Optic nerve head drusen

Optic disc drusen are congenital and developmental anomalies of the optic nerve head seen commonly in clinical practice, often as an incidental ophthalmologic finding during routine exams. Optic disc drusen are a form of calcific degeneration in some of the axons of the optic nerve. Visual acuity is often not affected but the visual fields of these patients can be abnormal and deteriorate over time. Optic disc drusen are familial and are not uncommon. They are thought to be the result of pathology at the level of the optic nerve head itself. The diagnosis can be made with clinical findings combined with B scan ultrasound and computed tomography. In addition, newer modalities using optic nerve head tomography are proving to be very useful. Since children as well as adults are affected, it is important to consider optic nerve head drusen in the differential diagnosis of papilledema or optic nerve swelling.     

Intraocular lens surfaces and their relationship to postoperative glare

PURPOSE: To estimate the potential for surface reflections in recently introduced intraocular lenses (IOLs) and to determine optic surface designs that will reduce surface reflections. SETTING: Mayo Clinic, Rochester, Minnesota, USA. METHODS: Surface-reflected glare in the unaccommodated human crystalline lens and in 6 IOLs (Bausch & Lomb SoFlex LI61U, Pharmacia CeeOn 911A, Allergan Sensar AR40, Bausch & Lomb Hydroview H60M, Alcon AcrySof MA60BM, Alcon AcrySof SA30AL) was examined in a physiologic eye model using the ZEMAX optical design program. Internal and external surface reflections were described and compared in terms of IOL surface reflectivity (%), area of the reflected glare image (mm(2)), and relative intensity of the reflected glare image. RESULTS: Compared to surface reflections from the unaccommodated human lens with a corneal power of 43.0 diopters, all the IOLs increased the relative intensity of internal and external reflections by 3- to 36-fold except the MA60BM and the SA30AL, which increased the relative intensity of internal and external reflections by 730- to 1090-fold. CONCLUSIONS: All the IOLs studied variably increased internal and external surface reflections when compared to the human crystalline lens. Surface reflections were minimized in optic designs with an anterior radius of curvature of approximately 17.0 mm or less.     

Proper positioning of the plume evacuator in the VISX Star3 excimer laser minimizes central island formation in patients undergoing laser in situ keratomileusis

PURPOSE: To identify risk factors in a series of patients who developed steep central islands after laser in situ keratomileusis (LASIK). METHODS: We analyzed and compared the refractive and topographic outcome of a study group composed of 83 eyes of 44 patients who underwent LASIK using the VISX Star3 excimer laser with a refraction-matched control group of 83 eyes treated later. The vacuum aspirator of the excimer laser was abnormally positioned during the surgeries performed in the study group. RESULTS: Mean preoperative spherical equivalent refraction in the study group was -6.75 +/- 2.50 D. Four eyes with a mean preoperative spherical equivalent refraction of -9.27 +/- 2.29 D developed steep central islands. Thirty-three (38%) of 83 eyes treated needed retreatment for residual myopia or myopic astigmatism. In the control group, mean preoperative spherical equivalent refraction was -6.76 +/- 2.50 D. Ninety-three percent of eyes were within +/- 1.00 D of target refraction. Five (6.02%) of 83 eyes required retreatment and no eyes developed central islands. CONCLUSION: The abnormally positioned vacuum aspirator coupled with the higher preoperative refractive correction were the likely causative factors for central island formation and the increased incidence of undercorrection in these patients.     

Occupational cocaine exposure of crime laboratory personnel preparing training aids for a military working dog program

The potential for passive cocaine exposure was evaluated in crime laboratory employees preparing training aids for a military working dog program (MWD). The primary goal of the study was to elucidate the routes of exposure and implement procedural changes that would minimize this risk. Several work environments and laboratory procedures were examined by monitoring personal breathing zones (PBZ), ambient airborne cocaine levels in the laboratory spaces, and urinary levels of the primary cocaine metabolite, benzoylecgonine. The study was performed initially using current laboratory procedures to establish a baseline and to identify potential sources of exposure. A subsequent study was performed to determine the effectiveness of the follow-up procedure in reducing exposure. As a result of the changes, the 8-h time weighted averages (TWAs) were 40 to 80% lower in the follow-up study as compared to the baseline assessment. Dermal absorption and PBZ inhalation of cocaine during manufacture were likely the most significant source of cocaine exposure. Ambient airborne cocaine may have also contributed to the total exposure, but for most observations, the concentrations were significantly less than those determined from PBZ monitoring. The maximum ambient cocaine concentration was 0.0144 mg/m(3) compared to a maximum of 0.4004 mg/m(3) observed during PBZ monitoring. Occupational exposure decreased in the follow-up study because of the proper use of personal protective equipment and improvements in engineering controls.     

Vulnerable atherosclerotic plaque: clinical implications

Coronary Artery Disease (CAD) remains globally the leading cause of death and long-term morbidity. Among the many manifestations of CAD, acute coronary syndrome (ACS), ranging from unstable angina to acute myocardial infarction, is the most catastrophic event due to our inability to predict its occurrence. Despite improved treatments of CAD, ACS results in sudden death or permanent disability in a substantial percentage of patients. If we could predict the timing of ACS or better yet prevent its occurrence, we could alter the otherwise unfavorable course of CAD. Several studies have convincingly demonstrated that majority of all ACS develops from previously mild to moderate stenoses. Thus, based on these and autopsy studies, sudden disruption or rupture of the non-obstructive "vulnerable" atherosclerotic lesion is currently considered the cause of ACS. Recent clinical studies have substantiated earlier autopsy observations that plaque vulnerability is a systemic process, involving multiple locations concurrently. Although the exact inciting factors of the vulnerable plaque rupture are unknown, inflammation is accepted to be a pivotal event. The possibility of stabilizing the vulnerable plaques has strongly been supported by the lipid lowering trials, in which dramatic reduction of the acute coronary events was noted despite subtle improvements in luminal diameter. Furthermore, antiplatelet therapies have become an important preventative therapy due to the essential role of platelets in the aftermath of plaque rupture. Finally, various imaging modalities to diagnose the plaque vulnerability could help prevent the acute coronary events in the future.     

Improving the care of ESRD patients: a success story

Medicare's health care quality improvement program (HCQIP) is a national effort to improve beneficiaries' quality of care. The end stage renal disease (ESRD) HCQIP was implemented in 1994 in response to criticism about the poor quality of care received by ESRD patients. Quality improvement efforts initiated by the ESRD Networks and dialysis providers in response to the HCQIP have demonstrated substantial improvement in care for dialysis patients. This article describes the evolution of the ESRD HCQIP and its successful application in the ESRD program.     

Serological criteria for evaluation and licensure of new pneumococcal conjugate vaccine formulations for use in infants

The World Health Organization (WHO) is undertaking a series of consultations on serological criteria for the evaluation and licensure of new formulations/combinations or different vaccination schedules of pneumococcal conjugate vaccines. The lack of a definitive serological correlate of protection and the multiplicity of antigens involved, especially since the clinical efficacy of most of the individual serotypes represented in the only licensed vaccine has not been established, are hindering the formulation of criteria for licensure of new formulations or combinations of the vaccine. This report analyses the various options with their relative merits and drawbacks and provides preliminary recommendations as guidance to regulatory agencies in evaluating these vaccines for the purposes of licensure. More detailed recommendations for production and control of pneumococcal conjugate vaccines, including criteria for evaluation for licensure, are currently being drafted.     

Susceptibility of black fly larvae (Diptera: Simuliidae) to lawn-care insecticides individually and as mixtures

Urban and suburban watersheds have the potential to be highly impacted by chemicals, especially insecticides to control insect pests on lawns, ornamental plants, and home gardens. Three of the most common lawn-care insecticides detected in urban watersheds, carbaryl, chlorpyrifos, and malathion, have been evaluated using an acute orbital shaker toxicity test to determine their respective concentrations that produce 50% mortality (LC50) in Simulium vittatum Zetterstedt cytospecies IS-7 larvae. Results of the 48-h LC50 tests show chlorpyrifos to be the most toxic to black fly larvae (LC50 = 0.28 microg/L) followed by carbaryl (LC50 = 23.72 microg/L) and malathion (LC50 = 54.20 microg/L). These insecticides were also tested as binary and ternary mixtures using the toxic unit (TU) approach. Toxicity was shown to be greater than additive for the ternary mixture of chlorpyrifos-carbaryl-malathion (LC50 = 0.56 TU) and the binary mixtures of chlorpyrifos-malathion (LC50 = 0.72 TU) and carbaryl-malathion (LC50 = 0.78 TU). The binary combination of chlorpyrifos and carbaryl was shown to be additive (LC50 = 0.98 TU). These results indicate that aquatic invertebrate populations in urban and suburban streams may experience a higher-than-expected increase in toxicity-related effects when all three chemicals are present in the waterway.     

Predicting sediment toxicity using logistic regression: a concentration-addition approach

The question posed in this article is how useful the chemical concentration measurements for predicting the outcome of sediment toxicity tests are. Using matched data on sediment toxicity and sediment chemical concentrations from a number of studies, we investigated several approaches for predicting toxicity based on multiple logistic regression with concentration-addition models. Three models were found to meet criteria for acceptability. The first model uses individual chemicals selected using stepwise selection. The second uses derived variables to reflect combined metal contamination, polycyclic aromatic hydrocarbon (PAH) contamination, and the interaction between metals and PAHs. The third and final model is a separate species model with derived variables. Overall, these models suggest that toxicity may be correctly predicted approximately 77% of the time, although prediction is better for samples identified as nontoxic than for those known to be toxic.