Biomedical subjects

Jacob T Wilensky

Publications and source records attributed to Jacob T Wilensky.

6 recordsLinked to original sources

PubMed2006

Treating chronic noninfectious posterior segment uveitis: the impact of cumulative damage. Proceedings of an expert panel roundtable discussion.

Chronic noninfectious posterior segment uveitis refers to inflammation of the retina, choroid, vitreous, or optic nerve, and may result in permanent vision loss. The inflammation can be constant, or characterized by periodic exacerbations on an underlying baseline of inflammation. Recent studies indicate that this vision loss often results from cumulative damage over multiple recurrences of inflammation, rather than from a single initiating event. Most forms of local therapy provide only transient suppression of inflammation, and the use of systemic agents may be limited by serious side effects. The course of uveitis may, therefore, be marked by recurrent episodes of inflammation, each contributing to progressive and permanent loss of visual acuity. The goal of uveitis treatment should not only be to suppress inflammation when it recurs but also to attain complete remission of inflammation, and thus prevent complications such as cystoid macular edema (CME) and permanent cumulative damage. The RETISERT intravitreal implant offers sustained local control of inflammation without the systemic side effects that limit standard immunosuppressive and oral corticosteroid therapies. The recommendation of the expert panel was that RETISERT is a useful addition to the armamentarium for the treatment of chronic noninfectious posterior segment uveitis and may help to prevent cumulative damage from repeated occurrences of inflammation, especially when vision can be improved rather than only stabilized.

Anti-Inflammatory Agents↗

PubMed2005

Driving performance of glaucoma patients correlates with peripheral visual field loss.

PURPOSE: To identify clinical vision measures that are associated with the driving performance of glaucoma patients who have visual field loss and visual acuity better than 20/100 and to compare the driving performance of glaucoma patients with the driving performance of a group of age- and sex-equivalent individuals without eye disease. PATIENTS: Forty patients with glaucoma and 17 normally sighted control subjects participated in this study. METHODS: Clinical vision data, consisting of visual acuity, letter contrast sensitivity, and visual fields, were collected. Driving performance was assessed by (1) an interactive driving simulator that measured 7 indices of performance (including number of accidents) and (2) the self-reported accident involvement for the past 5 years. MAIN OUTCOME MEASURES: Driving simulator performance and real-world, self-reported accident involvement. RESULTS: The number of accidents as measured on the driving simulator in the glaucoma group was significantly correlated with three Goldmann visual field measures: combined horizontal extent (rho = -0.47, P = 0.01), total horizontal extent (rho = -0.49, P = 0.007), and total peripheral extent (rho = -0.55, P = 0.002). There were no statistically significant correlations between the driving performance of the glaucoma group and the visual acuity or contrast sensitivity measures. When compared with the control group, a significantly greater proportion of the glaucoma group reported having at least one real-world accident within the past 5 years (Fisher exact test, P = 0.005). CONCLUSIONS: Visual field reduced to less than 100 degrees of horizontal extent may place patients with peripheral field loss at greater accident risk. A higher incidence of real-world and simulator accidents was found for the group with glaucoma.

Adult↗

PubMed2004

Long-term visual outcome of transscleral laser cyclotherapy in eyes with ambulatory vision.

OBJECTIVE: To determine the long-term visual acuity (VA) outcome of eyes with ambulatory vision (20/80 or better) that were treated with transscleral laser cyclotherapy. DESIGN: Observational case series. PARTICIPANTS: Twenty-one eyes of 21 patients who had been treated with laser cyclotherapy and who had been followed up at least 1 year. METHODS: A retrospective chart review was conducted to record the prelaser best-corrected VA and then the last available post laser VA and duration of follow-up. Additional laser or surgical interventions for glaucoma control were also recorded. MAIN OUTCOME MEASURES: Changes in VA from pretreatment to last available examination. RESULTS: The 21 eyes were followed for a mean of 40.7 months (range, 13-88 months); 17 eyes had a final vision within 1 line of the prelaser VA. One eye improved 3 lines, and 3 eyes deteriorated 3 or more lines. CONCLUSIONS: Most eyes with 20/80 or better VA maintained close to that acuity after laser cyclotherapy after a mean follow-up of 40.7 months. These good visual results offer support for those who believe that the indications for laser cyclotherapy should not be limited to eyes with poor VA or potential.

Adolescent↗

PubMed2004

The role of diurnal pressure measurements in the management of open angle glaucoma.

PURPOSE OF REVIEW: The measurement of intraocular pressure (IOP) is essential in the diagnosis and management of open-angle glaucoma, but a single measurement in the ophthalmologist's office may or may not reflect what the IOP is at other times of the day or night. It is well documented that the range of the daily fluctuations in IOP is greater in patients with glaucoma than in normal individuals, and a report by Asrani et al. suggested that the range of the diurnal fluctuation may be an independent risk factor for the progression of visual field loss. There have been reports of nocturnal increases in IOP, particularly in patients with normal tension glaucoma, and some ophthalmologists believe these may account for progression of visual field loss in some patients with glaucoma. This review will analyze recent articles that report the impact of various glaucoma therapies on the diurnal IOP curve and the use of diurnal curves in glaucoma diagnosis. RECENT FINDINGS: A number of recent publications document that antiglaucoma medications with a long duration of action reduce the range of diurnal fluctuation more than the shorter duration medications. Laser trabeculoplasty and trabeculectomy also narrow the range of diurnal fluctuation, and at least one recent study finds that trabeculectomy reduces the diurnal range more than medical therapy does. Several recent studies of diurnal IOP in patients with glaucoma have failed to document such diurnal IOP spikes, so the published data available have not supported this hypothesis. SUMMARY: One recent report has reconfirmed that a single IOP measurement in the office may not accurately indicate what is happening to the IOP of a patient with glaucoma throughout the day. Other reports have confirmed that treatment that lowers IOP narrows the range of diurnal IOP fluctuation, and one of these reports suggests that surgical reduction of IOL may narrow the fluctuation more than medical reduction of IOP. The reports of IOP during the night have not provided clear answers about what happens to IOP during sleep.

Antihypertensive Agents↗

PubMed2003

Angle-closure glaucoma in teenagers.

OBJECTIVE: To report the occurrence of angle-closure glaucoma in 2 teenagers. DESIGN: Observational case reports, review of literature. METHODS: Review of case histories, examinations, biometries, visual fields, and ultrasound biomicroscopy findings in 2 teenagers with angle-closure glaucoma. MAIN OUTCOME MEASURES: Intraocular pressure, gonioscopy, Humphrey 24-2 visual field (SITA Standard), and ultrasound biomicroscopy. RESULTS: The first case involved a 15-year-old white male who presented with an intraocular pressure of 60 mm Hg in the right eye and 24 mm Hg in the left eye and 360-degree appositional closure in both eyes. Ultrasound biomicroscopy revealed prominent bilateral ciliary pigment epithelial cysts pushing the iris anteriorly towards the angle. The second case involved a 14-year-old white male with a strong family history of primary angle-closure glaucoma. The patient had pupillary block and an intraocular pressure of 24 mm Hg in the right eye and 40 mm Hg in the left eye on routine eye examination. Gonioscopy and ultrasound biomicroscopy revealed appositional closure of the angle in all 4 quadrants bilaterally. CONCLUSION: Primary angle-closure glaucoma is uncommon in younger individuals. Therefore, the finding of angle-closure glaucoma in a young individual should alert the physician to the possibility of a secondary cause of angle closure, such as iris pigment epithelial cysts. In addition, special attention to family history is important as the configuration of an occludable anterior chamber angle may, in some instances, be inherited.

Adolescent↗

PubMed2003

Comparison of contrast sensitivity, visual acuity, and Humphrey visual field testing in patients with glaucoma.

BACKGROUND: Despite their normal or near-normal Snellen visual acuity, patients with glaucoma often complain of "poor" vision. OBJECTIVE: To investigate the relationship between large-letter contrast sensitivity, high-contrast visual acuity, and visual field defects in patients with glaucoma who have 20/40 or better visual acuity. DESIGN: Prospective, cross-sectional case series. PATIENTS AND METHODS: We evaluated 250 eyes of 144 subjects from the Glaucoma Service at the University of Illinois at Chicago College of Medicine. Subjects with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension who met the 20/40 or better vision requirement were recruited. Visual acuity was measured using the rear-illuminated Lighthouse Visual Acuity Chart at 4 m. Contrast sensitivity was measured using the Pelli-Robson Chart in a front-illuminated box with even luminance across the chart. Visual fields of the patients were measured using the 24-2 full-threshold program on the Humphrey Visual Field Analyzer. RESULTS: A significant correlation (r = 0.57, P < 0.001, n = 127) was found between the visual field mean deviations and the contrast sensitivity scores. The correlation (r = -0.322, P < 0.001, n = 127) was less between the visual field mean deviation and the log MAR visual acuity values, as was the correlation between the contrast sensitivity scores and log MAR visual acuity values (r = -0.370, P < 0.001, n = 127). In the subgroup of patients with chronic open-angle glaucoma, the correlation between the mean visual field deviation and the contrast sensitivity score was higher at 0.689 (P < or = 0.001, n = 62). CONCLUSIONS: Reduced contrast sensitivity is significantly correlated with visual field losses in patients with glaucoma and a visual acuity of 20/40 or better. The study data support the conclusion that, compared with visual acuity, the disease process preferentially affects contrast sensitivity. In our previous work, contrast sensitivity was shown to be more related than visual acuity to real-world function in patients with early glaucomatous changes.

Contrast Sensitivity↗