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Biomedical subjects

Joseph M Miller

Publications and source records attributed to Joseph M Miller.

15 recordsLinked to original sources
PubMed2006

Amblyopia in astigmatic children: patterns of deficits.

Neural changes that result from disruption of normal visual experience during development are termed amblyopia. To characterize visual deficits specific to astigmatism-related amblyopia, we compared best-corrected visual performance in 330 astigmatic and 475 non-astigmatic kindergarten through 6th grade children. Astigmatism was associated with deficits in letter, grating and vernier acuity, high and middle spatial frequency contrast sensitivity, and stereoacuity. Although grating acuity, vernier acuity, and contrast sensitivity were reduced across stimulus orientation, astigmats demonstrated orientation-dependent deficits (meridional amblyopia) only for grating acuity. Astigmatic children are at risk for deficits across a range of visual functions.

Amblyopia↗
PubMed2006

Prevalence of high astigmatism, eyeglass wear, and poor visual acuity among Native American grade school children.

PURPOSE: The purpose of this study was to examine the prevalence of astigmatism and poor visual acuity and rate of eyeglass wear in grade school children who are members of a Native American tribe reported to have a high prevalence of large amounts of astigmatism. METHODS: Vision screening was conducted on 1,327 first through eighth grade children attending school on the Tohono O'odham Reservation. Noncycloplegic autorefraction was conducted on the right and left eye of each child using the Nikon Retinomax K+ autorefractor, and monocular recognition acuity was tested using ETDRS logarithm of the minimum angle of resolution (logMAR) letter charts. RESULTS: Tohono O'odham children had a high prevalence of high astigmatism (42% had > or = 1.00 D in the right or left eye) and the axis of astigmatism was uniformly with-the-rule. However, only a small percentage of children arrived at the vision screening wearing glasses, and the prevalence of poor visual acuity (20/40 or worse in either eye) was high (35%). There was a significant relation between amount of astigmatism and uncorrected visual acuity with each additional diopter of astigmatism resulting in an additional 1 logMAR line reduction in visual acuity. CONCLUSIONS: Uncorrected astigmatism and poor visual acuity are prevalent among Tohono O'odham children. The results highlight the importance of improving glasses-wearing compliance, determining barriers to receiving eye care, and initiating public education programs regarding the importance of early identification and correction of astigmatism in Tohono O'odham children.

Adolescent↗
PubMed2005

Prescribing eyeglass correction for astigmatism in infancy and early childhood: a survey of AAPOS members.

PURPOSE: To determine prescribing practices of pediatric ophthalmologists for astigmatism and astigmatic anisometropia in infants and young children. METHODS: A survey was sent to the 700 North American AAPOS members listed in the 2004 web site directory. RESULTS: A total of 412/700 surveys (59%) were returned. The level of astigmatism at which pediatric ophthalmologists prescribe eyeglasses for astigmatism varies considerably across the age range from birth to 3 years. The level at which 50% would prescribe glasses was > or =4.00 D from 0 to <6 months and decreased to > or =2.00 D by 2 to <3 years. Furthermore, one-fifth indicated that they would not prescribe eyeglasses for astigmatism in infants <6 months of age. Prescribing practices for astigmatic anisometropia were slightly less variable across age, with 50% of respondents indicating that they would prescribe eyeglasses for astigmatic anisometropia > or =3.00 D from 0 to <6 months, decreasing to > or =1.50 D by 2 to <3 years. CONCLUSIONS: The American Academy of Ophthalmology Preferred Practice Patterns guidelines accurately reflect prescribing practices of pediatric ophthalmologists for 1- and 2-year-old children for bilateral astigmatism and astigmatic anisometropia. However, the AAO guidelines do not accurately reflect the prescribing practices for children in the 0 to <1-year age range. For children 0 to <6 months of age, pediatric ophthalmologists indicate that they typically require a higher amount of astigmatism or astigmatic anisometropia than that recommended by the AAO guidelines, or they do not prescribe glasses at all.

Academies and Institutes↗
PubMed2005

Initial and repeat testing for chlamydia during pregnancy.

OBJECTIVE: This study was done to evaluate the prevalence of chlamydia in late pregnancy after an initial negative test. METHODS: This retrospective cohort study reports prenatal patients entering care between January 1998 and May 2000 at an inner city community based clinic (n = 752). Patients were evaluated if results of initial and late tests (34 weeks gestational age) for chlamydia were known. Charts were abstracted for demographic and pregnancy-related factors. Analysis for categorized data was by chi-squares and odds ratios. Continuous data were analyzed by t-test. Significance was accepted if p < 0.05. RESULTS: The prevalence of chlamydia was 17.8%, with 3.9% having only the second test positive. Treatment failure and/or reinfection were found in 13.3%. Factors correlated with chlamydial carriage include: age 19 years (p < 0.001), gonorrheal carriage (p < 0.001), lower gravidity (p < 0.01), lower parity (p < 0.05), and never having married (p < 0.001). Logistic regression identified gonorrheal carriage and age 19 years as important for both initial and late chlamydial cervicitis. Marital status was important for initial tests only. CONCLUSIONS: In our high-risk population, repeat testing for chlamydia in late pregnancy was found appropriate.

Adolescent↗
PubMed2005

Severe Graves' ophthalmopathy in pregnancy.

BACKGROUND: Thyroid ophthalmopathy is a rare extrathyroidal complication most commonly associated with Graves' disease. The disease course ranges from mild to severe, with severe cases resulting in major visual impairment and facial disfigurement. CASE: A 22-year-old primigravida developed severe thyroid ophthalmopathy during pregnancy, requiring high-dose steroids and surgical orbital wall decompression to restore visual acuity. CONCLUSION: Severe thyroid ophthalmopathy can occur in the euthyroid pregnant patient. Corticosteroid therapy and surgical intervention may be required during pregnancy in this clinical scenario.

Adult↗
PubMed2004

Safety and efficacy of 2% pirenzepine ophthalmic gel in children with myopia: a 1-year, multicenter, double-masked, placebo-controlled parallel study.

OBJECTIVE: To evaluate the safety and efficacy of the relatively selective M(1) antagonist pirenzepine hydrochloride in slowing the progression of myopia in school-aged children. METHODS: This was a parallel-group, placebo-controlled, double-masked study in healthy children, aged 8 to 12 years, with a spherical equivalent of -0.75 to -4.00 diopters (D) and astigmatism of 1.00 D or less. Patients underwent a baseline complete eye examination and regular examinations during a 1-year period. The setting was 13 US academic clinics and private practices. Patients were randomized in a 2:1 ratio to receive 2% pirenzepine ophthalmic gel or a placebo control twice daily for 1 year. RESULTS: At study entry, the spherical equivalent was mean +/- SD -2.098 +/- 0.903 D for the pirenzepine group (n = 117) and -1.933 +/- 0.825 D for the placebo group (n = 57, P = .22). At 1 year, there was a mean increase in myopia of 0.26 D in the pirenzepine group vs 0.53 D in the placebo group (P < .001). No patients in the placebo group and 13 (11%) of 117 patients in the pirenzepine group discontinued participation in the study because of adverse effects (5 [4%] of 117 due to excessive antimuscarinic effects). CONCLUSIONS: Pirenzepine is effective and relatively safe in slowing the progression of myopia during a 1-year treatment period.

Child↗
PubMed2004

Treatment of astigmatism-related amblyopia in 3- to 5-year-old children.

Best-corrected acuity was measured for vertical and horizontal gratings and for Lea Symbols recognition acuity in 3- to 5-year-old children with high astigmatism and in non-astigmatic children. There was significant amblyopia among astigmatic children at baseline. There was no evidence that eyeglass correction of astigmatism resulted in a reduction in amblyopia over a 4-month average treatment duration (although vision in astigmatic children was significantly improved immediately upon eyeglass correction, indicating that eyeglass correction did provide a visual benefit). Treatment outcome results are discussed in terms of both methodological issues and theoretical implications.

Amblyopia↗
PubMed2004

The startle test revisited.

OBJECTIVE: Our purpose was to the compare fetal heart reaction to external physical stimulation with the nonstress test (NST). STUDY DESIGN: This prospective study evaluates documentation of fetal heart rate accelerations by two methods. The standard NST was performed prior to the ultrasound evaluation. The NST results were unavailable to the ultrasonographer. M-mode ultrasound was used initially to detect a stable heart rate. Then the ultrasound transducer was used to stimulate fetal movement by indenting the uterus over the fetal small parts. A second fetal heart rate was determined within 15 seconds after stimulation. RESULTS: A total of 194 patients underwent 235 studies. The patient population included four sets of twins. When the NST was reactive, 151/216 had an ultrasound startle response of > or =15 beats per minute; however, all nonreactive NSTs were associated with an ultrasound response of 14 beats per minute or less (p<0.001). A receiver-operating characteristic curve comparing the ultrasound fetal response to the startle with the NST identified the area under the curve to be 0.948, consistent with high specificity and sensitivity. CONCLUSION: The fetal heart rate response to external stimulation identifies 67% of patients with a reactive NST.

Female↗
PubMed2003

Amblyopia in astigmatic preschool children.

Best-corrected acuity was measured for vertical and horizontal gratings and for recognition acuity optotypes (Lea Symbols) in a group of three- to five-year-old children with a high prevalence of astigmatism. Results showed meridional amblyopia (MA) among children with simple/compound myopic or mixed astigmatism, due to reduced acuity for horizontal gratings. Children with simple/compound hyperopic astigmatism showed no MA, but did show reduced acuity for both grating orientations. Reduced best-corrected recognition acuity was shown by both myopic/mixed and hyperopic astigmats. These results suggest that optical correction of astigmatism should be provided prior to age three to five years, to prevent development of amblyopia.

Amblyopia↗
PubMed2003

A cost-benefit analysis of vision screening methods for preschoolers and school-age children.

INTRODUCTION: The purpose of this study was to determine costs and benefits of visual acuity screening (VAS) or photoscreening (PS) in children. METHODS: A societal-perspective, decision-analytic model compared VAS and PS conducted in three age groups: children 6 to 18 months, 3 to 4 years, and 7 to 8 years old. Literature estimates of sensitivity, specificity, and prevalence were used. Cost estimates and referral rates for surgical treatment were derived from a managed care database and the United States Social Security Administration. RESULTS: All the benefit-to-cost ratios exceeded 1.0, meaning that all screening programs studied had benefits that exceeded the cost of screening. The total net benefit was highest for PS in children of 3 to 4 years of age (19,412 US dollars) and the least for VAS in children 7 to 8 years of age (15,179 US dollars). The benefit-to-cost ratio was highest for the VAS in children 3 to 4 years of age (162 US dollars) and least for PS in infants 6 to 18 month old (140 US dollars). Sensitivity of the PS instrument and VAS charts were the most influential variables in determining the most cost-beneficial program. CONCLUSIONS: Based on the best available data, the net benefit of PS in 3 to 4 year old preschool children is greater than VAS in children 7 to 8 years of age, PS in toddlers, and VAS in children 3 to 4 years of age.

Age Factors↗
PubMed2003

Initial and repeated screening for gonorrhea during pregnancy.

BACKGROUND AND GOAL: Late pregnancy rescreening is advised for at-risk patients, but data supporting this recommendation are lacking. The intent of this study was to determine the value of a late-pregnancy test for gonorrhea after a negative initial test at the beginning of prenatal care. STUDY DESIGN: A retrospective chart review of clinic records over a 29-month period identified patients with a positive DNA direct assay for gonorrhea either initially or at 34 weeks. RESULTS: Of 751 women, 38 (5.1%) had gonorrhea diagnosed at their first testing; 19 women (2.5%) were positive only at their second screening. For one patient, both tests were positive. CONCLUSION: Repeating screening for gonorrhea at 34 weeks in a high-prevalence population is warranted.

Adult↗
PubMed2003

Cost-efficient vision screening for astigmatism in native american preschool children.

PURPOSE: To design and test a cost-efficient, community-based vision screening program for a population of Native American preschool children in which there is a high prevalence of astigmatism. METHODS: Based on analysis of vision screening and eye examination data from a preschool population with a 33% prevalence of astigmatism, comparative costs to conduct a 1000-child screening program with a target sensitivity of 90% were estimated for photoscreening, noncycloplegic autorefraction, autokeratometry, and Lea symbols distance visual acuity testing. Results of the cost analysis and examination of sensitivity and specificity data from the preschool population led to development of a hybrid screening program of autokeratometry and visual acuity screening with referral thresholds of 2.25 D of corneal astigmatism or inability to read a 20/63 Lea symbols line on two separate attempts. The screening program was prospectively implemented in a community-based screening of a similar cohort of 167 children, and its efficiency was evaluated by comparison to results of cycloplegic refraction. RESULTS: The community-based screening showed 96.8% sensitivity and 79.2% specificity for detecting the presence of refractive astigmatism of 1.50 D or more. CONCLUSIONS: Referring children who have at least 2.25 D of corneal astigmatism or acuity worse than 20/63 on two attempts, provides the high sensitivity and specificity associated with automated keratometry while maintaining an acuity component that can detect other causes of reduced acuity in the absence of astigmatism.

Astigmatism↗
PubMedDate not supplied

Higher order aberrations in normal, dilated, intraocular lens, and laser in situ keratomileusis corneas.

PURPOSE: To compare repeated measures of Zernike polynomial higher-order aberrations in 29 normal, 13 dilated normal, 11 intraocular lens (IOL), 11 laser in situ keratomileusis (LASIK), and one refractive keratectomy (RK)/IOL subject. METHODS: At least three Shack-Hartmann images were obtained from each subject, and higher order (uncorrectable by spectacles) Zernike representation was determined. For each subject, confidence intervals for each Zernike coefficient were determined as a function of pupil size. Significant (P<.05) coefficients were averaged within groups, and group means were compared to normal subjects. RESULTS: No differences were seen between the normal and dilated groups at P=.05. The patients with prior LASIK and IOL surgery showed statistically significant elevation of 4th order spherical aberration and total wavefront variance for pupil sizes greater than 5 mm, compared to normals. CONCLUSION: Both IOL and LASIK surgery elevate spherical aberration and wavefront variance, with increasing magnitude of effect with increasing pupil size, although pupillary dilation alone did not produce statistically different changes, as compared to normal subjects. These findings demonstrate that IOL implantation can produce more net aberrations than LASIK, and demonstrate a new opportunity to optimize surgical results.

Cornea↗