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

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.

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.

Retinopathy of prematurity (ROP) is a disease characterized by abnormal growth of retinal blood vessels in the eyes of premature infants. It is especially severe in the tiniest, most premature infants, whose chances of survival have increased with advances in neonatal care. Infants in whom ROP is diagnosed during the perinatal period are at risk for ocular abnormalities and for deficits in visual function. This article reviews the classification of ROP, summarizes current recommendations for screening of ROP in the perinatal period, and describes recent findings with respect to ocular and visual acuity outcomes of infants with ROP.