Optometry clinics : the official publication of the Prentice Society最新文献

A general overview of age-related macular degeneration, including its definition, classification, and epidemiology, is followed by specifically described clinical findings of this disorder. Included are the differential diagnosis, histopathology, prevalence, risk factors, and natural history of each individual form. Also presented are the issues of optometric management, including clinical recognition of choroidal neovascularization, timely referral for retinal consultation and angiography, preventive therapies, current and emerging trends in the medical and surgical treatment, and appropriate follow-up.

Pediatric vision care is important to the welfare of every child. Recent research has shown that early vision care is advantageous for proper vision development. Primary vision care is recommended for infants and young children. Techniques used for the pediatric population are different from those used for the adult population. Measurement of visual function is greatly dependent on the examiner's skill in integrating knowledge of normal development, use of age-appropriate tests, and observational abilities. This paper is a summary of techniques that are applicable to the primary care examination of infants and young children. Comments are included on patient management and practice preparation to welcome young children.

The use of pharmacological agents in children warrants special consideration because children have variable pharmacokinetic parameters. Not only are the pharmacokinetic properties of drugs different in children as compared with adults, but these properties can undergo rapid change as children grow and mature. Furthermore, many drugs that would be useful in the pediatric population lack the indication for use in children and, therefore, dosing guidelines are not available. This paper presents an overview of basic pharmacokinetics in children and pediatric dosing guidelines.

The introduction of laser photocoagulation for the treatment of macular disease has enabled many patients to retain visual acuity and retard additional deterioration of vision. Treatable maculopathy can occur as the result of choroidal neovascular development, idiopathic central serous choroidopathy, and retinal vascular disease. Variations in the treatment of these maculopathies include type of laser used, spot size, duration of treatment, burn pattern, and intensity of the burn. The cause of the maculopathy determines the type of laser photocoagulation that is most appropriate. While some forms of treatment leave characteristic scars, others leave hardly a trace. Use of fluorescein angiography, and in some cases indocyanine green angiography, is essential in the determination of the appropriate laser treatment modality.

A comprehensive case history is vital in the diagnosis and management of neuro-ophthalmic disease. This history is developed throughout an examination, and it is expanded whenever follow-up evaluations occur. Major objectives for developing a neuro-ophthalmic case history include having the patient reveal any clues suggesting that organic lesions exist, and subsequently exploring for characteristic ocular and nonocular symptoms that might prove helpful in localizing such lesions. The history is considered when selecting diagnostic procedures for the workup of neuro-ophthalmic patients, and it is especially vital in the decision as to which management options to pursue.

Ophthalmic fluorescein angiography is an important clinical procedure used to investigate and document the status of the retinal and choroidal vascular systems. Administered intravenously and followed by rapid-sequence serial photographs, the fluorescein dye produces an angiographic display that is used to visualize and document retinal blood flow dynamics while recording the integrity of the inner blood-retinal barriers and the fine details of the retinal pigment epithelium. It is an important diagnostic and research tool, and has the added advantage of serving to illustrate the manner in which the retina and choroid respond to disease. More visual resolution is possible with this diagnostic procedure than with others, and it is a valuable adjunct to stereoscopic fundus biomicroscopy and binocular indirect ophthalmoscopy. The procedure has further utility in determining the suitability for laser photocoagulation surgery in macular and retinal vascular disease states. Ophthalmic angiography is also applicable the anterior segment, where it is employed as a research tool in the evaluation of conjunctival, episcleral, corneal, and especially iris blood vessels. Anterior segment use of fluorescein angiography has yet to become a prevalent clinical tool; rather, it currently has more extensive application through research, in developing a better understanding of the nature of anterior segment disorders.

For most people, walking is an automatic, unconscious activity, characteristic of each individual. Patterns of gait can be reflective of a person's body structure, occupation, and personality, as well as health status. Most parents who watch an infant beginning to walk realize that locomotion is a highly complex, learned process. Years of training and practice are necessary for the sensory-motor system to become adept at automatically generating the motor commands necessary to permit walking without conscious effort. The characteristic adult pattern of walking does not emerge until up to 7 to 9 years of age, after the neuromusculoskeletal systems have undergone constant modification and development of improved neural controls. Important information pertinent to the patient's health status can be obtained by observing his or her manner of walking. This article will review abnormal gait patterns due to nervous system dysfunction. To help understand abnormal gaits, a brief review of the underlying components of walking is necessary.

Multiple sclerosis is a demyelinating disease of the central nervous system that commonly presents with ocular manifestations. These ocular manifestations include vision loss and optomotor deficit. Treatment modalities should include treatment of the systemic disease as well as the ocular disease. New treatment protocol suggests that the best way to treat optic neuritis is with IV methylprednisolone, unless there is some serious contraindication for the patient. The use of interferon and cyclosporin as well as other anti-inflammatory agents may be useful in the future.