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PubMed2006

Neuro-ophthalmologic presentations of hemicrania continua.

PURPOSE: We describe a series of patients with hemicrania continua, a rare indomethacin-responsive primary headache syndrome, who presented for evaluation with neuro-ophthalmologic signs and symptoms. DESIGN: Observational case series. METHODS: Nine patients between the ages of 29 and 58 years were seen with various neuro-ophthalmologic findings and a unilateral continuous headache. A detailed history was taken from each patient, followed by a focused ophthalmologic and neurologic examination. The risks and benefits of treatment with indomethacin were discussed. Patients were instructed to call after several days of treatment to report any change in their headache and neuro-ophthalmologic symptoms, in addition to any adverse side effects. RESULTS: All patients responded favorably to indomethacin, with rapid near-complete or complete resolution of headache and autonomic symptoms, and treatment was initiated as early as possible. CONCLUSIONS: Because of its absolute response to indomethacin, recognizing the neuro-ophthalmologic symptoms of hemicrania continua as a component of the headache syndrome is critical for prompt initiation of treatment.

Adult↗

PubMed2003

Cost-effectiveness of glycemic control and ophthalmological care in diabetic retinopathy.

AIMS: Glycemic control and ophthalmological care are known to significantly diminish the risk of visual impairment and blindness by diabetic retinopathy (DRP). The (cost-)effectiveness of both strategies was studied to highlight their benefits for patients and care providers. METHODS: A computer analysis was developed, following the progression of DRP and the effectiveness of metabolic control and ophthalmological care continuously and individually in cohorts of type I and type II DM patients with divergent degrees of compliance. Costs relate to present medical charges in the Netherlands. RESULTS: Intensive glycemic control shortens the duration of blindness in a type I DM patient by 0.76 years, intensive ophthalmological care by 0.53 years. One year sight gain may cost 1126 euros by providing ophthalmological care and 50479 euros by glycemic control. The duration of blindness drops in a type II DM patient by 0.48 and 0.13 years, respectively, whereas the effectiveness decreases as the age of onset of DM rises. CONCLUSIONS: The vast majority of diabetic patients benefits from both intensive glycemic control and intensive ophthalmological care, but these cost-effective interventions which are not only complementary, but also substitute each other, require lasting, full compliance by all parties concerned.

Adult↗

PubMed2002

Cross-sectional study of the ophthalmological effects of carbon disulfide in Chinese viscose workers.

This article presents cross-sectional investigation results of ophthalmological effects for the occupational exposure to carbon disulfide of workers at a large viscose fibre factory in the middle part of China. The total of 271 exposed subjects (191 males, 80 females) and 133 workers (93 males, 40 females) not exposed to any toxic agent in the working environment underwent ophthalmological examination. The self-administered questionnaire collected data on the medical history and ophthalmological complaints during the past three months. The ophthalmologic examination included routine examination for retinal capillary anomalies and and color vision with the FM 100-Hue test method. Nearly all subjects did not use respirators, smocks or aprons, gloves or other personal protective devices during work time. The average personal CS2 exposure level in the present study was 13.7-20.05 mg/m3. The FM 100-Hue test results showed that the total error scores of the exposed group, whether male or female, were higher than that of the control, the discrimination of the green and blue zones was also impaired significantly. A fundus examination showed no retinal capillary anomalies or other serious ophthalmological symptoms that may be related to effects of CS2. In conclusion, color vision was disturbed in workers exposed to CS2, at levels below the present threshold value. Reduced color discrimination may be attributed to long-term carbon disulfide exposure and suggests that health surveillance of workers exposed to carbon disulfide should include the FM 100-Hue Test as a sensitive and easy method.

Adult↗

PubMed1987

Neuro-ophthalmological complications of coronary artery bypass graft surgery.

In a prospective study of neurological complications of coronary bypass surgery, detailed pre- and post-operative bedside ophthalmological evaluation was undertaken in 312 patients. Post-operative neuro-ophthalmological complications developed in 80/312 (25.6%) patients and included: areas of retinal infarction (17.3%); retinal emboli (2.6%); visual field defects (2.6%); reduction of visual acuity (4.5%) and Horner's syndrome (1.3%). Neuro-ophthalmological complications were not observed in a control group of 50 patients undergoing major peripheral vascular surgery. Ten of 75 patients reviewed at 6 months still had detectable neuro-ophthalmological abnormalities, but functional disability occurred only in those with persistent visual field defects. Multivariate analysis revealed that extra-coronary vascular disease, severe and prolonged duration of heart disease prior to operation, and large drop in haemoglobin level during surgery may predispose to neuro-ophthalmological complications.

Adult↗

PubMed2004

Neuro-ophthalmological findings in sarcoidosis.

PURPOSE: This review emphasizes the importance of neuro-ophthalmological signs and symptoms in sarcoidosis. The presence of ophthalmological and neuro-ophthalmological findings may lead to diagnosis of the disease and the initiation of adequate treatment. MATERIAL AND METHODS: Patients who had been diagnosed with neurosarcoidosis during the period 1990 - 2001 were identified from the departmental diagnostic index. The history, clinical, laboratory and imaging data of patients were analysed. RESULTS: Fifteen patients were identified, four men and 11 women, with a mean age of 44.1 years (range 26-65 years). In six of the 15 (40%), neurological deficits were the initial symptoms. Nine (60%) had known sarcoidosis at the time of presentation. Ten patients (66%) had ophthalmological/neuro-ophthalmological symptoms and signs. CONCLUSION: Neuro-ophthalmological symptoms may develop early in neurosarcoidosis. If neuro-ophthalmological symptoms arise in patients with established biopsy-proven sarcoidosis, the diagnosis is usually easy to make. However, a number of patients with neurosarcoidosis may present with neuro-ophthalmic symptoms before systemic involvement becomes obvious. In this situation the diagnosis is challenging, and the major goal is to establish the presence of systemic sarcoidosis.

Adult↗

PubMed2000

Ophthalmologic abnormalities in mentally retarded.

PURPOSE: To determine the prevalence and types of ophthalmologic abnormalities in mentally retarded subjects. METHODS: Seventy-three institutionalized mentally retarded subjects (41 boys and 32 girls) aged 5 to 19 years (mean: 11.5 years) were examined ophthalmologically during a three month period (from May to July 1999). The eye examination consisted of visual acuity testing (illiterate Snellen E-chart or acuity card procedures), pupillary reflex and motility evaluation, cover test for phoria and tropia, examination of adnexa and anterior segment (magnifying glass or slit-lamp biomicroscopy if indicated and possible), retinoscopy and direct ophthalmoscopy. All subjects were evaluated pediatrically, neurologically, psychologically and otorhinolaryngologically if indicated. RESULTS: Ophthalmologic abnormalities were found in 60.2% of the subjects. Eyelid abnormalities accounted for 21.7%, fundus abnormalities for 21.6%, refractive errors for 15% and ocular motility disorders for 13.6%. Taken separately, optic atrophy (16.4%) was the most frequent disorder, followed by refractive errors (15%), hypertelorism (12.3%), epicanthus (10.9%) and nystagmus (8.2%). Strabismus and mongoloid obliquity of lids were seen in 5.4% each other while ptosis was disclosed in 4.2% of cases. Visual acuity tested in 60 subjects revealed that 25 (41.6%) had visual impairment. Of all subjects 10.9% required corrective glasses while 9.6% needed corrective surgery for strabismus and ptosis. CONCLUSION: This study shows a high prevalence of ophthalmologic abnormalities in mentally retarded subjects. This is in agreement with the results of several other previous studies. It's therefore essential to screen mentally disabled subjects ophthalmologically.

Adolescent↗

PubMed2001

[Usefulness of routine ophthalmologic examination for cytomegalovirus retinitis in acquired immunodeficiency syndrome patients].

PURPOSE: To evaluate the usefulness of routine ophthalmologic examinations for cytomegalovirus retinitis in acquired immunodeficiency syndrome (AIDS) patients. METHODS: Clinical symptoms of cytomegalovirus (CMV) retinitis in patients with AIDS who had circulating CD4+ T lymphocytes 50/microliter or less and received monthly ophthalmological examinations (examined group) were compared with those of the patients detected by non-routine ophthalmological examinations (unexamined group). RESULTS: The patients in whom early CMV retinitis was detected by monthly ophthalmological examinations had no subjective symptoms or iritis. The size of CMV retinitis was smaller than 2 disc diameters and it did not extend to the papillomacular area in a majority of the patients. On the other hand, the size of CMV retinitis in the unexamined group was larger than 10 disc diameters and it extended to the papillomacular area in most cases. The visual prognosis of the examined group was better than that of the unexamined group. CONCLUSIONS: To protect visual acuity, it is important to conduct monthly ophthalmological examinations in patients with AIDS whose serum CD4+ T lymphocyte counts are 50 cells/microliter or less.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Ophthalmologic abnormalities in children from a Turkish school for the deaf.

The aim of this study was to determine the nature and prevalence of ophthalmologic abnormalities in deaf children. Complete ophthalmologic examinations were performed on 104 children aged 7 to 20 years from a Turkish school for the deaf. Of 104 children, 42 children (40.4%) had some form of ophthalmologic abnormality, with the vast majority (31 patients, 29.8%) being refractive errors. The prevalence of hypermetropia, myopia and astigmatism was found to be higher over the general population. Of 104 children, 19 (18.2%) had ocular motility disturbances and one had external adnexal anomaly. Two (1.8%) children had anterior segment and nine (8.6%) children had posterior segment pathologies. Routine ophthalmologic examinations should be carried out in this population because deaf children use sight to compensate for hearing problems. Ophthalmologists play an important role in the diagnosis and correction of ophthalmologic abnormalities.

Adolescent↗

PubMed2005

[Antimicrobial susceptibility surveillance of recent isolates from ophthalmological infections to gatifloxacin and other antimicrobial drugs].

The antimicrobial susceptibility of 240 isolates from the ophthalmological infections during July 2003 to March 2004 was determined to gatifloxacin (GFLX), levofloxacin, lomefloxacin and cefmenoxime applicable for ophthalmological infections. The in vitro activities of these drugs against the fresh isolates were compared. The quinolones including GFLX were potently active against Gram-positive bacteria, except for MRSA, a major causative pathogens for ophthalmological infection. When MIC ranges, MIC50 and MIC90 of three quinolones were compared, it was considered that the activity of GFLX was the most active of them. GFLX showed to be more active against opportunistic pathogens including Pseudomonas aeruginosa than other antimicrobial agents, and GFLX was especially potent against Streptococcus pneumoniae and Enterococcus faecalis. In conclusion, GFLX exhibits a potently active against fresh isolates from ophthalmological infections, and has an effective potential in the treatment of ophthalmological infections with the drug to administer eye drops.

Anti-Infective Agents↗

PubMed1998

[The importance of informed consent in the field of ophthalmology].

Ocular diseases have some characteristics that are different from diseases of other organs. First, patients clearly can judge for themselves whether or not they can see better postoperatively. Second, because several parameters such as visual acuity and intraocular pressure, are obtained from patients, patient's families and others can objectively judge the post-treatment status. Therefore, clinical information is easily available to others besides the physician. Third, except for acute ocular diseases such as retinal detachment, acute glaucoma, and ocular trauma that easily can result in blindness, ophthalmologists usually treat eyes that will maintain a certain visual acuity level. These are the primary reasons why patients and families complain about unfavorable post-treatment subjective symptoms. Because of these three characteristics of ocular disease, informed consent (IC) is extremely important in the field of ophthalmology. I studied ophthalmology and IC at Harvard Medical School, Boston, from 1980 to 1983, and again in 1989. Strict IC is mandatory in the United States. However, the concept of IC in the US cannot always be adapted to fit Japanese culture. The different legal concepts of IC in the two countries are discussed in this paper. Since I returned to Japan, our Department of Ophthalmology incorporated several new concepts into our clinical practice. For example, we now broadcast live surgeries of patients with severe proliferative diabetic retinopathy by closed-circuit TV to their families in the hospital. This has fostered great communication and confidence among patients, their families, and doctors. In 1994, we also began inter-hospital and international IC via telemedicine and telescience. The video conferencing system VisionSeries (Panasonic Broadcast and Television System Company) is used to communicate between Asahikawa Medical University and 10 branch hospitals. INS net 1500 or INS net 64 (3 lines) transmits full-motion (30 frames/second) color fundus images and biomicroscopic images. Ocular surgeries performed by ophthalmologists using operating microscopes at each branch hospital also are transmitted to Asahikawa Medical University to facilitate consultation with more experienced ophthalmologists. The transmitted images of the fundus and biomicroscopic findings are satisfactory, and they allow surgeons to conduct useful discussions among themselves and with the family members during the surgeries in real time. When the patients' families are in local cities, surgeons can transmit the operations via the telemedicine system link to the nearby hospital, and the ophthalmologists there can narrate the surgeries in real time. On November 14, 1996, our technology was used internationally for the first time to transmit ocular images and live ocular surgeries between Asahikawa Medical University, Japan, and the Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA. Telemedicine and telesurgery will be useful scientific tools in the field of Ophthalmology in the near future. We believe that this technology literally opens up the world to scientific and medical collaboration. Patients with vision deficiencies and blinding disease are certain to be the ultimate beneficiaries of these interactions. Lastly, ideal implementation of IC in the field of Ophthalmology are discussed in this paper.

Cataract Extraction↗

PubMed1990

[The organization of work in the pediatric department of an urban ophthalmologic hospital].

The paper analyses the work of a children ophthalmological department and of a centre of microsurgery in children created on its basis, that are attributed to the structure of the town ophthalmological clinical hospital in Kharkov. The paper presents data on the structure of eye pathology, surgical activity (it makes up 60%), suggestions for optimizing the work of the department. A positive role in optimization of work in children department is its belonging to a big ophthalmological hospital. This allows to widely use for children the whole store of diagnostic means, different surgical equipment, other technical means. Of importance is a permanent contact with the chair of children ophthalmology, enrollment of physicians into research work, constant improvement of their skill.

Child↗

PubMed1986

Ophthalmology in Chile.

The practice of ophthalmology in Chile does not differ much from that in the United States. Basic ophthalmologic knowledge is the same, and common clinical problems are solved in the same way. The difference becomes evident in the more complex clinical problems. We have the knowledge and ability to perform the treatment but come up against the problem of high cost of technical instruments. Vitreous surgery, intraocular lens surgery, and laser treatments are performed, but we have to overcome the obstacles of obtaining the expensive and limited number of instruments. Perhaps, a US ophthalmologist will not understand this problem because, as I became aware during my stay as a fellow at The Wilmer Institute, Baltimore, and at other times when I have visited the United States, these difficulties do not arise. Lasers are bought, instruments are ordered by telephone, and manufacturers swamp the doctors with propaganda and offers of "call toll free for 30 days on trial." On the other hand, we know that, due to our efforts and using the means at our disposal, we have managed to keep the specialty at a high level, solving health problems and making the practice of ophthalmology pleasant in this beautiful country. Chilean ophthalmology has great prestige in South America. It has been the forerunner in the instruction of ophthalmologists, creating a method of teaching and of systematic specialization that has been unique in Latin America. It is an example to other branches of medicine in Chile. Although ophthalmologists are badly distributed in the country, considering our particular geographic and economic conditions, they fulfill their objectives in providing adequate visual health care for the population. This has come about through the combined effort of all Chilean ophthalmologists based on the example of their predecessors. Also, there has been a sense of solidarity among us, with responsibility and enthusiasm shown in practicing and in communicating ophthalmic precepts altruistically to the coming generations.

Chile↗

PubMed2003

[Measuring patient's quality of life in ophthalmology].

BACKGROUND: The assessment of patient's quality of life is not only of vital importance for clinical trials of new therapies but also becomes more and more implemented into daily clinical therapeutical decisions. METHODS: Different methods for evaluating quality of life are available. A well-known questionnaire for measuring global quality of life is the Short Form 36 (SF 36). However, in ophthalmology more specific instruments for measuring visual quality of life are needed. We review the usefulness of specific questionnaires such as the Visual Function 14 (VF-14) or the National Eye Institute Visual Function Questionnaire (NEI-VFQ) in their application to common ophthalmologic diseases such as cataract, age-related macular degeneration and glaucoma. Studies applying these methods were identified by a search in the Medline database. RESULTS: Several instruments to measure visual life quality in ophthalmologic patients are available. Internal consistency and validity are shown. CONCLUSIONS: Evaluating visual quality of life is an important parameter for assessing ophthalmologic diseases and the value of different therapies. It is an important outcome variable in clinical studies. Furthermore, individual visual quality of life should be considered in individual therapeutic decisions and helps to assess the economic effect of current and new therapies.

Aged↗

PubMed1998

[An ophthalmologic image databank on the Internet].

The Internet has become a powerful, international source for information, and it has shown an exponential growth because of the ease of access and the immediate availability of information. We introduced a new ophthalmological atlas including ICD coding on the World Wide Web. So far, more than 500 lantern slides of typical and interesting ophthalmological findings have been selected and digitized. These pictures were integrated in a data base, which was arranged for ease and speed of search and retrieval. In its background, the data base contains a list of over 4700 ICD-encoded diagnoses to which the picture-documented findings are linked. Comments on pictures can be added by the author or by users. The data base contains several lists, such as a list of ICD codes and diagnoses, a list of all pictures with corresponding diagnoses, a list of all diagnoses and number of pictures, a list of those diagnoses for which the corresponding picture is available, as well as a list of comments on each picture. Special program scripts handle the user's search key words for diagnoses and extract the required information out of the data base, using Windows NT. Search results are presented on an automatically built-up webpage. To provide fast speed of search all pictures initially are shown in a small format (thumbnails) with little amount of data. The related full-size picture is retrieved by a single mouse click. Moreover, the name and institution of the author, diagnostical hints and comments on pictures by the author or by users are offered for each diagnosis available. The Giessen Ophthalmological Picture Atlas can be reached under www.med.unigiessen.de in the Internet. It allows a fast search free of charge from all over the world and, therefore, offers an additional option to obtain specific ophthalmological information for various purposes.

Databases, Factual↗

PubMedDate not supplied

Education to increase ophthalmologic care in older onset diabetes patients: indications from the Wisconsin Epidemiologic Study of Diabetic Retinopathy.

Both physicians and diabetic persons must be educated about the need for regular ophthalmologic examinations to prevent blindness. A large population-based study of diabetic persons living in Southern Wisconsin (Wisconsin Epidemiologic Study of Diabetic Retinopathy), designed to evaluate the incidence and associated risk factors for diabetic retinopathy, provided the opportunity to evaluate an intervention to increase ophthalmologic care. As part of this study, a sample of persons less than 80 years of age with older onset diabetes of less than 15 years duration was identified and examined in both 1980-1982 and 1984-1986 (n = 619) using standardized protocols. Study subjects received educational material on diabetic eye disease, and examination findings were conveyed to each participant and their primary physician. To evaluate the effect of this intervention, a random representative sample of diabetic persons who were not selected for examination (a nonintervention control group) was identified and interviews were completed with 241 (80%) of the surviving subjects. The two study groups were similar with respect to demographic factors, employment status, medical history, and frequency of physician visits and hospitalizations, but not for income. Self-assessments of general health were also identical between the selected and nonintervention groups. Overall, both groups reported very similar patterns of ophthalmologic care, visual impairment, and knowledge of retinopathy. These results suggest that a more intensive intervention is needed to improve the ophthalmologic care patterns of the diabetic population at risk of eye disease.

Adult↗

PubMed2004

Attrition from ophthalmology residency programs.

PURPOSE: To investigate the incidence of and reasons for voluntary resident attrition from ophthalmology training programs. DESIGN: Retrospective survey. METHODS: A survey was mailed to residency program directors of the 121 Accreditation Council for Graduate Medical Education-accredited ophthalmology residency programs asking them to report the number of residents who withdrew from training during 2001 to 2002 and the reasons for withdrawal. RESULTS: Of 102 responding programs, 13 (12.7%) had one resident withdraw from training in the academic year 2001 to 2002. These 13 residents represented 1.1% of all ophthalmology residents in training at the responding institutions during that academic year. The most frequent reason for withdrawing was to enter another medical specialty. CONCLUSIONS: Voluntary resident attrition from ophthalmology training programs is uncommon. The 1.1% attrition rate in this study is the lowest among published reports of attrition from other specialties.

Career Choice↗

PubMed2005

Herb and vitamin supplementation use among a general ophthalmology practice population.

PURPOSE: To survey comprehensive ophthalmology patients about their use of vitamins and herbal supplements. DESIGN: Cross-sectional survey. METHODS: A survey instrument was developed and distributed to 397 patients presenting to a main campus university-based comprehensive ophthalmology clinic and to an off-site comprehensive ophthalmology clinic. Information gathered included demographics, use of prescription medications, use of vitamin and herbal supplements, the reasons for using these supplements, perceived benefits of these products, where the information regarding them was gathered, and with whom patients had discussed their use. RESULTS: Fifty-eight percent of patients reported nearly daily use of vitamins. Multivitamins were the most common vitamin and were used by 46% of the patients. Eight percent of patients used herbal products on a daily basis. Twenty-six percent learned about vitamins from their primary care physician (PCP), and just 2% from their ophthalmologists, while 35% discussed their actual use with a PCP, and 5% with their ophthalmologists. Just 2% of these patients learned of herbs from a PCP, and <1% from an ophthalmologist. Older patients used multivitamins and other vitamins most frequently, while gender and education were not predictive of vitamin or herbal use. Mean monthly spending on vitamins by users was 15.74 dollars, while herbal users spent a monthly mean of 15.35 dollars. CONCLUSIONS: Vitamins and herbs are used by a significant number of patients in a comprehensive ophthalmology setting. Given the prevalence of vitamin and herbal use, ophthalmologists should systematically inquire about their use.

Adolescent↗

PubMed2003

Complications of ophthalmologic nerve blocks: a review.

Complications of ophthalmologic nerve blocks are rare, but they can have serious life- and sight-threatening consequences. Knowledge of the potential complications is essential for the anesthesiologist who performs ophthalmologic nerve blocks. However, most anesthesiologists are unfamiliar with these complications because the majority have been reported in the ophthalmology literature. We review the complications that may occur during the placement of ophthalmologic blocks and their appropriate prompt treatment.

Brain Stem↗