Journal of the American Optometric Association最新文献

Background: Posterior keratoconus is a rare corneal disorder characterized by a diffuse or localized protrusion of the posterior corneal surface into a thinning stroma. It is believed to be a congenital, nonprogressive condition.

Case report: A case of bilateral circumscribed posterior keratoconus is presented. Diagnostic ocular signs include localized protrusion of the posterior corneal surface, normal anterior corneal surface, stromal thinning, and endothelial changes. However, anterior corneal contour reveals progressive steepening in this case.

Conclusion: Posterior keratoconus is an unusual corneal anomaly with subtle clinical features. Recognition of these signs is essential in the diagnostic and management processes.

Background: Several ophthalmic conditions manifest a flecked retina. Developing an understanding of their clinical presentations will enable the practitioner to most appropriately manage these conditions.

Case report: A 27-year-old Middle Eastern woman manifested flecked retinas and nyctalopia. She had been given a diagnosis of retinitis punctata albescens, an inherited, progressive, night blindness; however, the medical history and clinical findings were not consistent with this disorder. Rather, they were consistent with fundus albipunctatus, an autosomal recessive, stationary, night blindness. The clinical presentation of fundus albipunctatus is characterized by discrete, white dots at the level of the retinal pigment epithelium and stable night blindness. A prolonged time for dark adaptation is required to produce normal amplitude electroretinograms in fundus albipunctatus as the result of a delay in the regeneration of rhodopsin. An electroretinogram administered after a prolonged dark adaptation time confirmed the diagnosis of stationary night blindness.

Conclusion: In order to ensure an accurate diagnosis for fundus albipunctatus, it is important to be aware of the clinical characteristics and appropriate electroretinogram protocol for this disorder.

Background: This study uses information collected in a private optometric practice to describe the relationship between age and the add power needed to correct presbyopia.

Methods: Computer-assisted data analysis with a database management program, Q&A, and Microsoft Excel was used to assess the relationship between age and presbyopic addition. Data collected from 3,645 examinations by one practitioner in a single private practice--over a period of approximately 23 years--were entered into the database. The patient base was primarily white and about equally divided between the sexes. The practitioner generally used the fused cross cylinder for the tentative presbyopic addition and refined this by patient preference and best visual acuity at near, all using a carefully determined near working distance.

Results: The presbyopic addition increased rapidly in patients from ages 40 to 50 years, the rate at age 40 being about 0.22 diopters per year and the average rate during the 40- to 50-year-old decade being about 0.12 diopters per year, or approximately 0.25 diopters every 2 years. After the patient reaches 50 years of age, the presbyopic addition increased more slowly, at the rate of approximately 0.03 diopters per year--or approximately 0.25 diopters in 8 years.

Conclusions: Quantitative data taken from more than 3,600 refractions showed a nearly parabolic relationship between age and presbyopic addition from approximately the age of 40 to 75 years.

Background: Photopsia is a relatively common symptom reported by patients in primary eye care settings. Although there are many possible etiologies, photopsia (light flashes) is usually associated with one of the following: (1) posterior vitreous detachment, (2) migraine with aura, (3) migraine aura without headache, and (4) retinal break or detachment. Each of these clinical conditions has symptoms and physical findings that will usually render the diagnosis apparent.

Methods: It is important from a clinicolegal standpoint that specific procedures be performed to differentially diagnose the responsible condition and deliver appropriate follow-up care.

Background: Limitations of the surgical correction for myopia include inaccuracy, instability, treatment of the central optical zone, and lack of reversibility. KeraVision Intacs offer an alternative that addresses these shortcomings.

Methods: We present 1 year of follow-up information on 95 subjects enrolled in the United States Food and Drug Administration Phase III clinical trials.

Results: At 1 year, 99% of patients (89 of 90) had 20/40 uncorrected vision or better. Ninety-two percent of eyes (83 of 90) were within 1.00 D of intended correction and 76% of eyes (68 of 90) were within 0.50 D of intended correction. Stability was achieved at 3 months, with 96% of subjects (86 of 90) having less than 1.00 D of change from their previous examination. In a substudy, 89% eyes (58 of 65) varied within +/- 0.50 D over the course of a day. Corneal curvature changed as predicted, resulting in a prolate aspheric shape within the central optical zone. Most complications or adverse events experienced were managed with additional medication or surgical intervention, resulting in a favorable outcome for subjects.

Conclusions: KeraVision Intacs are effective, predictable, stable, and safe. This additive technique may also offer reversibility.

Background: Cat-scratch disease is a subacute regional lymphadenitis, usually preceded by a history of a cat scratch or exposure to kittens. The disease is caused by Bartonella henselae, and possibly Bartonella quintana, pleomorphic gram-negative rods formerly known as Rochalimaea henselae and Rochalimaea quintana. Ocular involvement is rare and typically manifests as either Parinaud's oculoglandular syndrome or neuroretinitis. Patients with neuroretinitis resulting from cat-scratch disease may be asymptomatic or experience mild-to-severe vision loss. The clinical features, angiographic appearance, differential diagnosis, and management of cat-scratch neuroretinitis are discussed.

Case report: A 30-year-old white woman reported to the eye clinic with painless, decreased vision in the right eye. A diagnosis of cat scratch neuroretinitis was made on the basis of the history of cat scratch, clinical appearance, and angiographic findings. Treatment with oral ciprofloxacin restored vision to normal in 4 weeks.

Conclusion: Painless vision loss associated with optic nerve swelling and macular star exudate should alert suspicion of systemic disease. Additional findings--including positive history of a cat scratch, lymphadenopathy, and flu-like symptoms--may indicate Bartonella henselae or Bartonella quintana infection. While treatment remains controversial, appropriate serology testing may aid in the diagnosis and management of the underlying infection.