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

Basal cell and squamous cell carcinomas are actinic lesions that must be considered in the differential diagnosis of growths of the eyelid. Basal cell carcinoma is the most common eyelid cancer. It tends to grow slowly, and rarely if ever metastasizes. Basal cell carcinoma can, however, grow by direct extension to adjacent structures including the brain. Basal cell carcinoma can be managed by Moh's surgery, excision, cryosurgery, radiation, and chemotherapy. Squamous cell carcinoma has similar epidemiology to basal cell carcinoma. However, it grows much faster and it can metastasize (up to 20% of the time). It is best managed by conventional surgery, cryosurgery, and sometimes radiation. Squamous cell carcinoma can have a grim prognosis if not detected and treated promptly.

Retinoblastoma is the most common primary intraocular tumor of childhood. The most common presenting sign of retinoblastoma is leukocoria; the second most common presenting sign is strabismus. The optometrist's ability to recognize the presenting signs and symptoms of retinoblastoma can lead to early diagnosis and expeditious treatment. Treatment modalities include enucleation, radiotherapy, cryotherapy, photocoagulation, and chemotherapy. Goals of treatment include patient survival and preservation of vision. Cooperation of the optometrist, the ophthalmologist, the ophthalmic nurse, the pediatric oncologist, and the radiation therapist plays an important role in the long-term survival of these children.

Polycarbonate lenses should be prescribed for wear by participants of contact sports during athletic activities. Frames that meet the specifications of American Society for Testing and Materials F803-88a should be prescribed for sports in which there is a significant risk of eye injury. Because of the high-energy collisions in some sports, helmets are also essential for both face and eye protection. Functionally one-eyed athletes should not participate in sports in which adequate eye protection is not available. It is inadvisable to recommend radial keratotomy to athletes who will participate in contact sports.

Cancer is a leading cause of morbidity and the second leading cause of mortality in the United States. The eye and adnexa are potential foci of neoplastic disease, either as primary sites or as sites of metastatic carcinoma. The most frequent anatomical site of ocular cancer is the eye, followed by the orbit, the conjunctiva, and the lacrimal gland. The average annual age-adjusted incidence of ocular cancer varies between 0.6 per 100,000 and 0.9 per 100,000 for the male population and between 0.5 per 100,000 and 0.8 per 100,000 for the female population. The distribution of eye cancer risk by age is bimodal, with peaks occurring during early childhood and again during adulthood. Retinoblastoma is the most common ocular malignancy in children, and uveal melanoma is the most common ocular malignancy in adults.

Hyphema is a potentially sight-threatening sequela of blunt trauma. Delayed healing time, poor visual outcome, and complications such as corneal blood staining, anterior and posterior synechiae, increased intraocular pressure, and glaucomatous optic atrophy are most often associated with hemorrhage filling more than one half of the anterior chamber. Rebleeds are most likely 3 to 5 days following injury, in children, in blacks (particularly if they have sickle cell disease), and in persons who have ingested aspirin or other antiplatelet compounds. Treatment of hyphema is controversial, and medical therapy (antibiotics, cycloplegics, steroids, aminocaproic acid) should be tailored to suit the needs of each case. Intraocular pressure-reducing medications may be required if there is significant elevation of IOP. The affected eye should be protected with a shield, and follow-up examinations should be conducted as necessary. Both the anterior and posterior eye should receive careful assessment.

The demands on the visual system during athletic performance are among the most rigorous of any activity. Because vision influences the capacity of an athlete to perform the tasks of a sport, scientific research has been performed to investigate the link between skill and vision. Most research efforts have been directed toward identifying the visual skills necessary for sports and determining if the skills of athletes differ from those of nonathletes. These efforts, though incomplete, have suggested that certain visual skills are important to performance in selected sports and that the visual skills of athletes and nonathletes do differ. There is as yet a paucity of research to support the hypothesis that the visual skills of athletes can be enhanced by visual training and that enhanced visual skills will result in improved athletic performance. Additional research efforts are needed to answer the many intriguing questions posed by the relationship between vision and sports.

Marksmen and hunters present unique challenges to the prescribing optometrist. History-taking must be thorough, to discover the specific interests of the patient, the weapon used, and the level of skill. Appropriate protective eyewear should be prescribed for all hunters and marksmen, with well-designed frames and polycarbonate lenses. Providing excellent distance acuity is an obvious requirement for these persons, and not only Snellen charts but also contrast sensitivity may be used to measure acuity. The most demanding patient is a presbyopic pistol shooter, who may require the use of apertures, low plus lenses or adds, or special design eyewear to provide the acuity needed for the alignment of front and rear sights. Another problem is eye dominance, which may be a consideration for left-eye (crossed) dominant individuals. Physiological diplopia may be a concern for beginning marksmen, and occlusion of the nonsighting eye or training to learn to ignore the diplopia may be necessary. Optometrists should be prepared to offer these and other services to this interesting class of patients.

Metastasis to the eye represents by far the most common form of intraocular and orbital cancer. This form of malignant disease may present with a variety of signs and symptoms including pain, vision loss, visual field defect, and proptosis. This varied clinical presentation is described, and available treatment modalities are discussed.

Tumors of the conjunctiva are easily visible to professional and lay observers. Because of this, they are frequently a source of patient self-referral. These lesions range from benign to malignant, and a differential diagnosis often requires the collaboration of the surgeon and pathologist as well as the diagnosing clinician. This article reviews the spectrum of conjunctival lesions based on how they appear to the clinician, with brief guidelines regarding management.