Journal of the American Optometric Association最新文献

Background: We conducted a pilot study to assess the effect of 0.1% diclofenac sodium eyedrops on the initial comfort of rigid gas permeable (RGP) contact lenses.

Methods: A double-masked, placebo-controlled, crossover trial was performed on 20 unadapted subjects. In Phase I, subjects used either 0.1% diclofenac or placebo eyedrops four times per day for 3 days before RGP lenses were dispensed. Contact lenses were inserted on Day 4 and worn for 8 continuous hours. Eyedrops were used twice during the 8-hour period. Ocular symptoms were graded on a visual analog scale at six points during the day. Visual acuity and slitlamp examinations were performed at the same six study points. After a 2-week wash-out period, subjects received the opposite treatment in Phase II, following the same protocol used in Phase I.

Results: The treatment effect was tested using the Mainland-Gart chi-square test. There was no statistically significant treatment effect (chi-square = 0.20, p = 0.653) on patient symptoms. Biomicroscopy findings were analyzed and, likewise, showed no significant treatment effect (chi-square = 2.10, p = 0.15).

Conclusions: Data from this pilot study showed no statistically significant reduction in symptoms or signs with diclofenac eyedrops.

Background: Giant-cell arteritis (GCA) is a systemic, inflammatory vasculopathy that affects small- to medium-sized arteries. Arterial wall inflammation results in reduction of blood flow and subsequent ischemia. Arteries of the head and neck are particularly susceptible, including the ophthalmic and posterior ciliary arteries. The eye care provider is in a position to assist with the ultimate diagnosis of GCA.

Case report: A 79-year-old black man was referred to the eye clinic for evaluation of exophthalmos of the left eye. The patient reported increasing proptosis over the previous 6 months; a history of sudden, permanent vision loss of the affected eye (approximately 2 years earlier); and generalized malaise and chronic frontal headache. Examination did reveal an exophthalmic eye of approximately 8-mm difference by Hertel exophthalmometry. Fundus examination revealed optic nerve pallor O.S. CT scan revealed chronic inflammatory changes of orbital tissue, including the extraocular muscles. No compressive lesions were present. Laboratory testing indicated an elevated erythrocyte sedimentation rate. A tentative diagnosis of giant-cell arteritis was made, which was confirmed with temporal artery biopsy.

Conclusions: Patients with ocular complications secondary to GCA manifest several different ocular symptoms, including unilateral and bilateral intermittent blur, sudden complete vision loss, double vision, etc. This was an unusual case of GCA because the initially manifested ocular sign was unilateral proptosis. The patient probably had initial ocular complications of GCA 2 years previously, with sudden loss of vision in the left eye. The patient never sought medical attention at that time, and the unilateral exophthalmic eye resulted from chronic inflammatory orbital changes associated with GCA.

Background: In this study, we evaluated the pH value of nine artificial tears solutions in order to investigate whether their pH changed over time. These solutions are designed to have a pH value within the ocular comfort range and to come close to the physiological tears' pH.

Methods: Fifteen bottles of each solution were randomly chosen from different production lots. Increments of 0.05 ml were taken daily from each bottle and measured daily, using a micropH 2002 Crison pH-meter over a period of 60 days.

Results: The values obtained fall within the ocular comfort range. Also, we obtained nonstatistically significant variations over time for each solution (p > 0.01). The results revealed differences between solutions, some solutions coming close to the tear's pH and others being slightly more acidic or alkaline.

Conclusions: We may assume that all the solutions evaluated will not affect either the ocular physiology or the contact lens wear. The practitioners should know the properties of the solutions, thus selecting the adequate solution for each type of patient.

Background: The purpose of our study was to present descriptive findings of ocular abnormalities in vision screening examinations of abused and neglected children. We compared the prevalence and the nature of eye diseases and refractive error between abused and neglected boys staying at the Hathaway Home, a residential facility for abused children, and boys from neighboring Boys and Girls clubs.

Methods: The children in the study received vision screening examinations through the UCLA Mobile Eye Clinic following a standard format. Clinical data were analyzed by chi-square test.

Results: The children with a history of abuse demonstrated significantly higher prevalence of myopia, astigmatism, and external eye disorders.

Conclusions: Our study suggests that children with a history of abuse may be at higher risk for visual impairment. These visual impairments may be the long-term sequelae of child abuse.

Vision therapy is prescribed to treat diagnosed conditions of the visual system. Effective therapy requires visual skills to be developed until they are integrated with other systems and become automatic, enabling individuals to achieve their full potential. The goals of a prescribed vision therapy treatment regimen are to achieve desired visual outcomes, alleviate the signs and symptoms, meet the patient's needs, and improve the patient's quality of life.

Background: Floppy eyelid syndrome may be the underlining cause of papillary keratoconjunctivitis. Patients initially report a nonspecific irritation, redness, or a foreign body sensation.

Methods: As a result of its vague presentation, floppy eyelid syndrome is frequently misdiagnosed. A careful slit-lamp evaluation and a complete history aids in the diagnosis.

Conclusions: The most distinctive feature of floppy eye syndrome is a pliant upper tarsus that is easily everted without excess manipulation. Histopathology has attributed the laxity of the lid to a decreased amount of elastin within the tarsus. Treatment includes prevention of the upper lid from everting during sleep or surgical procedures such as horizontal eyelid shortening. Our case report illustrates a patient with a classic case of floppy eyelid syndrome.

Purpose: Residents of nursing homes do not have the same access to health care as do other elderly persons. Some sources have indicated that only 20% of nursing home residents in the United States ever receive eye care services in the nursing home. We sought to determine the availability of eye care services in Missouri nursing homes.

Method: A survey was mailed to all licensed nursing homes in the State of Missouri (1,199). The survey inquired about the type of nursing facility, their location, and types of medical care and eye care provided at their institution. Information was also requested regarding the number of patients eligible for Medicare, Medicaid, and other third-party coverage. A 6-week period was allowed for responses.

Results: A response rate of 26.86% was obtained. Larger facilities were more likely to provide services than smaller facilities, and skilled nursing facilities were more likely to provide services than residential care facilities. Overall, 73% of the responding facilities provided some type of eye care services, as compared with 81% providing medical care. However, only 21% of nursing facilities have any type of regular schedule for provision of these services. Approximately 40% of the nursing homes without eye care services were interested in adding those services within a year, while half of those were not interested in adding them for their patients.

Conclusions: Eye care services are available for many Missouri nursing home patients, but there is a lack of understanding as to how those services can be used. This can have considerable impact in meeting the health care needs of these patients, as well as enhancing the quality of life.