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

Child abuse and neglect is a problem that has existed for many years. Federal guidelines and state laws make it necessary for the optometrist to be aware of the definitions that describe abuse and neglect. In addition, it is necessary to review the characteristics of the child and caregiver to ascertain who may be at risk. Physical signs, such as specific types of fractures, burns, scalds, and bruises, should act as a key to suspected abuse. The most frequent ocular sign of abuse is intraocular hemorrhage. Other ocular manifestations include periorbital edema, ecchymosis, and retinal detachment, to name a few. Sexual abuse is also of concern. If a sexually transmitted disease is present in a young child, abuse should not be ruled out. It is the responsibility of the health care provider to report any suspected episodes of child abuse and neglect.

Most children with congenital anomalies, teratogenesis, inborn errors of metabolism, and acquired toxicity or injury will have abnormal growth and development during the first few years of life. Many of the conditions are treatable, and early intervention is associated with improved prognosis. Developmental and growth assessment should be part of any routine visit to a primary care clinician. An overview of normal growth and development is outlined, and some common abnormalities are discussed.

Liability claims involving eye care for pediatric patients may constitute as much as 20% of claims against optometrists, with the most common sources of litigation being failure to detect tumors affecting the visual system, improper diagnosis and management of binocular vision disorders, and injuries from shattered spectacle lenses. Claims for pediatric patients tend to allege large damages, partially because of the significant effect exerted by lifelong vision impairment or loss of vision.

Choroidal neovascularization is an important disease process that can result in severe vision loss in the affected eye. It has been a challenge for ophthalmic physicians to manage this complicated disease, especially when the neovascularization is subfoveal. Our increased understanding of macular disorders has allowed the development of advanced instrumentation and techniques in the treatment and management of choroidal neovascularization. As a treatment alternative to laser therapy, skilled vitreoretinal surgeons today have the technical ability to partially restore and maintain central visual function by surgically removing subfoveal choroidal neovascular membranes. Management of this condition may consist of monitoring the neovascularization, performing laser therapy, or surgically removing the choroidal neovascularization. This paper is limited to the surgical management of this disorder.

Choroidal neovascularization (CNV) is an important clinical finding that is associated with many ocular conditions, including inflammatory, infectious, degenerative, hereditary, and congenital disorders, ocular tumors, trauma, and a few miscellaneous disorders. The growth of new choroidal vessels beneath the retinal pigment epithelium is associated with specific clinical signs. The clinical recognition of CNV plays a key role in the prognosis and management of these disorders. The clinical presentation of each disorder associated with CNV is reviewed in this paper, with comments on the location and the frequency of CNV occurrence.

Epiretinal membranes are a common finding in older patients but are rare in young patients. Although they may be associated with other ocular conditions, most epiretinal membranes occur in the absence of ocular pathology. Patient symptoms range from asymptomatic to complaints of severe vision loss and metamorphopsia. Epiretinal membranes are commonly classified according to their density and contractile characteristics. In this review, cellophane maculopathy refers to thin, glistening membrane, surface wrinkling maculopathy is characterized by fine, superficial retinal folds and macular pucker is associated with a dense, grayish-white membrane causing a characteristic pattern of severe retinal distortion. With sufficient visual disturbance, epiretinal membranes may be treated by pars plana posterior vitrectomy and epiretinal membrane peeling.

Macular hole is a common cause of vision loss in older persons. Macular hole is formed by an actual hole through the neurosensory retina in the foveola area. The neurosensory retina adjacent to the hole is typically detached, which results in decreased central vision. Macular hole can be bilateral. Vitreous interactions with the posterior retinal surface are thought to be the essential cause of idiopathic macular hole formation. Until recently, no treatment was available for macular hole. Various surgical procedures are now being performed to repair macular hole and restore the neurosensory retina to its normal anatomical position. This paper presents the clinical characteristics of macular hole, reviews its incidence and its pathogenesis, and discusses the benefits and risks of surgical intervention in idiopathic macular hole formation.

Contact lenses for children are used to correct a variety of conditions. This paper reviews fitting of soft, silicone elastimer, and rigid gas-permeable contact lenses for therapeutic treatment of aphakia, anisometropia, myopia, hyperopia, esotropia, irregular astigmatism, and nystagmus. Cosmetic custom designs are described for the treatment of aniridia, albinism, amblyopia, and corneal disfigurement. Working with children and gaining their trust requires inventiveness and patience. Prescribing contact lenses for them requires developing good cooperation between the child, the parents, and the practitioner. The rewards of contact lenses wear for the appropriate pediatric patients include improving not only their vision but also their quality of life.