new digital imaging with objective, automated, computerized image analysis. METHODS: Two-hundred six children aged 9 months to 16 years were prospectively studied in a University-based pediatric ophthalmology practice. Images were taken by volunteers with a modified digital camera which, when downloaded, were analyzed within 35 seconds by new image analysis software. The analysis was compared to a masked review of a complete pediatric ophthalmic exam. RESULTS: Overall agreement between physician and the objective computerized analysis was 86.9%. Positive predictive value was 91%, sensitivity was 89%, and specificity was 83%. CONCLUSIONS: This automated digital imaging screening system eliminates human bias and provides accurate and immediate results. The system requires no special expertise.

Adolescent↗
PubMedDate not supplied

The intraoperative oculocardiac reflex as a predictor of postoperative vaso-vagal responses during adjustable suture surgery.

1. Adjustable suture surgery has become a popular method of strabismus correction in cases in which results are less predictable, such as reoperations, thyroid ophthalmopathy, and blind eyes. 2. Some adjustable strabismus surgery patients experience significant vaso-vagal responses (V-VR) during postoperative adjustment. 3. A positive intraoperative oculocardiac reflex under general anesthesia during strabismus surgery is highly predictive of a postoperative V-VR during planned adjustment.

Anesthesia, General↗