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Biomedical subjects

L J Singerman

Publications and source records attributed to L J Singerman.

At least 19 recordsLinked to original sources
PubMed2001

Natural history of choroidal neovascularization in high myopia.

High myopia, or pathologic myopia, usually refers to a condition in which individuals have greater than 6 diopters of myopia or an axial length greater than 26 to 27 mm. The natural history of choroidal neovascularization in high myopia is variable, and reports to date have some conflicting information, but analysis shows fairly poor final visual outcomes. This outcome complicates recommendations for treatment and must be considered in future studies aimed at managing this disease.

Choroidal Neovascularization↗
PubMed1999

Visual acuity outcomes of patients 50 years of age and older with high myopia and untreated choroidal neovascularization.

OBJECTIVE: To evaluate visual outcomes of untreated submacular choroidal neovascularization (CNV) in patients 50 years of age and older with high myopia. DESIGN: Retrospective observational case series. PARTICIPANTS: Twenty-two eyes in 22 patients were studied. All were 50 years of age and older with myopia of 6.0 diopters (D) or greater or an axial length of 25.5 mm or greater. Patients had untreated CNV documented by clinical examination and fluorescein angiography at two medical centers between 1986 and 1997. INTERVENTION: Demographic and clinical data were abstracted from patients' medical records. MAIN OUTCOME MEASURE: Visual acuity at 1 year after CNV diagnosis. RESULTS: The study included 22 eyes of 22 patients (mean age, 63.1 years; mean refraction, -11.0 D). Baseline visual acuity (VA) in the study eye was 20/40 or greater in 2 (9%) patients, 20/50 to 20/150 in 9 (41%) patients, and 20/200 or less in 11 (50%) patients. Drusen were present in seven (32%) eyes, and lacquer cracks were noted in ten (45%) eyes. Mean refractive error was -7.0 D for patients with drusen and -12.5 D for patients without drusen. Choroidal neovascularization was less than 0.25 disc diameters (DD) in 11 (50%) eyes, 0.25 to 0.5 DD in 5 (23%) eyes, and greater than 0.5 DD in 6 (27%) eyes. Visual acuity in the study eye 1 year after CNV diagnosis was 20/40 or greater in 3 (14%) patients, 20/50 to 20/150 in 3 (14%) patients, and 20/200 or less in 16 (73%) eyes. The presence of drusen was significantly associated with older age and a lower degree of myopia but was not associated with size of the CNV or visual acuity outcome. CONCLUSION: When compared to patients younger than 50 years of age with high myopia and CNV reported in previous publications, the patients in the current series generally have poorer visual outcomes.

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PubMed1998

Long-term tamoxifen citrate use and potential ocular toxicity.

PURPOSE: To estimate the prevalence of abnormalities in visual function and ocular structures associated with the long-term use of tamoxifen citrate. METHODS: A single-masked, cross-sectional study involving multiple community and institutional ophthalmologic departments was conducted with a volunteer sample of 303 women with breast cancer currently taking part in a randomized clinical trial to determine the efficacy of tamoxifen (20 mg/day) in preventing recurrences. Participants included women who had never been on drug (n=85); women who had taken tamoxifen for an average of 4.8 years, then been off the drug for an average of 2.7 years (n=140); and women who had been on tamoxifen continuously for an average of 7.8 years (n=78). Women were evaluated by questionnaire, psychophysical testing, and clinical examination to determine any abnormalities in visual function and the comparative prevalences of corneal, lens, retinal, and optic nerve pathology. RESULTS: There were no cases of vision-threatening ocular toxicity among the tamoxifen-treated participants. Compared with nontreated participants, the tamoxifen-treated women had no differences in the activities of daily vision, visual acuity measurements, or other tests of visual function except for color screening. Intraretinal crystals (odds ratio [OR]=3.58, P=.178) and posterior subcapsular opacities (OR=4.03, P=.034) were more frequent in the tamoxifen-treated group. CONCLUSIONS: Women should have a thorough baseline ophthalmic evaluation within the first year of initiating tamoxifen therapy and receive appropriate follow-up evaluations.

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PubMed1996

An eyelash in the vitreous cavity without apparent etiology.

Intraocular eyelashes are an infrequent complication of trauma to the eye. Intraocular cilia have a variable prognosis ranging from acute inflammation to remaining dormant within the vitreous for several years. However, intraocular cilia in the anterior chamber have been associated with delayed inflammatory responses, while intravitreal cilia may cause rhegmatogenous retinal detachment. All cases reported in the literature to this point have been able to identify some history of trauma, be it acute or remote. In this report a case is described in which intravitreal cilia were not associated with a history of trauma.

Eye Diseases↗
PubMed1994

Diabetic retinopathy. Preserving your patients' sight.

Diabetic retinopathy is a major cause of morbidity and the leading cause of legal blindness in working-age persons in the United States. Retinopathy affects both juvenile-onset and noninsulin dependent diabetics. Most visual loss occurs in patients because they are seen late in the course of their disease. Several clinical trials have aided in establishing recommended screening and referral guidelines for patients with diabetes mellitus. Treatment strategies based on clinical trials are reviewed as well as the importance of control of both hyperglycemia and hypertension. Ocular findings are illustrated and discussed. The primary care physician can substantially reduce the risk of blindness and visual impairment in diabetic patients by prompt recognition of the ocular findings and understanding the importance of timely ophthalmologic evaluation.

Blindness↗
PubMed1993

Prospective evaluation of the effect of pseudophakic cystoid macula edema on contrast sensitivity.

OBJECTIVE: To evaluate the effect of pseudophakic cystoid macular edema (PCME) on contrast sensitivity. DESIGN: Best-corrected visual acuity, fluorescein angiogram, and contrast sensitivity measurements were obtained before surgery and at 8 weeks and 8.5 months after surgery. Eyes were classified as having no PCME, transient PCME, or persistent PCME. PARTICIPANTS: The study population consisted of 31 consecutive patients undergoing extracapsular cataract extraction with posterior chamber intraocular lens implantation between September 1990 and March 1991. MAIN OUTCOME MEASUREMENTS: Outcomes were best-corrected visual acuity and contrast sensitivity. RESULTS: Analysis of variance showed a significant decrease for all spatial frequencies at 8 weeks (P < .005) and for higher frequencies at 8.5 months (P < .05) in both PCME groups and for higher frequencies at 8 weeks in the transient PCME group. CONCLUSION: Decrease in contrast sensitivity associated with PCME may account for persistent visual difficulties despite good Snellen visual acuity.

Cataract Extraction↗
PubMed1992

Microrips of the retinal pigment epithelium.

We describe six patients with exudative age-related macular degeneration who had retinal pigment epithelial detachments with associated overlying neurosensory detachments. During fluorescein angiography, each patient demonstrated a solitary, intense, central serouslike leak at the edge of the retinal pigment epithelial detachment with passage of fluorescein into the subretinal space. In patients in whom the location of associated choroidal neovascularization was evident, the leakage site was remote to the area of neovascularization. Our observations suggest that these leaks result from small retinal epithelial rips, which we termed "microrips," that differ from conventionally described retinal pigment epithelial rips in clinical course and response to laser treatment. We hypothesize that the mechanisms and forces that generate these microrips are different from those producing conventionally described retinal pigment epithelial rips.

Aged↗
PubMed1989

Natural history of subfoveal pigment epithelial detachments associated with subfoveal or unidentifiable choroidal neovascularization complicating age-related macular degeneration.

There have been few studies of the natural history of pigment epithelial detachments associated with choroidal neovascularization, and none confined to subfoveal lesions. We studied the natural history of 55 eyes in 53 patients who had age-related macular degeneration and subfoveal pigment epithelial detachment associated with choroidal neovascularization that was subfoveal or unidentifiable in location. Life table analysis showed that, at 1-year follow-up, 65% had a visual acuity less than 20/200 and 26% had less than 5/200. Age was a significant risk factor for reduction in both initial and final visual acuity. The presence of both hemorrhage and exudate on initial presentation was a significant risk factor for poor initial visual acuity.

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PubMed1989

Tunable dye laser photocoagulation for choroidal neovascularization complicating age-related macular degeneration.

We report our first 146 consecutive eyes treated with tunable dye laser for choroidal neovascular membrane (NVM) complicating age-related macular degeneration (AMD). They were treated with the orange (595 nm; N = 6), red (630 nm; N = 23), yellow (577 nm; N = 67), or sequential red-yellow (N = 50) wavelength of the tunable dye laser. All had a minimum 180 days follow-up. Eyes were analyzed as two groups categorized by pretreatment visual acuity (VA): 20/100 or better (N = 101), and 20/200 or worse (N = 45). Change in VA between baseline and most recent follow-up was studied by age, laser color, previous non-dye laser treatment, and number of treatments. Age was a statistically significant variable (chi 2 = 6.61, degree of freedom = 2, P less than 0.05). In eyes with initial VA of 20/100 or better, age also was significant for cumulative percent loss in VA of greater than or equal to 2 lines. We discontinued using orange after poor early clinical results. Our results suggest that the dye laser's variety and combination of wavelengths may provide advantages in treating NVM complicating AMD.

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PubMed1988

Laser photocoagulation for choroidal new vessel membrane complicating age-related macular degeneration associated with pigment epithelial detachment.

We studied 124 consecutive eyes that had laser photocoagulation for choroidal new vessel membranes (NVM) associated with pigment epithelial detachment (PED). In many cases, the extent of the NVM was uncertain. We thought it was not subfoveal in all cases but it possibly may have been subfoveal in one subgroup of cases. With a mean follow-up of 16 months, vision was stable or improved in 53% of the treated eyes. There was no difference in outcome between argon-treated and krypton-treated eyes. On the basis of fluorescein angiograms, we classified 86 of the eyes into four nonexclusive groups. Vision was stable or improved in 68% of eyes with juxtafoveal or extrafoveal PED, 48% with subfoveal PED, 76% with juxtafoveal or extrafoveal NVM, and 50% of eyes with possibly subfoveal NVM. A randomized clinical trial of laser photocoagulation for NVM in PED is both indicated and warranted. A pilot study under the auspices of the Macular Photocoagulation Study is now under way to determine the feasibility of and develop a protocol for such a trial.

Aged↗
PubMed1988

Current management of choroidal neovascularization.

Age-related macular degeneration is the leading cause of blindness in Americans over age 65. In 1982, the Macular Photocoagulation Study (MPS) established that argon laser photocoagulation reduces the risk of severe visual loss in eyes with extrafoveal choroidal neovascularization (CNV) associated with macular degeneration. Subsequently, similar results were found for histoplasmic and idiopathic choroidal neovascularization. There are also encouraging data on photocoagulation of CNV in other diseases and with different wavelengths. The MPS Group has found the krypton laser to be effective for juxtafoveal CNV secondary to histoplasmosis and is evaluating argon green and krypton red lasers for subfoveal CNV. Other investigators are evaluating laser treatment of CNV associated with myopic degeneration, pigment epithelial detachment, and angioid streaks. The new tunable dye laser may further expand our ability to treat this disorder. Until CNV can be prevented, laser photocoagulation remains the treatment of choice, and clinical trials should identify appropriate cases.

Age Factors↗
PubMed1987

Krypton and argon laser photocoagulation for central serous chorioretinopathy.

Based on medical records, the authors divided 86 eyes of 84 patients with central serous chorioretinopathy with serous detachment of the macula and retinal pigment epithelial leakage on fluorescein angiography into three groups: no laser treatment (45 eyes), argon laser treatment (26 eyes), and krypton laser treatment (15 eyes). One or more episodes of recurrence developed during the follow-up period in 10 untreated eyes (22%), 9 argon-treated eyes (35%), and 0 krypton-treated eyes. The difference in recurrence rate between argon- and krypton-treated eyes was statistically significant. The findings suggest that whenever laser treatment is indicated, krypton red laser photocoagulation may reduce the incidence of recurrence in eyes with central serous chorioretinopathy.

Adult↗
PubMed1987

Vision loss in age-related maculopathy: primary care referral guide.

The primary care practitioner is frequently the first professional to whom the elderly patient will complain of blurred or distorted vision. The authors focus here on the leading cause of vision loss in the elderly--age-related macular degeneration (ARMD)--and the role of primary care in its detection and in referral for treatment. An overview of ARMD is presented, with discussion of pathophysiology, various forms of the disease, and available treatments. The importance of referral of these patients at the primary care level is noted. The authors also comment on patient education, low vision aids, and eye care for the disadvantaged.

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