Journal of the American Optometric Association最新文献

Background: Almost 25 million workers in 1.2 million commercial buildings in the United States have symptoms of sick building syndrome (SBS). It is a source of ocular discomfort and may exacerbate the successful wear of contact lenses. This study examines the relationship between SBS and oculovisual discomfort.

Methods: Measurements of carbon dioxide, formaldehyde, temperature, and humidity were performed in 12 public office buildings that contained a total of 877 occupants. A questionnaire survey of the occupants was also performed.

Results: Thirty-five percent of the occupants of the buildings were dissatisfied with the indoor-air quality. Twenty-nine percent of the office building occupants reported ocular discomfort.

Conclusion: There was a significant correlation between eye irritation, throat irritation, and symptoms of blurred near vision. Ocular discomfort could be an indicator of poor indoor-air quality and a sick building syndrome.

Background: Hyperopia is the most common refractive error of children. Children with mild (or even moderate) levels of hyperopia usually do not experience visual problems resulting from this hyperopia. However, children with moderate-to-high degrees of hyperopia are at significantly increased risk for the development of amblyopia and strabismus. It is this association with these visually threatening disorders that makes hyperopia in children an important public health problem. In addition, even lesser degrees of hyperopia may affect the child's ability to perform well in near-related tasks, such as reading. The effect hyperopia has on an individual child is dependent on a variety of factors, including the magnitude of hyperopia, the age of the individual, the status of the accommodative and convergence system, and the demands placed on the visual system. Early detection and treatment of hyperopia may help prevention of potential complications from adversely impacting the child's vision. Although much is known about childhood hyperopia and its effects on vision, there is also much that is not known. The natural history, ocular biometry, relationship to accommodative function, the indications for treatment, and the most effective treatment modalities are among the underlying issues and clinical considerations awaiting more complete understanding.

Background: Automated perimeters (in general) are similar; however, caution may be exercised when visual field results from two different instruments are compared. The purpose of this study was to compare threshold measurements in the central field between the Synemed (Optifield 1) Glaucoma Test and the Humphrey 30-2 test in a young patient population.

Methods: One hundred twenty subjects were tested. The subjects were selected according to specific criteria considering ocular and systemic disease and refractive error. The ages ranged from 15 to 35 years, with a mean age of 25.9 years. The central 30 glaucoma test was used with the Synemed instrument, and the 30-2 test was used with the Humphrey instrument. Mean threshold values for the entire field, hemifields, quadrants, and sectors were compared between instruments.

Results: The difference in the mean value for the collective threshold values for each pattern for each instrument were calculated and compared. The difference between the instruments for the mean dB threshold value for each pattern was less than the expected short-term fluctuation and therefore are equivalent for clinical purposes.

Conclusion: For the patterns examined here, the Synemed Optifield 1 and Humphrey Field Analyzer provided comparable results in this population.

Background: Ocular toxocariasis is a rare infection caused by the nematode larvae of toxocara canis, which is commonly found in dogs. Human transmission is usually via geophagia, the ingestion of food contaminated with the toxocara eggs, or contact with infected puppies, often resulting in devastating ocular and/or systemic effects. Distribution is worldwide; however, a higher incidence is demonstrated in the United States.

Methods: A 17-year-old black woman sought treatment at a neighborhood health center with a report of gradual decrease in vision from her left eye over a 3-month period. Her ocular and systemic histories were unremarkable. Anterior segment evaluation revealed no signs of anterior uveitis. The posterior pole showed a 1.5 DD, round, raised, white, subretinal lesion adjacent to the fovea with an overlying serous retinal detachment and retinal hemorrhage.

Results: She was referred to a retinologist who performed both fluorescein and indocyanine green (ICG) angiographies. A serum toxocara ELISA test was also ordered. Fluorescein angiography revealed hyperfluorescence consistent with the granuloma. The ICG demonstrated an occult choroidal neovascular membrane (CNV) underlying the area of hemorrhage inferotemporal to the granuloma.

Conclusion: This paper illustrates the case presentation and includes an extensive review of the ocular and systemic manifestations of toxocariases. A description of ICG videoangiography, therapeutic approaches, and management will also be discussed.

Background: Although vision therapy has reportedly been very successful in elimination of asthenopic symptoms in adults with convergence insufficiency, controlled studies have not been performed, and a clinical bias exists against prescribing vision therapy for adults with convergence insufficiency.

Methods: Sixty adult males over the age of 40 years (median age, 65 years) with convergence insufficiency were divided into three treatment groups: office-based vision therapy with supplementary home therapy, home therapy only, and a control group.

Results: Vision therapy was successful in 61.9% of patients who received in-office plus home therapy, in 30% of patients who received home therapy only, and in 10.5% of the control group. The success rate for patients who received active in-office vision therapy supplemented with home procedures was significantly greater than that for controls. Home therapy alone was less successful than in-office therapy. The success rate obtained with home therapy alone was not significantly greater than that demonstrated by controls.

Conclusions: Vision therapy is effective in eliminating asthenopia and improving convergence function in adult patients. In-office therapy combined with home therapy tends to produce better results than does home therapy alone.

Background: Apraclonidine 1.0% has been shown to reverse the potential intraocular pressure (IOP) increase after pupil dilation IOP increases in patients with chronic open-angle glaucoma. However, it is only approved for preventing IOP spikes after laser surgery. The purpose of this study is to determine the effectiveness of 0.5% apraclonidine in reversing IOP increases after pupillary dilation in patients with chronic open-angle glaucoma.

Methods: Twenty-two patients with chronic open-angle glaucoma were found to have an increase in post-dilation IOP of at least 4 mmHg from pre-dilated levels (baseline) in both eyes. IOP was measured 1 hour after dilation, after which two drops of 0.5% apraclonidine were instilled in one eye and the IOP was remeasured 15 minutes later in both eyes. Instillation of 0.5% apraclonidine in one eye was continued every 15 minutes and IOP was measured 15 minutes after each instillation, until the pressure returned to baseline levels.

Results: The IOP of the initially treated eye of all 22 patients returned to within levels clinically insignificant from baseline IOP within 90 minutes. By comparison, the IOP of the control group (untreated eye) remained elevated. Once the initial treatment eye returned to baseline levels, the control group was then treated with 0.5% apraclonidine, resulting in a lowering effect of the IOP in similar fashion to the initial treated group.

Conclusions: Apraclonidine 0.5% appears to be effective in reduction of post-dilated IOP increases in patients with chronic open-angle glaucoma.

Background: Fibrous histiocytomas are a diverse group of soft tissue tumors classified histiologically as benign, locally aggressive, and malignant. These tumors are found throughout the body, but seem to have an affinity for the periorbital area. They account for one percent of all ocular masses and are the most common primary mesenchymal tumor of the orbit. Associated ocular signs and symptoms include decreased visual acuity, proptosis, diplopia, pain, restricted extraocular muscle movement, swelling of the eyelids, and conjunctiva, as well as disk edema.

Case report: A case of a benign orbital fibrous histiocytoma is presented. The patient reported intermittent pain and occasional diplopia; severe edema of the right upper eyelid; and proptosis and inferior vertical displacement of the right globe were observed. Computed tomography revealed a well-defined mass that was subsequently surgically removed and histopathological results from the Armed-Forces Pathology Institute confirmed the diagnosis.

Conclusions: Orbital fibrous histiocytomas are rare periocular tumors that can manifest multiple ocular signs and symptoms. Careful histologic examination is necessary for diagnosis, since these tumors have a wide range of morphology. Differential diagnoses include orbital masses with similar radiologic or histologic findings.

Background: Although poor access to general medical care services has been documented widely, the unmet need for supplemental health care services--such as eyeglasses--has been largely ignored. This article documents the inability to obtain eyeglasses on the national level and for various subpopulations using the 1994 Robert Wood Johnson Foundation National Access to Care Survey.

Methods: The Survey, a followup to the 1993 National Health Interview Survey, collected data on respondents' inability to obtain health care services due to access barriers. The sample comprised 3,480 observations, weighted to represent the U.S. civilian non-institutionalized population.

Results: More than 5% of the U.S. population reported an unmet need for eyeglasses, and of these, more than 80% cited financial reasons as the primary barrier. Persons in poor health and blacks were most likely to face barriers to obtaining eyeglasses.

Conclusion: Understanding this under-served population and their unmet needs can help policymakers formulate new initiatives. The focus on preventive care within managed care organizations may ease some barriers for the insured population. Policy should focus on uninsured and underinsured working individuals who cannot afford and do not receive public assistance for needed eye care.

Purpose: This study investigated whether there is a significant correlation between mild-to-moderate patient reports of dry eye and results on the tear ferning and impression cytology tests.

Methods: One hundred and four subjects were surveyed for presence or absence of dry eye symptoms. Membrane impression cytology and tear ferning were performed on each subject. Impression cytology specimens were evaluated for the presence of goblet cells, presence of epithelial cell sheets, and epithelial cell morphology. Tear specimens were evaluated for quality of ferning.

Results: A significant correlation was found between subjective dry eye symptoms and impression cytology results (cc = 0.28, p = 0.003). However, there was no statistically significant correlation between dry eye symptoms and tear fern results (cc = 0.072, p = 0.458).

Conclusions: Impression cytology appeared to be a better predictor of mild-to-moderate dry eye symptoms than tear ferning.