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

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.

Evaluating the visual functioning of children with multiple impairments has long been a source of frustration for many eye care practitioners. A reflection of this difficulty is seen in the number of persons with multiple handicaps, especially children who are labeled "untestable" or "blind" by eye care specialists, but whose parents, teachers, and other caregivers know have some residual vision. These children with special needs may not be responsive to standard testing procedures for a variety of reasons. Stress-related behaviors, orthopedic and neuromuscular disorders, mental retardation, and preverbal levels of development will often greatly interfere with communication and co-operation levels. As parents, educators, and rehabilitation professionals have become aware of the importance of vision in the development of any child, the demand for comprehensive functional vision evaluations has substantially increased. The purpose of this paper is to present a functional vision evaluation for a child with special needs. Although one case is given as an example, guidelines for the evaluation of all special needs children are presented. It is important for eye care specialists to utilize these examination procedures in order to provide a framework from which comprehensive vision services can be delivered in conjunction with available community resources.

The visual system and its processing of sensory information can be affected in a variety of ways that may be either normal or associated with numerous disorders and diseases. Visual images produced by the intrinsic components of the eyes are often normal and are known as entoptic phenomena. In contrast, the visual system may be disrupted by various disorders and pathologic processes, which can result in metamorphopsia, transient loss of vision, and positive scotomas. Such disruptions can be secondary to retinal and optic nerve disease, migraines associated with visual auras, and cerebrovascular and neurologic diseases; they can also be side effects of certain drugs. In addition, the visual system may process incoming sensory information in such a way that what is seen is perceived incorrectly, i.e. illusion; or the visual system may produce images of things not really there, i.e. hallucination. Various types of visual phenomena, disturbances, and hallucinations are discussed. The numerous visual presentations need to be differentiated so that appropriate treatment, management, and patient education can be rendered.

Leber's hereditary optic neuropathy (LHON) is a distinct form of optic atrophy with a unique pattern of inheritance. The clinical reports of this disorder remain consistent with the original classic description made by Theodor Leber in 1871. Recent advances in the field of molecular genetics, however, have yielded insights into the etiological determinants underlying the clinical expression of LHON. Disease presentation, both ophthalmoscopically and clinically, are reviewed. Classic and atypical presentations are discussed with genetic testing as the definitive diagnostic measurement. Clinical and histopathological findings have led to the investigation of promising preclinical indicators of LHON symptomatology. Evidence of a multifactorial etiology has implicated a broad spectrum of potential intervention protocols. Teaming of the clinician and laboratory geneticist to identify those at risk is critical, not only for future clinical protocols, but to allow for immediate intervention when an effective therapy becomes available.

As the incidence of human immunodeficiency virus (HIV) infection increases throughout the world, there becomes a greater probability that the primary care clinician will be confronted by AIDS-related complications. Neuro-ophthalmic problems, including optic neuropathies, motility disturbances, and visual field defects, are an important and common part of the AIDS spectrum. However diverse and challenging to the clinician, they may be the initial presentation of HIV infection. While opportunistic infections and neoplasms comprise the major source of neuro-ophthalmic problems, HIV itself may also be included. This paper is a review of the common causes of AIDS-related neuro-ophthalmic disorders and their clinical manifestations.

The macula is extremely vulnerable to trauma. Acute trauma originates from three general categories of injury: blunt, remote, and photic. In all these types of trauma, minor injury may yield little or no permanent damage. The more severe cases of macular edema and tissue disorganization, however, can result in macular holes and scarring, which command the clinician's attention. Careful observation of the signs and symptoms involved in the natural history of macular trauma is needed.

Diplopia is a symptom that may be the result of paralytic strabismus. The causes of paralytic strabismus are deficiencies of cranial nerves III, IV, or VI. When encountering neurogenic diplopia, the clinician must determine which ocular motor nerve is involved. The clinician must then decide whether the disturbance is in the nerve nucleus, its fascicles, along the course of the nerve in the subarachnoid space, in the cavernous sinus, or at its termination within the orbit. With proper diagnosis, identification, and localization, appropriate management may be undertaken.

Cystoid macular edema (CME) may develop in association with a wide variety of ocular conditions. It is the result of cystic accumulation of extracellular intraretinal fluid in the outer plexiform and inner nuclear layers of the retina, as a result of breakdown of the blood-retinal barrier. It is most common following intraocular surgery, and in patients with venous occlusive disease, diabetic retinopathy, and posterior segment inflammatory conditions. A variety of approaches to the treatment of CME have been attempted, with a variable degree of success. These options have included topical and oral steroids, nonsteroidal anti-inflammatory agents, and laser photocoagulation treatment. The exact cause of CME and the effective treatment of this condition have remained elusive.

Idiopathic central serous chorioretinopathy is a very commonly seen disease process involving atypical RPE cells allowing the development of a neuroepithelial retinal detachment. Typically, this disease is self-contained and resolves spontaneously; however, on occasion, one must intervene by treating the area of atypical RPE with laser photocoagulation. Patients with ICSC should be monitored closely for any signs of choroidal neovascular membrane.