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PubMed1997

Factors associated with diabetic foot ulceration in Thailand: a case-control study.

A case-control study was conducted to determine factors involved in foot ulceration in Thai non-insulin-dependent (Type 2) diabetic patients. Fifty-five patients with foot ulcers (42 females and 13 males) and 110 patients without foot ulcers (83 females and 27 males) were evaluated for 26 factors possibly associated with foot ulceration. The results showed that diabetic patients with foot ulcers had significantly lower diabetic knowledge and foot-care practice scores; poorer glycaemic control, renal function, and visual function, and higher prevalence of retinopathy and peripheral neuropathy than diabetic patients without foot ulcers, whereas there were no differences in peripheral vascular status between both groups, each having a low prevalence. Multiple logistic regression analyses indicated that the risk of developing foot ulcers was associated with only three factors which were peripheral nerve status as determined by somatosensory evoked potentials (OR = 1.67; 95% CI 0.31 -8.97), visual acuity (OR = 0.223 per unit decrease in decimal visual acuity; 95% CI = 0.005, 0.39) and fasting plasma glucose level (OR = 1.01 per mmol l-1 increase; 95% CI = 1.00, 1.02). We conclude that peripheral neuropathy, visual impairment, and poor glycaemic control, but not peripheral vascular insufficiency, are the major independent risk factors associated with foot ulceration in Thai diabetic patients.

Adult↗

PubMed2002

Contrast sensitivity after laser in situ keratomileusis. one-year follow-up.

PURPOSE: To determine whether contrast sensitivity measurement, a more sensitive test of visual function than visual acuity, better characterizes visual outcomes after laser in situ keratomileusis (LASIK). SETTING: Hong Kong Laser Eye Centre, Hong Kong, China. METHODS: Contrast sensitivity was monitored in 41 LASIK patients for 1 year. Seven spatial frequencies (0.3, 0.8, 1.5, 3.4, 6.9, 10.3, and 20.5 cpd) were tested with 15 sequences per spatial frequency, and a staircase technique was used for target presentation. RESULTS: There was a general depression in the contrast sensitivity function after LASIK; 1.5 cpd and 3.4 cpd were the most affected frequencies. Recovery took at least 6 months. The reduction in contrast sensitivity was greater for higher amounts of myopia. CONCLUSION: The post-LASIK nonpermanent depression in contrast sensitivity was probably due to optical factors.

Adult↗

PubMed2005

[X-linked blue cone monochromatism. A familial case report].

CLINICAL CASE: A family affected by X-linked blue cone monochromatism is presented. There are 4 male affected individuals and 9 female carriers. DISCUSSION: The diagnosis of blue cone monochromatism is based on severely affected color vision with preserved blue function, poor visual acuity, nystagmus, nearly absent photopic ERG, and a family pedigree compatible with X-linked inheritance. The female carriers showed normal visual function and ocular motility. It is important to be familiar with non progressive cone dysgenesis in order to make a genetic diagnosis of the illnesses in this group.

Adult↗

PubMed1996

Fall-related factors and risk of hip fracture: the EPIDOS prospective study.

BACKGROUND: Most hip fractures result from falls. However, the role of fall-related factors has seldom been examined. Comparison of the predictive value of these factors with that of bone mineral density (BMD) has important implications for the prevention of hip fractures. METHODS: We assessed femoral-neck BMD by dual-photon X-ray absorptiometry and potential fall-related risk factors, which included self-reported physical capacity, neuromuscular function, mobility, visual function, and use of medication in 7575 women, aged 75 years or older, with no history of hip fracture recruited at five centres in France. We followed up these women every 4 months to record incident hip fractures. During an average of 1.9 years of follow-up 154 women suffered a first hip fracture. FINDINGS: In age-adjusted multivariate analyses, we found four independent fall-related predictors of hip fracture: slower gait speed (relative risk = 1 . 4 for 1 SD decrease [95% Cl 1.1-1.6)]; difficulty in doing a tandem (heel-to-toe) walk (1.2 for 1 point on the difficulty score [1.0-1.5]); reduced visual acuity (2.0 for acuity < or = 2/10 [1.1-3.7]); and small calf circumference (1.5 [1.0-2.2]). After adjustment for femoral-neck BMD, neuromuscular impairment--gait speed, tandem walk--and poor vision remained significantly associated with an increased risk of subsequent hip fracture. With high risk defined as the top quartile of risk, the rate of hip fracture among women classified as high risk based on both a high fall-risk status and low BMD was 29 per 1000 women-years, compared with 11 per 1000 for women classified as high risk by either a high fall-risk status or low BMD; for women classified as low risk based on both criteria the rate was five per 1000. INTERPRETATION: We conclude that neuromuscular and visual impairments, as well as femoral-neck BMD, are significant and independent predictors of the risk of hip fracture in elderly mobile women, and that their combined assessment improves the prediction of hip fractures.

Absorptiometry, Photon↗

PubMedDate not supplied

[Transdermal electrostimulation of optic nerves in neurosurgical patients with vision disorders].

Transcutaneous electrostimulation of optic nerves after Ye. B. Kompaneyets et al. (1985) was used in the treatment of 203 neurosurgical patients aged 5 to 65 years with vision disorders. Improvement of visual functions (vision acuity and/or visual field) was attained in 112 (55.2%) patients. No changes were observed in 91 (44.8%) patients. The authors investigated the relationship between the efficacy of transcutaneous electrostimulation of optic nerves and neurosurgical disease, status of visual function, history of vision disorders, ophthalmoscopic picture, and electrophysiological parameters. The best results were achieved in patients with traumatic injuries of the optic route at the base of the brain, with cerebrovascular aneurysms, and the hypertensive hydrocephalic syndrome. The results depended on the history and stage of vision disorders.

Adolescent↗

PubMed1995

A homozygous 1-base pair deletion in the arrestin gene is a frequent cause of Oguchi disease in Japanese.

Oguchi disease is a rare autosomal recessive form of congenital stationary night blindness with all other visual functions, including visual acuity, visual field, and colour vision being usually normal. A typical clinical feature of the disorder is a golden or gray-white discolouration of the fundus which disappears in the dark-adapted state and reappears shortly after the onset of light ('Mizuo phenomenon'; Fig. 1). The course of dark adaptation of rod photoreceptors is extremely retarded in Oguchi disease while that of cones appears to proceed normally. The locus for Oguchi disease was recently mapped between D2S172 and D2S345 on distal chromosome 2q by linkage analysis. Interestingly, the gene for arrestin, an intrinsic rod photoreceptor protein implicated in the recovery phase of light transduction, also maps to this region of chromosome 2q (refs 6, 7). Here we report that in five out of six unrelated Japanese patients with Oguchi disease, we have identified a homozygous deletion of nucleotide 1147 (1147delA) in codon 309 of the arrestin gene, predicting a shift in the reading frame and a premature termination of translation which may result in 'functional null alleles.'

Adolescent↗

PubMed2005

A randomized controlled trial to determine the effectiveness of prism spectacles for patients with age-related macular degeneration.

OBJECTIVE: To determine the effectiveness of prism spectacles in people with age-related macular degeneration by relocating the retinal image. METHODS: We implemented a randomized, placebo-controlled, double-masked trial. Participants with age-related macular degeneration received a standard low-vision assessment and the prescription of conventional low-vision aids 6 weeks before the study intervention. Participants were randomized to receive 1 of the following, including the optimal refractive correction: (1) custom, incorporating bilateral prisms to match participants' preferred power and base direction; (2) standard, incorporating standard bilateral prisms (6 prism diopters [Delta] base up for logMAR [logarithm of the minimum angle of resolution] visual acuity (VA) of 0.48-1.00 and 10Delta base up for logMAR VA of 1.02-1.68); or (3) placebo, consisting of spectacles matched in weight and thickness to prism spectacles but without prism. MAIN OUTCOME MEASURES: Outcomes measured binocularly at baseline and 3-month follow-up included distance logMAR VA, reading speed, critical print size, visual functioning questionnaires, and observed visual task performance. Scores on the 25-item National Eye Institute Visual Functioning Questionnaire and the Melbourne Low-Vision ADL (Activities of Daily Living) Index were converted to linear estimates using Rasch analysis. The Manchester Low Vision Questionnaire was used to collect descriptive data. RESULTS: A total of 225 participants completed the trial (median age, 81 years). We found no significant effect of treatment group on any of the outcome measures, including VA, the primary outcome (adjusted for baseline) (P = .63). Participants' responses to the Manchester Low Vision Questionnaire suggested that the prism spectacles added to their problems. CONCLUSIONS: Prism spectacles are no more effective than conventional spectacles for people with age-related macular degeneration.

Activities of Daily Living↗

PubMed1999

Comparison of the results of first and second cataract eye surgery.

OBJECTIVE: To compare the outcomes of second eye cataract surgery with those of first eye surgery. In particular, to evaluate changes in visual acuity (VA), visual function, and health status after the first and second eye surgeries. DESIGN: A cohort (case series) analysis of patients recruited in a clinical trial. PARTICIPANTS: A total of 403 consecutive patients with indication of noncombined first eye or second eye cataract surgery were recruited in 3 public hospitals in Barcelona, Spain. First eye surgery patients are compared to second eye surgery patients. INTERVENTION: Patients were evaluated both before surgery and 4 months after surgery by a standardized telephone interview and clinical examination. MAIN OUTCOME MEASURES: Visual acuity, visual function index (VF-14), a 14-item instrument designed to measure visual function, and the Sickness Impact Profile (SIP), a generic measure of health status. RESULTS: Full data were obtained from 315 (78%) patients: 249 who underwent first eye surgery only and 66 different patients who underwent second eye surgery. Significant improvement was found in both groups of patients for best-corrected VA in the operated eye (4.4 Snellen lines, P < 0.001; 4.2 Snellen lines, P < 0.001, respectively), VA in the better eye (2.8 Snellen lines, P < 0.001; 1.4 Snellen lines, P < 0.001), and visual function (26.3 Snellen lines, P < 0.001; 17.0 Snellen lines; P < 0.001). Four months after the operation, the VF-14 of the second eye group was slightly better (93.4 vs. 88.5; P = 0.09; score range: 0, worst, to 100, best). Psycho-social SIP scores improved in both groups (4.8, P < 0.001; 3.1, P = 0.016). Physical SIP score improved only in the first eye surgery group (1.8, P = 0.003) but not in the second eye surgery group (-1.0, P = 0.338; score range: 0, best, to 100, worst). CONCLUSIONS: The results of our study suggest that patients undergoing second eye cataract surgery show significant improvements in VA, visual function, and psycho-social health status. However, global and physical health status does not change after second eye cataract surgery.

Aged↗

PubMed1993

Consequences of reduced cerebral blood flow in brain development. II. Retardation of neurological outcome and phosphorus metabolism.

We investigated the temporal relationship of the emergence of biochemical abnormalities to the development of behavioral dysfunction to identify the central factors of ischemic neurological disorders in developing brains. To induce early ischemia, bilateral carotid artery occlusion (BCAO) was surgically performed on 21 cats at the second week of age. BCAO produces histopathological damage, including neuronal loss and thinning of white matter. 31P magnetic resonance spectroscopy was used to monitor brain oxidative metabolism, neuronal membrane growth, and myelination of the prefrontal cortex in the first 3 months. Neurological development was monitored by conducting 25 tests of reflex, motor, sensory, and integrated behavioral function. At 1 month, phosphodiester (PDE) levels, a component of membranes and myelin, were low in animals showing complete ligation. At 2 months, the growth of PDE was low (1/4 to 1/2 of normal) in BCAO animals, whereas normal animals demonstrated a 23% increase. Phosphocreatine (PCr) levels, indicated by PCr/ATP and PCr/inorganic phosphate ratios, were retarded at 2 months in completely ligated animals (1/4 of normal). Neurologically, the completely ligated animals showed retardation of general development. The retardation was most pronounced for integrative functions, including visual function, and became more pronounced later in development. The time course of emergence of the retardation generally coincided with emergence of abnormalities in phosphorous compounds. The simultaneous occurrence of several biochemical and functional abnormalities in development following early ischemic insult suggests a causal relationship between membrane and mitochondrial development and neurological function.

Adenosine Triphosphate↗

PubMed2002

Purification and electron microscopic visualization of functional human spliceosomes.

Pre-mRNA splicing takes place in a large and highly dynamic complex known as the spliceosome. Here we report the optimization of a maltose-binding protein (MBP) affinity-purification method to isolate functional spliceosomes for electron microscopic analysis. Visualization of the spliceosome preparations revealed distinct 40-60 nm particles. Immunogold-conjugated antibodies to spliceosome components specifically label these particles, which are eliminated by treatment with either RNase or protease. Moreover, spliceosomes assembled on two different pre-mRNAs are indistinguishable. This first visualization of purified functional spliceosomes assembled in vitro reveals striking structural features, including one or more central cavities and multiple elongate lobes.

Base Sequence↗

PubMed1990

Combined branch retinal artery and central retinal vein obstruction.

We observed seven patients with the unusual combination of a central retinal vein obstruction in conjunction with a simultaneous branch retinal artery obstruction. The patients presented with sectoral retinal whitening, as well as diffuse peripapillary and superficial retinal hemorrhages. In five of the seven patients, the retinal hemorrhages appeared most florid in the territory of the obstructed arteriole, resulting initially in the consideration that these cases represented a combined branch retinal artery and branch retinal vein obstruction. In all cases, however, the presence of dilated, tortuous veins with diffuse retinal hemorrhages, in addition to generalized delay in arteriovenous transit on fluorescein angiography, localized the venous blockage to the central retinal vein. No intra-arterial retinal emboli were visualized. Initially, five of the seven patients suffered markedly diminished visual function; although visual acuity returned to near normal in all but two patients. In the two patients with non-resolving, markedly impaired visual acuity, neovascularization of the iris complicated the clinical course. Both of these patients were treated with panretinal photocoagulation, with resolution of the iris neovascularization. These seven patients highlight another variation of combined arterial and venous retinal vascular disease.

Adult↗

PubMed1996

Visual impairment in preterm children with periventricular leukomalacia--visual, cognitive and neuropaediatric characteristics related to cerebral imaging.

Thirteen preterm children, aged 4 to 14 years, with visual impairment due to periventricular leukomalacia (PVL) were evaluated for visual function, intellectual level, cognitive profile and motor function. Their visual impairment was characterized by low acuity, crowding, visual field defects and ocular motility disturbances. Their cognitive profile was uneven, often with considerably higher scores on verbal than on visual-spatial tasks. Nine children had normal intelligence, three had mild mental retardation and one had severe mental retardation. In all the children, visual impairment was complicated by visual perceptual difficulties, accounting for their greater visual handicap than would be expected from their visual acuities and strabismus alone. Though CT or MRI revealed bilateral PVL in all the children, six had no motor impairment consistent with cerebral palsy, which is an unexpected finding.

Adolescent↗

PubMed1982

Pattern VEP in two immunochemical subtypes of optic neuritis.

Visual functions and visual evoked potentials (VEP) were compared in 2 groups of patients with optic neuritis (ON). The subdivision was based on the occurrence of oligoclonal IgG in the cerebrospinal fluid in some patients [the ON (+) group] but not in others [the ON (-) group]. At the onset of ON there were no other signs of neurological disease in these patients. Later the majority of those in the ON (+) group had developed multiple sclerosis but only one patient in the ON (-) group. Recovery after the acute optic inflammation was the same in both groups with respect to visual acuity and fields, but better in the ON (-) than in the ON (+) group with respect to colour vision and pattern VEP. A closer correlation between colour vision defects and VEP latency changes was found for the ON (+) than the ON (-) group, suggesting demyelinating disease as a more probable cause of the optic nerve inflammation in the former than in the latter group.

Adolescent↗

PubMed2005

Further validation of the Daily Living Tasks Dependent on Vision: identification of domains.

AIM: To examine the Daily Living Tasks Dependent on Vision (DLTV), a visual function questionnaire for domain structure, and redundancy. METHOD: 235 subjects underwent full ophthalmic assessment and completed the DLTV questionnaire by interview. Principal component analysis with varimax rotation and item response theory (IRT) were used to assign the items to domains. The internal consistency of each domain was examined using Cronbach's alpha. Redundancy was assessed by regressing each item in a domain against the remainder of items in that domain. RESULTS: Four domains were identified. Domain 1 was formed by nine items, which after applying IRT were seen to be among the most difficult questions in the instrument. Domain 2 contained eight items, all of which fell in the easier half of the instrument on applying IRT. Domain 3 contained only three items, all of which were among the easier questions and appear to deal with peripheral vision function. Domain 4 consisted of two items dealing with adaptation to light and dark conditions. Cronbach's alpha for each domain was 0.96, 0.93, 0.73, 0.66. Redundancy was found to be present in domain 1, which was therefore reduced by two items, with little effect on internal consistency. CONCLUSIONS: The authors believe using the domains identified in this report will optimise the information provided by patients on their ability to function on visually demanding tasks.

Activities of Daily Living↗

PubMed2005

Role of visual dysfunction in postural control in children with cerebral palsy.

INTRODUCTION: Deficient postural control is one of the key problems in cerebral palsy (CP). Little, however, is known about the specific nature of postural problems of children with CP, nor of the relation between abnormal posture and dysfunction of the visual system. AIM OF THE STUDY: To provide additional information on the association of abnormalities in postural control and visual dysfunction of the anterior or posterior part of the visual system. METHODS: Data resulting from ophthalmologic, orthoptic, neurological, neuro-radiological, and ethological investigations of more than 313 neurologically impaired children were retrospectively analyzed. RESULTS: Abnormal postural control related to ocular and ocular motor disorders consisted of anomalous head control and subsequent abnormal head posture and torticollis. The abnormal postural control related to retrochiasmatical damage of the visual system consisted of a torticollis combined with adjustment of the upper part of the body, as if at the same time adapting to a combination of defects and optimizing residual visual functions. CONCLUSION: Visual dysfunctions play a distinct role in the postural control of children with CP.

Adolescent↗

PubMedDate not supplied

[Visual rehabilitation in patients with retinitis pigmentosa].

PURPOSE: To determine which low-vision aids could be useful to patients with retinitis pigmentosa and also the benefits that the rehabilitation program could provide based on visual acuity and/or daily visual tasks. METHODS: A group of 30 patients with retinitis pigmentosa aged from 7 to 73 years were enrolled in this study. Visual acuity and visual function tests (visual field, full-field electroretinogram) was performed and low-vision aids tested. Information about the use of the remaining vision was obtained. After choosing the best optical or electronic devices and before their prescription, a low-vision training program was carried out. RESULTS: The best corrected visual acuity varied from HM (hand movements) to 20/40 for distance and visual acuity better than 16M to 0.5M for near. 90% of the patients had optical devices prescribed: 13 for near, 9 for distance, 2 electronic devices and 3 filters. Three patients with extremely narrow visual field and very low visual acuity were referred to orientation and mobility. CONCLUSIONS: The low-vision aids were useful for the retinitis pigmentosa patients: telescopes, hand-held magnifiers, stand magnifiers, half-eye base-in prism lenses, electronic devices and illumination control were beneficial to enhance visual acuity and visual efficiency. The prescription of low-vision aids was helpful in daily-life activities and a high level of satisfaction with the implemented visual rehabilitation program was reported.

Adolescent↗

PubMed1999

[The assessment of lateral orbitotomy by Krönlein-Reese-Berke in surgical treatment of primary non-malignant orbital tumors].

AIM: The assessment of lateral orbitotomy by Krönlein-Reese-Berke was made to evaluate the possibility of radical removal of primary orbital tumors, function of visual system and cosmetic effect after lateral orbitotomy. MATERIAL AND METHODS: The authors analysed a group of 14 patients treated for primary non-malignant orbital tumors. They were treated in I ENT Clinic of Silesian Medical Academy in Katowice surgically by Krönlein-Reese-Berke lateral orbitotomy. A control examination (after 3 years) performed in all 14 patients did not show recurrence of tumor, the motility of the eye ball and visual function was normal, cosmetic effect was good. CONCLUSIONS: We suggest that in the cases of primary non-malignant tumors localised in the lateral part of the orbita, orbitotomy by Krönlein-Reese-Berke is the optimal surgical approach.

Female↗

PubMed1992

Ocular manifestations of diabetes mellitus.

Diabetes mellitus afflicts approximately 14 to 15 million Americans and is a leading cause of new blindness in the United States. Since eye disease represents an end-organ response to a generalized medical condition, all structures of the eye are susceptible. Furthermore, diabetes produces multiple effects on visual function and visual acuity that require specific clinical consideration. This paper offers a review of some of the key ocular manifestations of diabetes mellitus.

Cataract↗