Usefulness of routine ophthalmologic examination for cytomegalovirus retinitis in acquired immunodeficiency syndrome patients

PURPOSE: To evaluate the usefulness of routine ophthalmologic examinations for cytomegalovirus retinitis in acquired immunodeficiency syndrome (AIDS) patients. METHODS: Clinical symptoms of cytomegalovirus (CMV) retinitis in patients with AIDS who had circulating CD4+ T lymphocytes 50/microliter or less and received monthly ophthalmological examinations (examined group) were compared with those of the patients detected by non-routine ophthalmological examinations (unexamined group). RESULTS: The patients in whom early CMV retinitis was detected by monthly ophthalmological examinations had no subjective symptoms or iritis. The size of CMV retinitis was smaller than 2 disc diameters and it did not extend to the papillomacular area in a majority of the patients. On the other hand, the size of CMV retinitis in the unexamined group was larger than 10 disc diameters and it extended to the papillomacular area in most cases. The visual prognosis of the examined group was better than that of the unexamined group. CONCLUSIONS: To protect visual acuity, it is important to conduct monthly ophthalmological examinations in patients with AIDS whose serum CD4+ T lymphocyte counts are 50 cells/microliter or less.     

What are the appropriate skills and knowledge required for the entry-level practice of optometry?

All health professions have developed a national program of competence assessment to address the specific issue of "entry-level practice." This is also true in optometry through the 3-Part examinations of the National Board of Examiners in Optometry. These examinations test the cognitive (knowledge) skills necessary to be fit to practice and the communication, affective and psychomotor skills that are required to apply the underlying knowledge in the solution of patient problems. The scope of the National Board examinations and how they change to keep pace with the expansion and the scope of practice, demonstrates that entry-level is a dynamic concept.     

Practical recommendations for measuring rates of visual field change in glaucoma

To date, there has been a lack of evidence-based guidance on the frequency of visual field examinations required to identify clinically meaningful rates of change in glaucoma. The objective of this perspective is to provide practical recommendations for this purpose. The primary emphasis is on the period of time and number of examinations required to measure various rates of change in mean deviation (MD) with adequate statistical power. Empirical data were used to obtain variability estimates of MD while statistical modelling techniques derived the required time periods to detect change with various degrees of visual field variability. We provide the frequency of examinations per year required to detect different amounts of change in 2, 3 and 5 years. For instance, three examinations per year are required to identify an overall change in MD of 4 dB over 2 years in a patient with average visual field variability. Recommendations on other issues such as examination type, strategy and quality are also made.     

Axial computerised tomography - answered and unanswered questions on the ophthalmologist (author's transl)]

The results of 67 examinations with computerized axial tomography are presented with reference to the indications. 15 examinations were performed in exophthalmos, 11 in unknown visual field defects, 9 in optic atrophy of unknown origin, 8 each in optic neuritis, papilledema and unclear visual disturbance. 8 furthur examinations were performed in different cases. The axial computerized tomography proved to be an efficient complementary examination technique if it is limited to well defined indications. The best results are obtained examining exophthalmos and visual field defects.     

Comparing the effectiveness of vision screenings as part of the school entrance physical examination to comprehensive vision examinations in children ages 3 to 6: an exploratory study.

PURPOSE: The purpose of this exploratory study was to investigate the effectiveness of vision screenings performed during school entrance physical examinations compared with comprehensive vision examinations in the state of Kentucky, which mandates comprehensive eye examinations for children, ages 3 to 6, who are entering the public school system. METHODS AND SUBJECTS: In this exploratory study, 1,386 children had forms submitted from 36 optometrists and 1 ophthalmologist reporting on their vision and eye problems. Vision and eye problems were defined as the presence of strabismus, amblyopia, or a refractive error requiring an optical correction, as determined by the optometrists or ophthalmologist using cycloplegic refraction. Among these 1,386 children, there were 300 diagnosed with vision problems. RESULTS: Sixty-six children were diagnosed with a vision problem who had not previously been to an eye doctor and had received a vision screening at their school entrance physical examination. In 56 of these 66 children, the vision problem was not detected by the vision screening, according to the parents. CONCLUSION: The exploratory study suggests that comprehensive vision examinations may identify some vision problems that were not found in children's preschool physical examinations that included vision screenings. A larger randomized study is needed to determine the most appropriate method of timely diagnosis of vision problems in children that can be corrected with early intervention in order to ensure the vision health and well-being of children entering the public school system.     

视觉功能检查在临床和科研中的应用

如今,随着人们对视觉功能的认识日益增强,视觉功能检查在临床和科研中的应用也越来越广.在临床中,除了眼科和视光学常规检查外,视觉功能的检查也非常重要.它是眼视光医师日常诊治的基本手段,主要分为常规的视觉功能临床检查和基于心理物理学的实验室测量两种.两种方法各有特点,它们的适当结合和分工,能使视觉功能检查更全面,更恰当地为临床及科研服务.     

头颅外伤所致同向偏盲6例报道

目的对颅脑外伤后，眼部表现基本正常的病人，设法寻找眼球后的视道有无损害。协助病灶的定位与诊断。方法：作全面的眼部检查，视野测试，及颅脑影像检查。结果就诊眼科时，6例中除1眼外，其余所有11眼的眼前段及眼底均正常，视力也在0．8至1．5，但视野检查时均发现了视道上段视纤维受损，所见视野缺损均与CT及X线所见的颅脑损伤处相符应。结论本文强调视野检查对颅脑外伤病人是否有视功能的损丧的重要性     

Malignant melanoma of the choroid in melanosis bulbi (author's transl)]

Report of a case with melanosis bulbi observed in a relatively young patient of 33 years, in which a malignant melanoma of the choroid developed. As reported in earlier examinations the incidence of malignant melanoma in cases of melanosis bulbi is much higher than in normal eyes. The authors recommend strongly routine biomicroscopic examinations in cases of melanosis bulbi every 1--2 years to recognize the development of a melanoma in an early stage.     

爆裂性眶骨骨折的诊断与治疗

目的了解目前对爆裂性眶骨骨折的诊断与治疗。方法回顾２０年间７８例爆裂性眶骨骨折检查包括Ｘ线检查１６例，超声波探查３１例，ＣＴ扫描７２例及各种检查方法在不同年代的临床应用。结果ＣＴ扫描阳性率１００％，有取代Ｘ线检查的趋势。超声波探查可显示眶内软组织改变，提供辅助诊断。结论现代影像学的进展，使人们认识爆裂性眶骨骨折，并对其治疗有所改进。     

Central serous retinopathy as the first manifestation of malignant melanoma of the choroid

The authors give an account of 12 patients where the original ophthalmological finding corresponded to central serous retinitis. In the course of check-up examinations the picture changed and finally the complex of applied examinations revealed that a malignant melanoma of the choroid was involved. The authors mention the time needed for the clinical decision on the final diagnosis of the disease which was confirmed histologically after enucleation of the eye. In the conclusion the authors draw attention to the necessity of frequent check-up examinations after the initial establishment of the diagnosis of central serous retinitis with regard to the differential diagnostic possibilities of the above disease.     

Findings of electrophysiological studies at various stages of combined surgical treatment of patients with proliferative diabetic retinopathy

Electrophysiological examinations of the pigmented epithelium, retina, and optic nerve have demonstrated the efficacy of combined surgical treatment for proliferative diabetic retinopathy at various stages of the condition. The findings are indicative of the process stabilization and of a reduction of the exudative component in the retina in late periods of the follow-up. The authors recommend combined electrophysiological examinations for monitoring the treatment results and for assessing the course of the process.     

Serologic and immunologic evaluation in uveitis

Following a brief discussion of the various general immunologic examinations useful in uveitis, the author goes on to stress the need for a goal of serologic examinations, taking the clinical picture and clinical context into account. In conclusion, a schematic approach is proposed which should be adhered to in paraclinical investigations.     

The Organisation and Findings of a School Vision Screening Service*

Our education systems place heavy reliance on visually presented material and consequently, children with vision defects need to be identified and treated when necessary. All school children should be given vision screening examinations. The scope of various vision screening methods and their relative merits are examined. The Victorian College of Optometry has been operating a school vision screening programme for some years and the clinical content of the screening examination together with the practical aspects of setting up and administering the programme are discussed. An analysis of the results of 1400 screening examinations, including some re-tests, is presented and compared with other data relating to the vision of school age children and, in view of these findings, recommendations are made about the need for universal and regular vision screening examinations for school children.     

An investigation of barriers and enablers to community eye care for children in England: A qualitative descriptive study

Purpose

Research suggests that there are challenges in the accessibility of eye care for children in England. This study explores the barriers and enablers to eye examinations for children under 5 years of age from the perspective of community optometrists in England.

Methods

Optometrists working in community settings were invited to participate in virtual focus group discussions using an online platform based on a topic guide. The discussions were audio-recorded, transcribed and thematically analysed. Themes were derived from the focus group data based on the study aim and research question.

Results

Thirty optometrists participated in the focus group discussions. The overarching themes identified as barriers to eye examinations for young children in a community setting were as follows: ‘Time and Money’, ‘Knowledge, Skills and Confidence’, ‘Awareness and Communication’, ‘Range of Attitudes’ and ‘Clinical Setting’. The key themes for enabling eye examinations for young children were as follows: ‘Improving behaviour’, ‘Enhancing training and education’, ‘Enhancing eye care services’, ‘Raising awareness’, ‘Changes in professional bodies’ and ‘Balancing commercial pressures and health care’.

Conclusion

Time, money, training and equipment are perceived by optometrists as key factors in providing an eye examination for a young child. This study identified a need for improved training and robust governance related to eye examinations for young children. There is a need for change within eye care service delivery such that all children, regardless of age and ability, are examined regularly, and by conducting these examinations, optometrists remain confident.     

Optimal Timing of Examination for Acute Retrolental Fibroplasia

The records of low birth weight infants who had ophthalmic examination during the first year of life were studied to determine the optimal age at which to screen for retrolental fibroplasia. Fifty-nine cases of RLF were detected in a total of approximately 175 examinations for the birth weight category under 1700 gm during a five-year period. Although about 25% of the initial examinations were performed prior to age 5 weeks, only two cases of RLF were found in that age range. Nine patients found to have a normal peripheral fundus at initial examination, later developed RLF. Since examinations performed during the fourth fortnight of life were 85% positive for RLF, and since retinal detachment in this condition rarely occurs before age 8 weeks, the present series of cases suggests that the optimal time for a single screening examination for RLF is between 7 and 9 weeks of age.     

Utilization of eye care providers by Canadian adolescents: evidence from the Canadian Community Health Survey

ObjectiveTo examine whether different government-insured eye care coverage policies affect adolescents' access to eye care providers (ophthalmologists and optometrists) in Canada.DesignCross-sectional survey.Participants11 015 Canadian adolescents aged 12 to 17 participated in the Canadian Community Health Survey (CCHS) 2007-2008.MethodsSelf-reported use of eye care providers, was compared between adolescents with and without government-insured routine eye examinations. The association between the utilization and the government coverage was evaluated by using prevalence ratios (PR) and 95% confidence intervals (CI).ResultsAcross Canada, 45.6% of adolescents used eye care providers over a 12-month period. The utilization rate was highest (46.4%) in provinces with insured routine eye examinations, lower (35.9%) in provinces without insured routine eye examinations, and lowest (27.1%) in the 3 territories. Significantly lower utilization rates were also found in males (10% less likely than females); in those without dwelling ownership (19% less likely than those who owned); in those who read fewer than 3 hours weekly (13% less likely than in those who read 3 or more hours per week); and in nondiabetics. After adjusting for the confounding effects of these factors, we found that adolescents living in provinces with uninsured routine eye examinations were 24% less likely to utilize eye care services (PR = 0.76; 95% CI 0.67-0.85); whereas those in the 3 territories were nearly 40% less likely to use eye care providers (PR = 0.63; 95% CI 0.48-0.83) compared to adolescents in provinces with insured routine eye examinations.ConclusionsLack of eye care insurance for routine eye examinations has a negative impact on adolescents' access to eye care providers in Canada.     

Factors influencing the detection of visual developmental deficits in 3-year-old kindergarten children

PURPOSE/BACKGROUND: In the 'Tübingen Kindergarten study', an orthoptic screening program for amblyopia in three-year-olds was evaluated. In the retrospective analysis presented here, the association between a child's history--especially participation in the regular preventive care examinations in Germany (U4 to U7)--and the time of detection of target diseases was investigated. METHODS AND SUBJECTS: The parents of three groups of children were interviewed by telephone. Group 1 consisted of 21 children already treated for amblyopia before orthoptic screening; group 2 of 26 children with target conditions newly detected by orthoptic screening; and group 3 of 32 children with newly detected moderate ametropia. The groups were tested for differences in history and utilization/results of the regular preventive care examinations. RESULTS: Participation in regular preventive care ranged from 82% to 92%. There were no significant differences between the groups. Nearly 90% of parents from groups 2 and 3 had not heard of amblyopia before orthoptic screening. Only one child had been referred after regular preventive care examinations. CONCLUSIONS: The regular preventive care examinations contributed little to the detection of amblyopia. The strong position of the pediatrician should be used for the early information of parents.     

Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases

OBJECTIVE: To assess the rate of annual eye examinations over time among older Americans with diabetes and chronic eye diseases. DESIGN: Longitudinal analysis of Medicare claims data. PARTICIPANTS: Random sample of Medicare beneficiaries aged 65 years or older. METHODS: Beneficiaries were followed between 1991 and 1999, unless mortality or enrollment in a health maintenance organization for > 6 months in a given 12-month period intervened. All claims data (both physician and facility) during this time were analyzed for the presence of International Classification of Diseases 9 codes consistent with 1 of the 3 study conditions and the performance of eye examinations. MAIN OUTCOME MEASURES: Claims submitted by optometrists, ophthalmologists, or other providers of eye care for subjects with diabetes, glaucoma, or age-related macular degeneration (ARMD). Rates were calculated on the basis of a 15-month time window for annual examinations rather than for 12 months to allow for less than full compliance with the guidelines for various reasons (e.g., bad weather). RESULTS: Among those with diabetes in this population, 50% to 60% had annual eye examinations in a 15-month period. Of those followed for at least 75 months after diagnosis, about three quarters had one or more 15-month gaps between visits. For subjects diagnosed with glaucoma, most visit rates were in the 70% to 90% range per 15-month period. The percentage of subjects with at least one 15-month period with no visits was considerably lower than for diabetes. The patterns for those with ARMD were in between those for diabetes and glaucoma. Over a nine-year period, only slightly over half of persons with at least one of the study conditions complied with practice guidelines. CONCLUSIONS: Annual eye examinations for persons diagnosed with diabetes, glaucoma, and ARMD are important for detecting potentially treatable vision loss among those already diagnosed with these conditions. Currently, actual rates of eye examinations for persons diagnosed with the study conditions fall far short of recommended rates. As such, approaches to enhancing longitudinal follow-up of those already in the eye care system are needed.     

眼球震颤诊治进展

眼球震颤是指双眼有节律的、不自主的,常呈对称共轭性的异常摆动,可根据发病年龄分为先天性眼球震颤和后天获得性眼球震颤。由于目前有限的诊治手段使得眼球震颤成为较为复杂的眼科疑难疾病之一。近年来,国际和国内对该类疾病的检测和诊疗水平在不断进步。本文将对眼球震颤的分类及特点,检查记录方法以及治疗的新进展进行综述。     

规范视功能临床检测不容忽视

随着人们生活方式的改变,用眼强度的增加,视觉功能异常的发生率越来越高。然而,在临床工作中对于视觉功能异常仍然普遍存在认识不充分、检查不规范和过度治疗等问题。视觉功能检测作为一种有效的临床特殊检查手段非常重要,但其遵循着一定的诊疗思路,而且并不是常规的眼科检测项目。在视觉功能检测过程中要注重系统化和规范化,调节和聚散功能的测量不可或缺。专业的人才培养和规范管理,以及临床科研的开展将促进该领域的持续良性发展。