PubMed Health⌕ Search

Biomedical subjects

Robert W Enzenauer

Publications and source records attributed to Robert W Enzenauer.

At least 19 recordsLinked to original sources
PubMed2006

A symptom survey and quality of life questionnaire for nasolacrimal duct obstruction in children.

PURPOSE: To develop and validate a new parental questionnaire addressing symptoms and health-related quality of life (HRQL) in childhood nasolacrimal duct obstruction (NLDO). DESIGN: Cross-sectional study. PARTICIPANTS: Children ages 6 to younger than 48 months with and without clinical signs of NLDO. METHODS: A new questionnaire was developed using semistructured interviews with parents of children with NLDO and through discussions with expert clinicians. Questionnaires were completed by parents of children with and without NLDO. Cronbach's alpha was calculated as a measure of internal-consistency reliability. Factor analysis was used to evaluate a priori subscales: symptoms and HRQL. Discriminant construct validity was assessed by comparing questionnaire scores between children with and without NLDO and between affected and unaffected eyes of children with unilateral NLDO. Instrument responsiveness was determined by comparing presurgical and postsurgical intervention scores in a subset of NLDO patients who underwent surgical treatment. MAIN OUTCOME MEASURE: The NLDO questionnaire score. RESULTS: Eighty-seven children were enrolled, 56 with and 31 without NLDO. All but 2 questions on the questionnaire showed a good distribution of responses, a high correlation with the rest of the questionnaire, and excellent discrimination between patients with and without NLDO. Cronbach's alpha values were good for the overall questionnaire (0.95), and for 2 predetermined subscales: symptoms (0.95) and HRQL (0.85). On a 0 to 4 scale, NLDO patients had worse scores compared with non-NLDO patients for both symptoms (mean difference, 2.1; 95% confidence interval [CI], 1.9-2.3) and HRQL (mean difference, 1.2; 95% CI, 0.9-1.5) subscales. The NLDO patients had worse scores before intervention compared with after intervention for both the symptoms (mean difference, 2.2; 95% CI, 1.6-2.9) and HRQL (mean difference, 1.4; 95% CI, 0.8-2.1) subscales. Finally, NLDO patients had worse symptom scores for affected eyes compared with unaffected eyes (mean difference, 2.3; 95% CI, 1.9-2.6). CONCLUSIONS: This novel NLDO questionnaire is useful in quantifying parental perception of symptoms and HRQL in childhood NLDO. The questionnaire may have a role in future clinical studies of NLDO.

Child, Preschool↗
PubMed2006

Postmortem orbital findings in shaken baby syndrome.

PURPOSE: To compare postmortem orbital findings in pediatric accidental head injury to Shaken Baby Syndrome (SBS). DESIGN: Retrospective study. METHODS SETTING: Institutional. STUDY POPULATION: Thirty-six patients underwent postmortem modified exenteration with sectioning of the orbital contents; 18 victims of SBS and 18 cases of fatal accidental head trauma. OBSERVATION PROCEDURE: In all cases of children who died from accidental head trauma, the orbital tissues were separated to expose the optic nerve sheath. Patients with gross evidence of hemorrhage within the sheath were included. All cases of SBS were included. After accidental head injury, exenteration was performed only if optic nerve sheath hemorrhage was suspected on gross examination. All children younger than 18 years old with head injury as primary cause of death were included. SBS is defined as having at least two of the following: (1) typical abnormal findings on neuroimaging, (2) typical skeletal injury, (3) retinal hemorrhages, (4) history of abusive shaking with or without blunt head trauma, or (5) an inadequate history to explain the observed injuries. MAIN OUTCOME MEASURE: Presence or absence of orbital hemorrhage. RESULTS: Orbital tissue injury is more common in SBS than accidental head trauma without orbital fracture. In addition, optic nerve sheath and optic nerve intradural hemorrhage are also significantly more common in SBS (P < .0001). CONCLUSIONS: Our study reports new evidence of injury to orbital tissues in SBS and supports the concept that these finding are due to unique acceleration-deceleration forces of this type of abusive head injury.

Child, Preschool↗
PubMed2006

Strabismus outcomes/quality control: the application of statistical process control (SPC) to one muscle and two muscle simple horizontal strabismus of 25 PD or less.

INTRODUCTION: Statistical Process Control (SPC) techniques were originally used for evaluating quality in manufacturing. The SPC chart consists of data plotted in a time sequence with the mean and upper and lower control limits (approximates +/- 3 standard deviations), graphically showing trends in the data. We employed SPC charts to analyze one and two muscle surgery for simple horizontal strabismus of 25 prism diopters (PD) or less. METHODS: We reviewed the records of 47 patients, 18 years and younger with consistent preoperative strabismus measurements of 25 PD or less, who underwent pure horizontal rectus muscle recession, resection, or both. SPC charts were used to compare the differences in preoperative and postoperative measurements of one muscle versus two muscle esotropia and exotropia using the QI analyst software package. RESULTS: The average preoperative measurements for esotropia were 19.6 PD of one muscle cases, and 23.8 PD for two muscle cases. For exotropia, these values were 16.7 PD for one muscle cases and 20.6 PD for two muscle cases. The average postoperative measurements for esotropia were 5.4 PD for one muscle cases, and 10.0 PD for two muscles cases. For exotropia, the values were 2.2 PD for one muscle cases, and 11.0 PD for two muscle cases. SPC charts displaying pre- and postoperative measurements for one and two muscle surgery for both esotropia and exotropia showed normal statistical fluctuation. Interestingly, two muscle postoperative measurements for both esotropia and exotropia had higher upper control limits (UCL) than one muscle measurements. Those patients requiring additional surgery, or whose postoperative measurements were greater than 15 PD were considered failed cases. The differences in failure rates between one muscle and two muscle cases were not "statistically significant" [p less than 0.05]. CONCLUSION: One muscle horizontal rectus surgery should be considered as an option when planning surgical treatment for medium angle strabismus. Statistical process control may be a valuable method to analyze variability in many ophthalmologic procedures, with the goal of minimizing variability to achieve better outcome.

Adolescent↗
PubMed2005

The management of strabismus in adults--II. Patient and provider perspectives on the severity of adult strabismus and on outcome contributors.

PURPOSE: As part of a larger study intended to evaluate the management of strabismus in adults, we documented and compared patient and provider perspectives on the various factors that may contribute to treatment outcome and value of strabismus care. METHODS: By completing a questionnaire, 170 patients with strabismus (ages 19 to 87 years) and 11 strabismus specialists who performed surgery on these patients each indicated the relative weight of several disease- and treatment-related contributors to the outcome and value of care. In addition, each respondent rated the severity of the strabismus before and after surgery. RESULTS: Overall severity ratings improved as a result of surgery. The improvement perceived by the physicians was 5.1 +/- 1.7 on a 10-point scale and was larger than the 2.6 +/- 3.6 points improvement perceived by the patients ( P < 0.001). Patients and physicians expressed different views on the relative contributions to outcome and value (overall P < 0.001). Both groups indicated "the condition," "the physician," and "the procedures" as the largest contributors, but "condition" was perceived as more important by the physicians than by the patients ( P < 0.001), and "physician" was more important to the patients than to the physicians ( P < 0.001). CONCLUSION: Although in approximate agreement on the main contributors to outcome and value, discrepancies exist between perspectives of patients and physicians on the relative weights of those contributors. Public information, education, and counseling may bring these perspectives better in line and ultimately improve both quality and patient satisfaction.

Adult↗
PubMed2005

The management of strabismus in adults--III. The effects on disability.

INTRODUCTION: This is the third article in a series on the various facets of the management of strabismus in adults. Here, we give a broad overview of the types and severity of disability and provide initial validation of an instrument (questionnaire) to assess these disability aspects. METHODS: After undergoing strabismus surgery, 101 patients from 6 centers completed a 6-item questionnaire in which they rated both the before-surgery and after-surgery severity of problems associated with their strabismus, ranging from specific health, daily functioning, social interaction, concerns about the future, and self-image to job-related difficulties. RESULTS: The before-surgery outcomes showed significant variation across the 6 types of problems (P < 0.001), with "specific health" and "daily tasks" yielding the highest problem rating. Patients with diplopia reported more severe problems with "daily tasks" (P = 0.004) and "concerns about the future" (P = 0.026) than patients without diplopia. Overall, all problem ratings declined after surgery (P < 0.001), but patients who were not successfully aligned were left with higher problem ratings on "specific health" (P = 0.005), "daily tasks" (P = 0.003), and "social interaction" (P = 0.024). CONCLUSIONS: The results indicate a wide range of disability aspects in adult patients with strabismus, with moderate differences between patients with or without diplopia. Improvements in disability after surgery, as reflected by these ratings, should be taken into account when assessing the health value of adult strabismus management.

Adult↗
PubMed2004

The application of statistical process control to horizontal strabismus surgery.

PURPOSE: Although originally developed to evaluate quality in manufacturing, statistical process control (SPC) techniques may be applicable to other frequently performed standardized processes. SPC analysis has rarely been used in medicine. We employed SPC charts to analyze the outcomes of one- and two-muscle horizontal strabismus surgery for esotropia and exotropia. METHODS: During a 33-month period between October 1, 1998 and July 1, 2001, we evaluated 95 patients undergoing strabismus surgery on either one or two previously unoperated eye muscles in one or both eyes. SPC charts were used to evaluate the success and validity of our surgical guidelines for horizontal recession and resection procedures. Data were divided into 2 groups, patients with esotropia and patients with exotropia, for computerized statistical analysis using QI Analyst (SPSS, Chicago, IL). RESULTS: Our results after horizontal strabismus surgery, both esotropia and exotropia repair, appear to follow the laws of statistical fluctuation or normal random variation. Our dose-response schedule produced a resultant ocular alignment or exit angle that appeared to be in statistical control, ie, variation from orthotropia that can be expected simply from normal random chance error with only a limited number of outliers. CONCLUSION: The resultant ocular alignment or exit angle after one- or two-muscle strabismus surgery may be described by standard models of statistical fluctuation. SPC may be a valuable method to analyze the variability of the results of many ophthalmologic procedures or treatments over time with the ultimate goal of producing better patient outcomes by decreasing variability.

Esotropia↗
PubMed2004

Vitamin A deficiency in Afghanistan.

PURPOSE: To evaluate children 6 years old and younger, lactating mothers, and women of childbearing age for vitamin A deficiency in the districts of Kabul City, Afghanistan. METHODS: A set number of patients selected randomly in all 13 districts of the city limits were examined between August and September 2000 for ocular signs of vitamin A deficiency. RESULTS: Night blindness, Bitot's spot, corneal ulceration, and corneal scars were seen in increased amounts as defined by the World Health Organization among the sampled population. CONCLUSIONS: Vitamin A deficiency is a moderate to severe public health problem in children and lactating mothers in Kabul City, Afghanistan.

Adult↗
PubMed2003

The management of strabismus in adults--I. Clinical characteristics and treatment.

INTRODUCTION: This is the first in a series of articles intended to evaluate the management of strabismus in adults, including clinical outcomes and the quality, cost, and value of treatment from the perspectives of patients and health care providers. Here we present clinical characteristics, complexity of surgery, treatment success, and resolved complaints in a group of adult patients who underwent strabismus surgery. METHODS: This is a multicenter retrospective study analyzing the type and amount of ocular misalignment before and after surgery in adult patients with strabismus onset before (BVM, or age < 9 years) or after (AVM, or age >/= 9 years) visual maturation. Success was evaluated in terms of alignment, motility, and the presence of diplopia; subjective success was measured in terms of resolved complaints. The complexity of surgery was determined using the Intensity/Complexity Index and compared with success rates. RESULTS: Data are reported on 299 patients (90 BVM and 145 AVM) whose eyes were successfully aligned in 63% of the BVM cases and 81% of the AVM cases. Subjective complaints resolved at similar rates in the BVM and AVM subgroups. Successful alignment was not correlated with complexity of surgery, but motility and sensory success rates were correlated with complexity of surgery. CONCLUSION: Within each of the BVM and AVM subgroups, this study of adult strabismus showed similar surgical success rates compared with published data. This qualifies these patient groups as clinically typical of adults undergoing strabismus surgery. Additional studies will expand on health value analyses.

Adolescent↗
PubMed2003

Relative costs of various preserved artificial tear solutions for the treatment of dry eye conditions.

PURPOSE: Tear substitutes are one of the primary treatment modalities for dry eye conditions. The goal of this research was to determine the least costly preserved artificial tear product for treating patients with mild dry eye conditions. METHODS: Eight manufacturers' samples of artificial tears were examined to determine the effect of bottle angle on the dispensing drop size, the average drop volume, the number of drops per bottle, the measured volume of a bottle compared with its advertised volume, and the approximate cost per year for dry eye treatment. Drop sizes (mass) were determined by weighing to the nearest milligram. The retail cost was assessed to determine the most economical tear substitute. RESULTS: For all samples tested, a smaller drop was produced when the bottle was held at a 45-degree angle as compared with a 90-degree angle from horizontal. At a 45-degree angle, Natural Tears Formula by Murine and Artificial Tears by Heath Pride produced the smallest drops, less than 0.030 g, closest to the volume of the lacrimal lake. Smaller drop size produced accordingly more drops per bottle. The measured total bottle volume averaged 3.5% more than the volumes stated on the labels. The most inexpensive sample based on cost per year of treatment was Natural Tears Formula by Murine at $11.29 annually. CONCLUSIONS: Cost comparison of commercial over-the-counter artificial tears is an important factor to patients being treated for a dry eye condition. Several factors are important when considering the economics of article tear substitutes: drop size, number of drops per bottle, the volume of the bottle, and the cost of treatment per year. Because this information may not be readily available to patients, it is of great importance that physicians educate their patients to make treatment of dry eye as affordable as possible. The least expensive artificial tear treatments could require prolonged use of the same bottle, which may be associated with contamination of the contents of that bottle over time. The potential contamination with the long-term use of artificial tears in a bottle is significant. Patients using the least expensive artificial tear treatments should be advised against prolonged use of the same bottle.

Drug Costs↗
PubMed2003

Internuclear ophthalmoplegia (INO): an unusual presentation of neuropsychiatric lupus erythematosus.

BACKGROUND AND PURPOSE: INO in SLE is uncommon, affecting < 5% of hospitalized SLE patients. A MEDLINE search 1966-2001 revealed only 22 reported cases. INO also rarely presents with diplopia. We report such a case. CASE REPORT: A 35 year old woman with long standing SLE developed the abrupt onset of diplopia, vertigo and ataxia. Physical examination was remarkable only for the neurologic examination with a left INO and abnormal cerebellar testing. Treatment with corticosteroids and intravenous cyclophosphamide resulted in resolution of her cerebellar and ocular symptoms.

Adult↗
PubMed2003

The efficacy of photoscreening for amblyopiagenic factors in a high risk population.

BACKGROUND: Amblyopia is the leading cause of monocular "legal" blindness in children and young adults, affecting 3% to 5% of the population. Factors producing amblyopia can be detected through a complete eye examination. Although it is important to treat children at risk for amblyopia as early as possible, appropriate screening methods for severely impaired individuals are lacking. The purpose of this study was to assess the ability of a photoscreening camera to detect amblyopiagenic factors (strabismus, unequal refractive error, and media opacities) in a group of disabled children, who were currently unscreenable with standard methodology. METHODS: Fifty-four high risk individuals, 6-20 years in age, were evaluated for amblyopiagenic factors using the MTI photoscreening camera, pre- and post-cycloplegia. The "gold standard" for comparison was a concurrent complete eye examination, including ocular health, visual acuity estimation, motility, ophthalmoscopy and clinical cycloplegic refractive error determination. Criteria for a "failure" on the clinical examination included myopia greater than -1.00 diopters (D), hyperopia greater than +3.00 D (2-6 years) and greater than +2 D (over 6 years), astigmatism greater than 1.5 D, unequal refractive error greater than 1.5 D, any strabismus, or any media opacity. RESULTS: Fifty- four individuals with disabilities, deemed untestable by standard vision screenings, were evaluated. The number of children with amblyopiagenic factors by complete cycloplegic ophthalmologic examination was 30 (55%) and by photoscreening was 25 (46%). Using the MTI photoscreener, the sensitivity was determined to be 83% with a specificity of 79%. The positive and negative predictive values of photoscreening were 83% and 79% respectively. CONCLUSIONS: The MTI photoscreener can detect such amblyopiagenic factors as high refractive error, strabismus, unequal refractive error, and significant media opacity. Photoscreening is an excellent way of obtaining valid vision screening with limited patient cooperation. Using photoscreening data, proper referrals can be made and prioritized for disabled individuals.

Adolescent↗