Journal of the American Optometric Association最新文献

Background: Most eye injuries are preventable. Military personnel, workers, athletes, and other spectacle wearers--especially children and the functionally one-eyed--who require protection from impact, should expect that safety eye-wear actually protects.

Purpose: To present to eye care professionals the current state-of-the-art in eye injury prevention.

Methods: A review of the current eye protection standards, guidelines, and warnings for the activities of daily living, work, hobbies, education, and sports with emphasis on the importance of standards and the role of the recently organized Protective Eyewear Certification Council (PECC).

Conclusions: The prescriber and dispenser are obliged to prescribe, fabricate, and dispense safe and effective eyewear. PECC will help the eye care professional fulfill this obligation.

Background: Duane's retraction syndrome (DRS) has been described as a clinical entity for more than a century. Although the majority of cases occur spontaneously, some cases of DRS are inherited.

Case reports: A young Romanian boy with a known left abduction deficit was determined to have DRS. On thorough examination of other family members, it was discovered that his younger brother and father also had the syndrome. Clinical findings of the affected family members are described.

Results: All three family members showed left esotropia in primary gaze, along with a compromised ability to turn the left eye outward. They also demonstrated an anomalous head turn to the left, and mild narrowing of the palpebral fissure and retraction of the globe on adduction. These are all classic signs of unilateral DRS.

Conclusion: These findings provide further evidence of an autosomal dominant mode of inheritance in some cases of DRS.

Background: A description and justification for using a standardized clinical low-cost, "low-technology," ocular and systemic "ARMD work-up" protocol was presented in the methods paper (Part I).

Methods: Fourteen male patients (70 +/- 9 years), receiving 0.73 +/- 0.45 portions of dark-green, leafy vegetables/day base intake, were placed on an additional portion of 5 ounces sauted spinach 4 to 7 times per week or lutein-based antioxidant (three patients). Detailed "ARMD work-up" data for six of these patients and summary pilot (case series) environmental intervention data are presented.

Results: One, Patients demonstrated short-term positive effects in visual function in one or both eyes with this mild therapeutic approach: Amsler grid (87%); Snellen Acuity (71%); Contrast sensitivity (92%); SKILL (65%); Glare recovery (69%); and Activities of Daily Vision Subscale (60%); Two, There was no obvious correlation between ophthalmoscopic appearance of the retina and visual outcome; and Three, Patient symptoms did not necessarily correlate with observed changes in visual function.

Conclusions: The approach to atrophic ARMD presented here warrants informal practitioner replication and formal randomized prospective clinical case-control evaluation.

Background: Age-related macular degeneration (ARMD) is the leading cause of blindness in people over the age of 65, and the prevalence of ARMD is expected to increase as the population ages. Although the incidence of ARMD increases sharply with age, recent studies indicate that prevention measures and dietary changes, implemented early in life, can reduce an individual's risk of ARMD.

Methods: Several dietary components have been proposed and studied with regard to their ability to protect against ARMD; these components include antioxidant vitamins and specific carotenoids. In particular, consumption of dark green, leafy vegetables has been shown in clinical studies to reduce the risk of ARMD.

Results: Biochemical studies of such vegetables have found that they contain several nutrients that may account for this effect, including high concentrations of the related carotenoids lutein and zeaxanthin. Structural and clinical studies have shown that these carotenoids are concentrated in the retinal macular pigment and that such accumulation is dependent on dietary intake. Further studies have indicated that the density of the macular pigment is related to preservation of visual sensitivity and (possibly) protection from ARMD.

Conclusions: Large-scale clinical trials will be necessary to demonstrate that specific agents can reduce the incidence of ARMD. Nevertheless, specific dietary components--particularly, the carotenoids found in dark green, leafy vegetables--have shown great promise. While lifestyle modifications such as smoking cessation, reduction of alcohol consumption, and the wearing of sunglasses may reduce the risk of ARMD, it is likely that consumption of specific dietary components can reduce the risk further.

Background: Diabetic retinopathy (DR) remains the leading contributor to severe vision loss in the United States among persons 20 to 70 years of age. Despite advances in disease management and treatment, patients with vision loss from DR continue to constitute a significant portion of patients served in vision rehabilitation service (VRS) settings. These patients present special challenges to VRS providers because of early onset, fluctuations in and the complex nature of vision loss, unique visual demands of disease management, and associated multi-system losses.

Case reports: After introductory epidemiologic review, a case presentation format is used to illustrate solutions a multidisciplinary VRS can offer the special visual challenges of the person with diabetes with vision loss from DR. Four patients are presented--ages 30 to 70 years--with varying degrees and types of vision loss, with different lifestyle demands and disease management needs. The cases address vocational issues, vision fluctuation, coordinating adaptive solutions to complex visual losses, and meeting diabetic needs to measure medication, insulin, and blood glucose levels, to maintain skin care, diet, exercise, transportation, family roles, and support systems.

Conclusions: The unique and complex needs of people with diabetes who experience vision loss can be well addressed through timely and ongoing VRS consultations, in conjunction with medical/ocular disease management.