Journal of the American Optometric Association最新文献

Background: The pediatric clinic of the State College of Optometry/University Optometric Center develops a yearly quality management plan to monitor patient care. One of the areas retrospectively reviewed for all outcomes is refractive amblyopia.

Methods: A retrospective review of records was performed on patients diagnosed with refractive amblyopia. With the use of a prescribed protocol, each patient's progress was tracked for a period of 6 months. Major emphasis was placed on outcome as related to treatment modality. Treatment alternatives were optical correction alone, optical correction in conjunction with patching, and optical correction and patching with vision therapy.

Results: Improvement criteria included a 2-line increase in visual acuity on the Snellen chart and an increase of 20 seconds of arc of stereopsis, as measured by the Wirt circles. The groups that patched with correction and those that received vision therapy had similar visual acuity improvement's; however, the latter group had a significantly greater improvement in stereopsis. Both groups performed significantly better in both categories when compared to the group receiving optical correction alone.

Conclusions: Though patching alone may be sufficient for improvement of visual acuity, binocular performance is significantly better when vision therapy is included in the treatment regimen.

Background: Patients with central serous chorioretinopathy (CSC) have sudden-onset, painless, uniocular blur that is typically diagnosed via fundus and fluorescein angiographic appearance. The etiology and pathophysiology are not fully understood; however, there may be an association with an infectious etiology. This article presents two cases of HIV-positive patients in whom central serous chorioretinopathy developed and discusses the possible relationship between the two cases. The differential diagnosis, clinical features, angiographic appearance, management options, and proposed etiologies of CSC will be presented.

Case reports: A 34-year-old black man HIV reported to the eye clinic with decreased vision in his right eye. A diagnosis of central serous chorioretinopathy (CSC) was made on the basis of the clinical and fluorescein appearance. He is currently being monitored for resolution. A 44-year-old black man with profoundly compromised immunity also came to the eye clinic with CSC and HIV retinopathy. He later progressed to CMV retinitis and subsequently died.

Conclusion: Although considered in many cases to be idiopathic, central serous chorioretinopathy has been associated with infectious etiologies, one of which could be HIV.

Background: This is the first ophthalmic report--to our knowledge--of an anterior uveitis secondary to sarcoidosis in a patient infected with human immunodeficiency virus (HIV). Other reported causes of uveitis in HIV-infected patients have included HIV, herpes zoster, tuberculosis, syphilis, toxoplasmosis, cryptococcus, rifabutin prophylaxis for mycobacterium, and protease inhibitors such as ritonavir and indinavir. Uveitis secondary to sarcoidosis in the non-HIV population is classically seen in young, female, African-American patients. There are rare reports, found exclusively in the pulmonary literature, of sarcoidosis in HIV-infected patients.

Case report: A 38-year-old African-American male infected with HIV was treated for chronic recurrent anterior uveitis secondary to sarcoidosis. His sarcoidosis was diagnosed 1 month earlier, along with the onset of his uveitis. During the previous 6 years he has been treated with anti-HIV antivirals as well as prophylaxis for opportunistic infections. To date, his infectious disease specialist continues to treat his HIV and systemic sarcoidosis.

Conclusion: Patients with HIV infection in whom sarcoidosis with secondary uveitis develops are very rare. Management of these patients requires careful use of topical and oral steroidal anti-inflammatories to control ocular and systemic sequelae of sarcoidosis. This case initiates some interesting questions about the immunology of sarcoidosis and its presence in immunocompromised patients. Use of steroids in an immunocompromised patient is clinically complex. Further clinical study is needed to elicit the full clinical significance of sarcoidosis and HIV infection.

Background: Management of HIV infection has been revolutionized in the past 3 years by the introduction of drugs significantly more potent than those previously available. Simultaneously revelations about dynamics of HIV infection and viral replication have altered concepts about HIV disease, as well as the need for therapeutic interventions.

Methods: A literature search was conducted of journals listed in the Index Medicus, as well as abstracts from annual meetings of the American Society for Microbiology, the Infectious Disease Society of America (Conference on Retroviruses and Opportunistic Infections), and the International Conferences on AIDS.

Results: Antiretroviral drugs of four differing pharmacologic classes are able to achieve profound suppression of viral replication when combined in varying regimens. Costs of medications remain high, many toxicities are associated with drug therapy, and regimens are both complex and daunting. In spite of many difficulties associated with highly active anti-retroviral therapy (HAART), many patients are able to achieve improved quality of life and longer survival.

Conclusions: Optometrists, as members of the health care team, play a role in diagnosis and management of HIV patients, in providing encouragement and empathy to patients--particularly emphasizing the need for adherence to complex therapy regimens, as well as the importance of regular followup.

Background: Acquired brain injury (ABI) is a general term referring to brain injury occurring secondary to trauma, stroke, or post-surgical complications. This paper reports on the occurrence of various ocular and visual conditions in an ABI patient sample.

Methods: The subjects for this study were 62 brain-injured adults who resided in two extended care facilities in the New York area. Subjects ranged from 19 to 70 years of age. The standard protocol for the visual evaluation incorporated a patient interview; cover test; refraction; and assessment of visual acuity, ocular motility, accommodation, binocularity, visual fields, color vision, contrast sensitivity, pupils, and anterior and posterior segments.

Results: Results were reported as a ratio comparing the occurrence of a condition in our ABI sample relative to that in a reference normal population (where normative data are available) and as a comparison to other published data on ABI samples. An increased occurrence of exo deviations, oculomotor dysfunctions, and vertical deviations was evident. An elevated occurrence of dry eye, blepharitis, optic nerve pathologies, and visual field deficits was also manifest.

Conclusion: Our patient sample demonstrates that certain ocular and visual conditions occur more frequently among ABI patients in comparison to a random, adult population.

Background: Laser pointers have been used inappropriately to harass and "dazzle" victims. Reports of retinal damage caused by pointers have also been circulated in the popular press.

Methods: Information on pointer abuse was collected from the literature and through discussions with specialists.

Results: Few, if any, documented cases of permanent retinal damage caused by laser pointers could be found. For actual damage to occur, viewing, times need to exceed approximately 10 seconds. Exposures of this duration would require the person being lased to cooperate by holding fixation on the laser beam.

Conclusions: Although the risk of permanent retinal damage from a laser-pointer beam is minimal, other risks include dazzle, annoyance, and concern that a weapon-aiming device rather than a pointer is generating the laser beam.

Background: Temporary loss of vision after ingestion of a large meal is a phenomenon that has been reported in only a small number of cases in the ophthalmic literature.

Case report: A 60-year-old man reported episodes of blurred vision associated with visual aberrations in his left eye for 5 minutes after eating large meals. His medical history was significant for carotid artery disease, hypertension, "diet-controlled" diabetes, and hypercholesterolemia. The patient's symptoms abated when he ate in smaller quantities and was placed on a regimen of IOP-lowering eye drops.

Conclusions: Postprandial transient visual loss can occur when blood gets shunted to the mesenteric system after eating, leaving the eye hypoperfused. It most commonly takes place in individuals whose ocular perfusion is already compromised by carotid disease, in combination with other vascular conditions that result in the inability to compensate for decreased perfusion to the eye. The signs and symptoms of postprandial visual loss--as well as the mechanisms thought to contribute to it--are discussed.