Name of Condition: Refractive Errors
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Pattern of Vitreo-Retinal Diseases at the National Referral Hospital in Bhutan: a Retrospective, Hospital-Based Study Bhim B
Rai et al. BMC Ophthalmology (2020) 20:51 https://doi.org/10.1186/s12886-020-01335-x RESEARCH ARTICLE Open Access Pattern of vitreo-retinal diseases at the national referral hospital in Bhutan: a retrospective, hospital-based study Bhim B. Rai1,2* , Michael G. Morley3, Paul S. Bernstein4 and Ted Maddess1 Abstract Background: Knowing the pattern and presentation of the diseases is critical for management strategies. To inform eye-care policy we quantified the pattern of vitreo-retinal (VR) diseases presenting at the national referral hospital in Bhutan. Methods: We reviewed all new patients over three years from the retinal clinic of the Jigme Dorji Wangchuck National Referral Hospital. Demographic data, presenting complaints and duration, treatment history, associated systemic diseases, diagnostic procedures performed, and final diagnoses were quantified. Comparisons of the expected and observed frequency of gender used Chi-squared tests. We applied a sampling with replacement based bootstrap analysis (10,000 cycles) to estimate the population means and the standard errors of the means and standard error of the 10th, 25th, 50th, 75th and 90th percentiles of the ages of the males and females within 20-year cohorts. We then applied t-tests employing the estimated means and standard errors. The 2913 subjects insured that the bootstrap estimates were statistically conservative. Results: The 2913 new cases were aged 47.2 ± 21.8 years. 1544 (53.0%) were males. Housewives (953, 32.7%) and farmers (648, 22.2%) were the commonest occupations. Poor vision (41.9%), screening for diabetic and hypertensive retinopathy (13.1%), referral (9.7%), sudden vision loss (9.3%), and trauma (8.0%) were the commonest presenting symptoms. -
Refractive Error Changes in Cortical, Nuclear and Posterior Subcapsular Cataracts
1524 Refractive error changes in cortical, nuclear and posterior subcapsular cataracts. D.B. Elliott & K. Pesudovs . Department of Optometry, University of Bradford, Bradford, United Kingdom.. Purpose • To determine the effect of the three main morphological types of age-related cataract on refractive error. Background • The increase in myopia in some patients with age-related nuclear cataract is well known (Brown & Hill, 1987). This change accounts for the “second sight of the elderly” in which the myopic shift provides normal reading ability without the need for spectacles. Distance vision, however, worsens. • Planter (1981) suggested that cortical opacity can induce hyperopic shifts. However, this claim has not been repeated since and no firm evidence is available. • Review papers suggest that cortical opacity can induce astigmatic changes (Brown, 1993). However, these reports were based on clinical impression with no supporting data. • . The prevalence of uncorrected refractive error in the elderly population is high (Wormald et al., 1992). It is likely that a reasonable proportion of these patients have refractive error changes induced by cataract. • It has been suggested that a delay in operating on age-related cataract of 10 years could reduce the number of patients requiring cataract surgery (Kupfer, 1985). The possible role of correcting cataract-induced refractive error to delay the need for surgery should be explored. Subjects • 98 elderly subjects (mean age 67 ± 8 years) were recruited. • 77 subjects had one type of morphological cataract: 34 subjects had cortical cataract, 21 had nuclear cataract and 21 had posterior subcapsular cataract (PSC). • 22 subjects had normal, healthy eyes. • Ocular screening excluded amblyopia, strabismus, eye disease or surgery. -
Fact Sheet: Refractive Errors
Fact Sheet: Refractive Errors More than 11 million Americans have common vision problems that can be corrected with the use of prescriptive eyewear such as glasses or contact lenses.1 These conditions are known as refractive errors and they occur when the eye doesn’t correctly bend, or ―refract,‖ light as it enters the eye. Common refractive errors include the following: o Nearsightedness (also called myopia)—A condition where objects up close appear clearly, while objects far away appear blurry. With nearsightedness, light comes to focus in front of the retina instead of on the retina. o Farsightedness (also called hyperopia)—A common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience farsightedness differently. Some people may not notice any problems with their vision, especially when they are young. For people with significant farsightedness, vision can be blurry for objects at any distance, near or far. o Astigmatism—A condition in which the eye does not focus light evenly onto the retina, the light-sensitive tissue at the back of the eye. This can cause images to appear blurry and stretched out. o Presbyopia—An age-related condition in which the ability to focus up close becomes more difficult. As the eye ages, the lens can no longer change shape enough to allow the eye to focus close objects clearly. Refractive errors are one of the most common—and correctable—causes of visual impairment in the United States. According to a recent study led by the National Eye Institute (NEI), approximately half of all American adults don’t have the 20/20 vision physicians consider optimal due to refractive errors.2 Women experience refractive error more frequently than men: Twenty-six percent more women aged 12 and older have uncorrected visual impairment due to refractive error compared with men aged 12 and older. -
Hyperopia Hyperopia
Hyperopia Hyperopia hyperopia hyperopia • Farsightedness, or hyperopia, • Farsightedness occurs if your eyeball is too as it is medically termed, is a short or the cornea has too little curvature, so vision condition in which distant objects are usually light entering your eye is not focused correctly. seen clearly, but close ones do • Its effect varies greatly, depending on the not come into proper focus. magnitude of hyperopia, the age of the individual, • Approximately 25% of the the status of the accommodative and general population is hyperopic (a person having hyperopia). convergence system, and the demands placed on the visual system. By Judith Lee and Gretchyn Bailey; reviewed by Dr. Vance Thompson; Flash illustration by Stephen Bagi 1. Cornea is too flap. hyperopia • In theory, hyperopia is the inability to focus and see the close objects clearly, but in practice many young hyperopics can compensate the weakness of their focusing ability by excessive use of the accommodation functions of their eyes. Hyperopia is a refractive error in • But older hyperopics are not as lucky as them. By which parallel rays of light aging, accommodation range diminishes and for 2. Axial is too short. entering the eye reach a focal older hyperopics seeing close objects becomes point behind the plane of the retina, while accommodation an impossible mission. is maintained in a state of relaxation. 1 Amplitude of Accommodation hyperopia Maximum Amplitude= 25-0.4(age) • An emmetropic eye for reading and other near Probable Amplitude= 18.5-.3(age) work, at distance of 16 in (40cm), the required amount of acc. -
MIOTICS in CATARACT SURGERY by Harold Beasley, MD
MIOTICS IN CATARACT SURGERY BY Harold Beasley, MD PROMPT MIOSIS OF the pupil after delivery of the lens in round pupil cataract surgery is recommended to protect the vitreous face, to prevent iris incarceration, and to facilitate the postplacement of corneoscleral sutures.1 It has been postulated that miosis also prevents the formation of peripheral anterior synechia, but this has not been demonstrated experimentally.2 An ideal miotic should produce prompt pupillary constriction and for a duration of 12 to 24 hours. It should also be nonirritating to anterior chamber structures. Acetylcholine ( 1.0 per cent)37 and a weak solution of carbachol (0.01 per cent) ,8 as well as pilocarpine, have been found to be satisfactory for this purpose. The purposes of this study were (1) to evaluate the effectiveness of miotics in preventing peripheral anterior synechia and in preserving the integrity of the vitreous face; and (2) to compare the effectiveness of acetylcholine 1 per cent and carbachol 0.01 per cent as miotics in round pupil cataract surgery. PROCEDURE This study compared three experimental treatments in a double blind procedure in which the code was left unbroken until all the data were accumulated. Selected patients were gonioscoped prior to surgery and only patients with grades Im or iv angles were chosen for this study. All patients were predosed with 2 per cent homatropine and 10 per cent phenylephrine. Prior to the injection of the test solution the pupillary diameters were measured before the section was made and immediately after lens extraction. Measurements were then made at two minutes and at five minutes after the intracameral instillation of 0.4- to 0.5-cc of the test solutions. -
Do You Know Your Eye Care Jargon? an OPTOMETRIST
Do you know your eye care jargon? Optometrists, Orthoptists and Opthalmologists all work in the field of eye care and often work as a team in the same practice. These various professional “categories” can cause quite a lot of confusion though. Not only do they sound similarbut some of their roles can overlap, thus making the differentiation even harder. One great example is that all these experts can recommend glasses. In this article, I will aim to overview the role of each specialty and so make it easier to identify who does what! The levels of training and what they are permitted to do for youas a patientare an important differentiator between these specialties. It will definitely help you make the best-informed decision when looking for help regarding your specific eye care issue. AN OPTOMETRIST In South Africa, Optometrists need to complete a four-year Bachelor of Optometry degree before they are permitted to practice. Once qualified, they provide vital primary vision care. They conduct vision tests and eye examinations on patients in order to detect visual errors, such as near-sightedness, long-sightedness and astigmatism. Optometrists also do testing to determine the patient's ability to focus and coordinate their eyes, judge depth perception, and see colors accurately. Once a visual „problem‟ has been identified andanalyzed, the optometristeffectively corrects them and their related problems, by providing comfortable glasses and or contact lenses. They are also responsible for the maintenance of these “devices”. Optometrists also play an important role in the diagnosis and rehabilitation of patients suffering from Low-vision. -
Diabetic Retinopathy
Postgrad MedJ7 1998;74:129-1 33 C The Fellowship of Postgraduate Medicine, 1998 Classic diseases revisited Postgrad Med J: first published as 10.1136/pgmj.74.869.129 on 1 March 1998. Downloaded from Diabetic retinopathy David A Infeld, John G O'Shea Summary Diabetes mellitus is the most common cause of blindness amongst the 25-65 Diabetic retinopathy is the com- year age group. The ocular complications of diabetes include diabetic monest cause ofblindness amongst retinopathy, iris neovascularisation, glaucoma, cataract, and microvascular individuals of working age. The abnormalities of the optic nerve. The most frequent complication is diabetic onset of retinopathy is variable. retinopathy.`' The risk of becoming blind increases with the duration of Regular ophthalmic screening is diabetes. The cumulative risk is higher in insulin-dependent diabetes mellitus essential in order to detect treat- (IDDM) than in noninsulin dependent diabetes mellitus (NIDDM).4 able lesions early. Retinal laser World-wide, it is estimated that over 2.5 million people are blind due to diabetes, therapy is highly effective in slow- which is thus the fourth leading cause ofblindness and an increasing problem in ing the progression of retinopathy developing nations.6 and in preventing blindness. As the Blindness commonly occurs from either macular oedema or ischaemia, vitre- sufferers of diabetes mellitus, the ous haemorrhage, or tractional retinal detachment.''5 Macular oedema is now commonest endocrine disorder, the leading cause of loss of vision amongst Western patients. It develops earlier now constitute approximately and is more severe in NIDDM than in IDDM.7 The treatment of macular 1-2% of Western populations, con- oedema has therefore been the subject of leading international studies. -
Myopia: More Than a Refractive Error − Lasik and Retinal Dystrophies
MYOPIA: MORE THAN A REFRACTIVE ERROR − LASIK AND RETINAL DYSTROPHIES WALRAEDT S.1*, LEROY B.P.1,2*, KESTELYN P.H.1, DE LAEY J.J.1 SUMMARY SAMENVATTING Three patients who had undergone laser in situ Drie patiënten die een correctie van myopie hadden keratomileusis (LASIK) correction for myopia were ondergaan met laser in situ keratomileusis (LASIK) first seen because of suboptimal visual acuity (VA) werden onderzocht omwille van postoperatieve sub- and night blindness and/or photophobia. After a com- optimale visus en nachtblindheid en/of fotofobie. Na prehensive examination including psychophysical uitgebreid onderzoek met inbegrip van psychofysi- and electrophysiological tests, two of the three pa- sche en electrofysiologische testen werd een dia- tients were shown to suffer from a progressive cone- gnose van progressieve kegeltjes-staafjesdystrofie ge- rod dystrophy. The third patient had retinitis pig- steld bij twee patiënten. De derde patiënt leed aan mentosa. These cases illustrate the need for in depth retinitis pigmentosa. Deze gevallen illustreren de preoperative evaluation in myopic patients about to noodzaak van een doorgedreven preoperatief onder- undergo LASIK when signs or problems of night blind- zoek bij myope patiënten die LASIK zullen onder- ness and/or photophobia are present. gaan met klachten van nachtblindheid en fotofobie. KEY WORDS RÉSUMÉ Retinal dystrophy, cone-rod dystrophy, Trois patients sont présentés ayant été examinés pour retinitis pigmentosa, photophobia, night une acuité visuelle sous-optimale et une héméralo- blindness, laser in situ keratomileusis, pie et/ou photophobie, après correction d’une myo- preoperative evaluation pie suivant la technique du laser in situ keratomi- leusis (LASIK). Sur base d’une évaluation élaborée, MOTS-CLÉS y inclus des tests psychophysiques et éléctrophysio- logiques, un diagnostic de dystrophie des cônes et Dystrophie rétinienne, dystrophie de type bâtonnets a été établi chez deux patients. -
Management Modalities for Keratoconus an Overview of Noninterventional and Interventional Treatments
REFRACTIVE SURGERY FEATURE STORY EXCLUSIVE ONLINE CONTENT AVAILABLE Management Modalities for Keratoconus An overview of noninterventional and interventional treatments. BY MAZEN M. SINJAB, MD, PHD anagement of keratoconus has advanced TAKE-HOME MESSAGE during the past few years, and surgeons can • When evaluating patients with keratoconus, ask now choose among numerous traditional and them to stop using RGP contact lenses at least 2 modern treatments. Traditional modalities weeks before evaluation to achieve correct Msuch as spectacle correction, contact lenses, penetrating measurement of the corneal shape. keratoplasty (PKP), and conductive keratoplasty (CK) • Interventional management modalities include CK, are still effective; however, demand for the last two has PKP, DALK, ICRSs, CXL, phakic IOLs, or some decreased with the advent of modern alternatives, specifi- combination of these treatments. cally intrastromal corneal ring segments (ICRSs) and cor- • Making the right management decision depends neal collagen crosslinking (CXL). Caution should be used on the patient’s corneal transparency and stress when considering these newer treatment modalities, and lines, age, progression, contact lens tolerance, surgeons should be aware of their indications, contraindi- refractive error, UCVA and BCVA, K-max, corneal cations, conditions, and complications before proceeding thickness, and sex. with treatment. Keratoconus treatments can be divided into two cate- Some patients achieve good vision correction and comfort gories, interventional and noninterventional. In this article, with this strategy. particular attention is given to ICRSs and CXL, as they are Advances in lens designs and materials have increased the the most popular emerging interventional management proportion of keratoconus patients who can be fitted with modalities for keratoconus. -
Updates on Myopia
Updates on Myopia A Clinical Perspective Marcus Ang Tien Y. Wong Editors Updates on Myopia Marcus Ang • Tien Y. Wong Editors Updates on Myopia A Clinical Perspective Editors Marcus Ang Tien Y. Wong Singapore National Eye Center Singapore National Eye Center Duke-NUS Medical School Duke-NUS Medical School National University of Singapore National University of Singapore Singapore Singapore This book is an open access publication. ISBN 978-981-13-8490-5 ISBN 978-981-13-8491-2 (eBook) https://doi.org/10.1007/978-981-13-8491-2 © The Editor(s) (if applicable) and The Author(s) 2020, corrected publication 2020 Open Access This book is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this book are included in the book's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the book's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifc statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. -
Myopia Dystopia Are Future Generations Doomed to an Ever-Worsening Spiral of Refractive Error?
NOVEMBER / DECEMBER 2013 # 03 Upfront In Practice NextGen Profession Blindingly Obvious Progress Predicting Outcomes of Stem Cells in Ophthalmology: How To Do Your Own With Glaucoma Anti-VEGF Therapy Are We Nearly There Yet? Market Research 10 26 – 28 35 – 37 40 – 41 Myopia Dystopia Are future generations doomed to an ever-worsening spiral of refractive error? 16 – 20 RETINAL DISEASE IS OUR FOCUS At Alimera Sciences, we are dedicated to developing innovative, vision-improving treatments for chronic retinal diseases. Our commitment to retina-treating ophthalmologists and their patients is manifest in a product portfolio designed to treat early- and late-stage diseases such as DMO, wet and dry AMD, and RVO.* Moving the back of the eye to the forefront of research and development. © 2013 Alimera Sciences Limited Date of preparation: March 2013 ILV-00182 * DMO-diabetic macular oedema; AMD-age-related macular degeneration; RVO-retinal vein occlusion. Online this Month Is Print Dead? Clearly not. You’re reading this... But that’s not to say there isn’t room for some exciting digital publishing, as proved by The Ophthalmologist iPad app. Here, we take you on a whistle-stop tour of the navigation features. Swipe left/right to the previous/next article Swipe up/down to read an article Formatted for landscape & portrait Go back to last read article Access the issues archive Quick access to all articles in issue Add an article to your favorites Full issue easy preview Interactive Icons: More information available More content available Or visit us on the web at www.theophthalmologist.com Contents 14 Feature 16 Myopia Dystopia Five questions that must be answered on the causes and consequences of near-sightedness, By Richard Gallagher 24 In Practice 03 Online This Month Upfront 24 Loss of Traction Mark Hillen asks if orcriplasmin 10 Blindingly Obvious Progress can.. -
Care of the Patient with Accommodative and Vergence Dysfunction
OPTOMETRIC CLINICAL PRACTICE GUIDELINE Care of the Patient with Accommodative and Vergence Dysfunction OPTOMETRY: THE PRIMARY EYE CARE PROFESSION Doctors of optometry are independent primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures as well as diagnose related systemic conditions. Optometrists provide more than two-thirds of the primary eye care services in the United States. They are more widely distributed geographically than other eye care providers and are readily accessible for the delivery of eye and vision care services. There are approximately 36,000 full-time-equivalent doctors of optometry currently in practice in the United States. Optometrists practice in more than 6,500 communities across the United States, serving as the sole primary eye care providers in more than 3,500 communities. The mission of the profession of optometry is to fulfill the vision and eye care needs of the public through clinical care, research, and education, all of which enhance the quality of life. OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE PATIENT WITH ACCOMMODATIVE AND VERGENCE DYSFUNCTION Reference Guide for Clinicians Prepared by the American Optometric Association Consensus Panel on Care of the Patient with Accommodative and Vergence Dysfunction: Jeffrey S. Cooper, M.S., O.D., Principal Author Carole R. Burns, O.D. Susan A. Cotter, O.D. Kent M. Daum, O.D., Ph.D. John R. Griffin, M.S., O.D. Mitchell M. Scheiman, O.D. Revised by: Jeffrey S. Cooper, M.S., O.D. December 2010 Reviewed by the AOA Clinical Guidelines Coordinating Committee: David A.