DOCSLIB.ORG

Should We Aggressively Treat Unilateral Congenital Cataracts?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Should We Aggressively Treat Unilateral Congenital Cataracts? 1120 Br J Ophthalmol 2001;85:1120–1126 Br J Ophthalmol: first published as 10.1136/bjo.85.9.1120 on 1 September 2001. Downloaded from CONTROVERSIES IN OPHTHALMOLOGY (Series editors: Susan Lightman and Peter McCluskey) Should we aggressively treat unilateral congenital cataracts? David Taylor, Kenneth W Wright, L Amaya, L Cassidy, K Nischal, Isabelle Russell-Eggitt View 1 Kenneth W Wright I do believe that visually significant congenital occurs. Even so, one might argue that this is cataracts should be treated aggressively with still only a “spare eye,” and that it is impossible early surgery! However, I advocate surgery to get the eyes to work together. only if the cataract is truly visually significant. Historically, patients with unilateral con- Small partial cataracts can often be treated genital cataracts had a very poor prognosis for with close observation or pupillary dilatation, obtaining binocular fusion and many studies possibly with part time occlusion therapy. have reported that 100% of patients with unilateral congenital cataracts develop strabis- mus.23However, in separate papers published Early surgery for unilateral congenital in 1992, Wright et al4 and Gregg and Parks5 cataracts—why? reported that good visual acuity, straight eyes, Some might protest that visual results are and good binocularity with stereopsis is possi- notoriously poor after surgery for a unilateral ble in patients with unilateral congenital congenital cataract. Why drag the family and cataracts. The key to the excellent outcomes child through all the turmoil required for the was the way the patients were treated. treatment of infantile cataracts for, at best, a Firstly, the patients had very early surgery “spare eye”? The answer is simple: two eyes are and immediate placement of an aphakic better than one. Two eyes give us a larger field contact lens usually by 4 weeks of age. The of view, a reserve if one eye is lost, and that case reported by Gregg and Parks5 had cataract wonderful trait of binocular vision with ster- http://bjo.bmj.com/ surgery with contact lens placement by the eopsis. Sure, you can get along with one eye but second day of life and ended up with 50 if there is any reasonable possibility for obtain- ing two functioning eyes, then we should go for seconds of arc of stereoscopic acuity and visual acuity of 20/25 in the aphakic eye. In the paper it! 4 I have both a personal and a professional of Wright et al, five of 13 (38%) patients with interest in unilateral cataract as my sister had unilateral congenital cataracts operated early technically successful unilateral congenital developed both good visual acuity and binocu- lar fusion. In both the Wright 4 and the on October 1, 2021 by guest. Protected copyright. 1 2 et al cataract surgery at 2 ⁄ years, followed by three 5 strabismus surgeries. She had a childhood of Gregg and Parks studies, extended wear being teased, an adult life of concern for her contact lenses were used not aphakic specta- one good eye and corrected vision of counting cles. Unilateral aphakic spectacles just do not fingers in the aphakic eye. do the job, as infants will never wear them full time and the unilateral magnification causes aniseikonia that disrupts binocular fusion. Can we realistically expect good visual Intraocular lenses have the theoretical advan- outcomes in children who have unilateral tage of providing a constant clear retinal image congenital cataracts? but early experience in newborns has been dis- With aggressive treatment the visual prognosis couraging, and they are not the standard of Pediatric is good, and there is even the possibility of care in infants. For me, optimal treatment is Ophthalmology obtaining binocular vision with stereoscopic early surgery and the contact lens placement Research and 1 Education acuity. Birch and Stager reported that a mean by 2 weeks of age. Cedars-Sinai Medical visual acuity of 20/60 (range 20/800–20/30) Secondly, both studies used immediate full Center, Cedars-Sinai was achieved if surgery was performed before 2 time binocular light occlusion when the Medical Towers, 8631 months of age, whereas surgery after 2 months cataract was first identified. Binocular occlu- West Third Street, of age resulted in poor visual acuity, ranging sion was continued until a clear retinal image Suite 304 E, Los from hand movements to 20/160. Thus, the was restored (that is, cataract surgery per- Angeles, CA 90048, USA prognosis for obtaining good visual function is formed and the contact lens placed—usually K W Wright possible if surgery is performed early, but hor- within 1 week). Binocular light occlusion or director rible if done late after irreversible amblyopia bilateral patching has been shown to preserve www.bjophthalmol.com Should we aggressively treat unilateral congenital cataracts? 1121 Table 1 Patching scheme for unilateral congenital Br J Ophthalmol: first published as 10.1136/bjo.85.9.1120 on 1 September 2001. Downloaded from cataracts after early surgery (surgery by 1 month of age) Age (months) Patching 0–1 No patching 1–2 1–2 hours/day 2–4 2–4 hours/day 4–6 50% awake hours 6–12 Up to 80% as indicated based on vision assessment visual cortical plasticity in the animal model and to be safe in human infants.6–8 Binocular occlusion is a way of postponing visual development until a clear retinal image can be established. I recommend binocular occlusion before surgery during the critical period of visual development (birth to 2 months of age) and for a duration of no longer than 2 weeks. Thirdly, after surgery and contact lens fitting, Wright et al 4 and Gregg and Parks5 used part time monocular occlusion of the good eye (less than 50%) to treat amblyopia rather than the standard treatment of full time occlusion. For the first month or two, virtually no patch- ing was performed, allowing for the develop- ment of binocular fusion. Full time monocular occlusion during early infancy destroys bin- ocular visual development and guarantees development of strabismus.3910 In addition, there is evidence that too much patching can actually reduce vision in the good eye (that is, Figure 1 This is my patient who had a dense congenital the phakic eye).11 Full time patching may be cataract, left eye, identifited at 1 day of age and had urgent necessary in older children with a cataract and surgery 48 hours after birth. The patient was treated aggressively with bilateral light occlusion from day 1 when strabismus (>1 year of age), but part time the cataract was identified, until a contact lens was fitted at patching is preferred in infants who have a 1 week of age. The patient wears a contact lens full time, left clear retinal image established during the first eye, and the right eye is being patched 4 hours a day. As pictured above, the patient is now 1 year old, has excellent few weeks of life (Table 1). fixation in each eye, straight eyes, and the family is very The papers by Wright et alT4 and Gregg and happy that aggressive treatment was initiated. Parks5 in 1992 and more recently by Brown et al12 in 1999, clearly show that good vision and prognosis include lamellar cataracts, posterior binocular fusion are not mutually exclusive, lenticonus, and persistent hyperplastic primary vitreous. These types of cataracts are often par- and that full time occlusion is not necessary if http://bjo.bmj.com/ a clear retinal image is established in early tial at birth and can progress over time, thus infancy. These papers are important as they allowing for early visual development. Another document that good visual acuity and binocu- indication for a good prognosis was the lar vision are obtainable through aggressive presence of straight eyes in these children. treatment (Fig 1). Approximately 50% of patients with a pre- sumed unilateral congenital cataract who had What about older children with presumed straight eyes and no strabismus obtained final unilateral congenital cataracts? visual acuity of 20/40 or better. The presence on October 1, 2021 by guest. Protected copyright. When an older child presents with a unilateral of straight eyes indicates that the cataract was cataract it can be diYcult to know whether the only partially obstructing the visual axis during cataract was there during the critical period the critical period of visual development and, if so, to what extent the cataract interfered indicating a relatively good visual prognosis. with visual development. Often, the clinician is unsure whether it is worthwhile removing the Indications for surgery—is the cataract cataract in a child who presents late after the visually significant? critical period of visual development. Should It is often diYcult to determine whether a par- we be aggressive in treating these children who tial cataract is visually significant in preverbal present late with presumed unilateral congeni- children. Neonates less than 8 weeks of age tal cataracts? This time the answer is some- normally have poor smooth pursuit eye move- times. Kushner13 reported relatively good ments and have not yet developed central fixa- results after surgery for monocular juvenile tion. Because of this, testing for fixation is not cataracts of undetermined onset. In the study very useful. Infant vision tests such as preferen- of Wright et al14 all patients presented after 10 tial looking and pattern visual evoked potential months of age and were treated with lensec- are also unreliable and diYcult to obtain tomy and aphakic contact lenses. Eighteen during the neonatal period. Neonates do not patients underwent surgery for a unilateral fully accommodate and it is diYcult to cataract and, of these, approximately 40% maintain their attention on the pattern stimu- obtained a visual acuity of 20/60 or better.
Load more

Recommended publications
  • Congenital Cataract
    3801 W. 15th St., Bldg. A, Ste. 110 Plano, TX 75075 Phone: (972) 758-0625 Fax: (972) 964-5725 Email: [email protected] Website: www.drstagerjr.com Congenital Cataract Your eye works a lot like a camera. Light rays focus through the lens on the retina, a layer of light-sensitive cells at the back of the eye. Similar to photographic film, the retina allows the image to be “seen” by the brain. Over time, the lens of our eye can become cloudy, preventing light rays from passing clearly through the lens. The loss of transparency may be so mild that vision is barely affected, or it can be so severe that no shapes or movements are seen—only light and dark. When the lens becomes cloudy enough to obstruct vision to any significant degree, it is called a cataract. Eyeglasses or contact lenses can usually correct slight refractive errors caused by early cataracts, but they cannot sharpen your vision if a severe cataract is present. The most common cause of cataract is aging. Occasionally, babies are born with cataracts or develop them very early in life. This condition is called congenital cataract. There are many causes of congenital cataract. Certain diseases can cause the condition, and sometimes it can be inherited. However, in most cases, there is no identifiable cause. Treatment for cataract in infants varies depending on the nature of each patient’s condition. Surgery is usually recommended very early in life, but many factors affect this decision, including the infant’s health and whether there is a cataract in one or both eyes.
    [Show full text]
  • Accommodation in the Holmes-Adie Syndrome by G
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.21.4.290 on 1 November 1958. Downloaded from J. Neurol. Neurosurg. Psychiat., 1958, 21, 290. ACCOMMODATION IN THE HOLMES-ADIE SYNDROME BY G. F. M. RUSSELL From the Neurological Research Unit, the National Hospital, Queen Square, London In 1936, Bramwell suggested that the title response to near and far vision respectively. But it "Holmes-Adie syndrome" be given to the clinical has also been noted that the reaction to convergence complex of a slowly reacting pupil and absent tendon may be remarkably wide in its range, considering reflexes in recognition of the descriptions by Holmes that it often follows a stage of complete paralysis (1931) and Adie (1932). Both authors had empha- (Strasburger, 1902). Not only is the reaction to sized the chief clinical features-dilatation of the convergence well preserved when compared to the pupil, apparent loss of the reaction to light, slow reaction to light, but it may in fact be excessive constriction and relaxation in response to near and (Alajouanine and Morax, 1938; Heersema and distant vision, and partial loss of the tendon reflexes. Moersch, 1939). In assessing the degree of tonicity Although the syndrome had been recognized wholly there are, therefore, two criteria: slowness ofguest. Protected by copyright. or in part many years previously (Strasburger, 1902; pupillary movement and preservation of the range Saenger, 1902; Nonne, 1902; Markus, 1906; Weill of movement. and Reys, 1926), credit must go to Adie for stressing Adler and Scheie (1940) showed that the tonic the benign nature of the disorder and distinguishing pupil constricts after the conjunctival instillation it clearly from neurosyphilis.
    [Show full text]
  • Visual Outcomes of Combined Cataract Surgery and Minimally Invasive Glaucoma Surgery
    1422 REVIEW/UPDATE Visual outcomes of combined cataract surgery and minimally invasive glaucoma surgery Steven R. Sarkisian Jr, MD, Nathan Radcliffe, MD, Paul Harasymowycz, MD, Steven Vold, MD, Thomas Patrianakos, MD, Amy Zhang, MD, Leon Herndon, MD, Jacob Brubaker, MD, Marlene Moster, MD, Brian Francis, MD, for the ASCRS Glaucoma Clinical Committee Minimally invasive glaucoma surgery (MIGS) has become a reliable on visual outcomes based on the literature and the experience of standard of care for the treatment of glaucoma when combined the ASCRS Glaucoma Clinical Committee. with cataract surgery. This review describes the MIGS procedures J Cataract Refract Surg 2020; 46:1422–1432 Copyright © 2020 Published currently combined with and without cataract surgery with a focus by Wolters Kluwer on behalf of ASCRS and ESCRS inimally invasive (sometimes referred to as mi- and thereby lower IOP. The endoscope consists of a fiber- croinvasive) glaucoma surgery (MIGS) is a pro- optic camera, light source, and laser aiming beam with an Mcedure that lowers intraocular pressure (IOP) 832 nm diode laser. The endoscope probe is introduced into without significantly altering the tissue, allows for rapid the globe via a limbal corneal or pars plana incision. The visual recovery, is moderately effective, and can be com- anterior approach requires inflation of the ciliary sulcus with bined with cataract surgery in a safe and efficient manner.1,2 an ophthalmic viscosurgical device, whereas the posterior This is in contrast to more conventional glaucoma surgery approach uses a pars plana or anterior chamber irrigation (eg, trabeculectomy or large glaucoma drainage device port. Although the anterior approach can be used in a phakic implantation), which requires conjunctival and scleral eye, it is typically performed with cataract extraction as a incisions as well as suturing.
    [Show full text]
  • Ocular Surface Disease: Supplement April 2018 Accurately Diagnose & Effectively Treat Your Surgical Patients
    Ocular Surface Disease: Supplement April 2018 Accurately Diagnose & Effectively Treat Your Surgical Patients Supported by an unrestricted educational grant from Ocular Surface Disease: Accurately Diagnose & Effectively Treat Your Surgical Patients Prevalence of Ocular Surface Disease and Its Impact on Surgical Outcomes Accurate diagnosis of dry eye disease is critical before cataract or refractive surgery By Elisabeth M. Messmer, MD ry eye is a common disease, but it may remain EPIDEMIOLOGY OF DRY EYE SYNDROME undetected. If it is not treated before cataract or 1-4 refractive surgery, patients may have suboptimal visual AFTER CATARACT SURGERY outcomes from their procedures. D l Very limited data available, mostly small descriptive/ IMPACT ON CATARACT SURGERY non-randomised studies There are a number of triggering factors for dry eye (Figure 1). l 10-20% of patients: DED induced or worsened after Cataract surgery worsens or causes dry eye in approximately uncomplicated cataract surgery 10% to 20% of patients (Figure 2).1-4 l In all studies: Signs and symptoms of dry eye In a study of 136 patients with a mean age of 71 years who increase after surgery were having cataract surgery, 22% had a prior diagnosis of dry eye that was not treated.5 Thirty-one percent complained l In most studies: gradual improvement of signs and of stinging, burning or other symptoms of dry eye when asked symptoms of dry eye within 3 months about their symptoms, and 41% reported a foreign body l In some studies: signs and symptoms persist > 3 months sensation. When the patients were examined, 77% had corneal staining and 50% had central staining.
    [Show full text]
  • Prominent and Regressive Brain Developmental Disorders Associated with Nance-Horan Syndrome
    brain sciences Article Prominent and Regressive Brain Developmental Disorders Associated with Nance-Horan Syndrome Celeste Casto 1,†, Valeria Dipasquale 1,†, Ida Ceravolo 2, Antonella Gambadauro 1, Emanuela Aliberto 3, Karol Galletta 4, Francesca Granata 4, Giorgia Ceravolo 1, Emanuela Falzia 5, Antonella Riva 6 , Gianluca Piccolo 6, Maria Concetta Cutrupi 1, Pasquale Striano 6,7 , Andrea Accogli 7,8, Federico Zara 7,8, Gabriella Di Rosa 9, Eloisa Gitto 10, Elisa Calì 11, Stephanie Efthymiou 11 , Vincenzo Salpietro 6,7,11,*, Henry Houlden 11 and Roberto Chimenz 12 1 Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Unit of Emergency Pediatric, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; [email protected] (C.C.); [email protected] (V.D.); [email protected] (A.G.); [email protected] (G.C.); [email protected] (M.C.C.) 2 Unit of Ophthalmology, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; [email protected] 3 Casa di Cura la Madonnina, Via Quadronno 29, 20122 Milano, Italy; [email protected] 4 Department of Biomedical, Dental Science and Morphological and Functional Images, Neuroradiology Unit, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; [email protected] (K.G.); [email protected] (F.G.) 5 Azienza Ospedaliera di Cosenza, Via San Martino, 87100 Cosenza, Italy; [email protected] 6 Pediatric Neurology and Muscular Diseases Unit,
    [Show full text]
  • Asymmetries of Dark and Bright Negative Afterimages Are Paralleled by Subcortical on and OFF Poststimulus Responses
    1984 • The Journal of Neuroscience, February 22, 2017 • 37(8):1984–1996 Systems/Circuits Asymmetries of Dark and Bright Negative Afterimages Are Paralleled by Subcortical ON and OFF Poststimulus Responses X Hui Li,1,2 X Xu Liu,1,2 X Ian M. Andolina,1 Xiaohong Li,1 Yiliang Lu,1 Lothar Spillmann,3 and Wei Wang1 1Institute of Neuroscience, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China, 2University of Chinese Academy of Sciences, Shanghai 200031, China, and 3Department of Neurology, University of Freiburg, 79085 Freiburg, Germany Humans are more sensitive to luminance decrements than increments, as evidenced by lower thresholds and shorter latencies for dark stimuli. This asymmetry is consistent with results of neurophysiological recordings in dorsal lateral geniculate nucleus (dLGN) and primary visual cortex (V1) of cat and monkey. Specifically, V1 population responses demonstrate that darks elicit higher levels of activation than brights, and the latency of OFF responses in dLGN and V1 is shorter than that of ON responses. The removal of a dark or bright disc often generates the perception of a negative afterimage, and here we ask whether there also exist asymmetries for negative afterimages elicited by dark and bright discs. If so, do the poststimulus responses of subcortical ON and OFF cells parallel such afterimage asymmetries? To test these hypotheses, we performed psychophysical experiments in humans and single-cell/S-potential recordings in cat dLGN. Psychophysically, we found that bright afterimages elicited by luminance decrements are stronger and last longer than dark afterimages elicited by luminance increments of equal sizes.
    [Show full text]
  • Expanding the Phenotypic Spectrum of PAX6 Mutations: from Congenital Cataracts to Nystagmus
    G C A T T A C G G C A T genes Article Expanding the Phenotypic Spectrum of PAX6 Mutations: From Congenital Cataracts to Nystagmus Maria Nieves-Moreno 1,* , Susana Noval 1 , Jesus Peralta 1, María Palomares-Bralo 2 , Angela del Pozo 3 , Sixto Garcia-Miñaur 4, Fernando Santos-Simarro 4 and Elena Vallespin 5 1 Department of Ophthalmology, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] (S.N.); [email protected] (J.P.) 2 Department of Molecular Developmental Disorders, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] 3 Department of Bioinformatics, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] 4 Department of Clinical Genetics, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] (S.G.-M.); [email protected] (F.S.-S.) 5 Department of Molecular Ophthalmology, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] * Correspondence: [email protected] Abstract: Background: Congenital aniridia is a complex ocular disorder, usually associated with severe visual impairment, generally caused by mutations on the PAX6 gene. The clinical phenotype of PAX6 mutations is highly variable, making the genotype–phenotype correlations difficult to establish. Methods: we describe the phenotype of eight patients from seven unrelated families Citation: Nieves-Moreno, M.; Noval, with confirmed mutations in PAX6, and very different clinical manifestations.
    [Show full text]
  • CAUSES, COMPLICATIONS &TREATMENT of A“RED EYE”
    CAUSES, COMPLICATIONS & TREATMENT of a “RED EYE” 8 Most cases of “red eye” seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red eye can also indicate a serious eye condition such as acute angle glaucoma, iritis, keratitis or scleritis. Features such as significant pain, photophobia, reduced visual acuity and a unilateral presentation are “red flags” that a sight-threatening condition may be present. In the absence of specialised eye examination equipment, such as a slit lamp, General Practitioners must rely on identifying these key features to know which patients require referral to an Ophthalmologist for further assessment. Is it conjunctivitis or is it something more Iritis is also known as anterior uveitis; posterior uveitis is serious? inflammation of the choroid (choroiditis). Complications include glaucoma, cataract and macular oedema. The most likely cause of a red eye in patients who present to 4. Scleritis is inflammation of the sclera. This is a very rare general practice is conjunctivitis. However, red eye can also be presentation, usually associated with autoimmune a feature of a more serious eye condition, in which a delay in disease, e.g. rheumatoid arthritis. treatment due to a missed diagnosis can result in permanent 5. Penetrating eye injury or embedded foreign body; red visual loss. In addition, the inappropriate use of antibacterial eye is not always a feature topical eye preparations contributes to antimicrobial 6. Acid or alkali burn to the eye resistance. The patient history will usually identify a penetrating eye injury Most general practice clinics will not have access to specialised or chemical burn to the eye, but further assessment may be equipment for eye examination, e.g.
    [Show full text]
  • Cone Contributions to Signals for Accommodation and the Relationship to Refractive Error
    Vision Research 46 (2006) 3079–3089 www.elsevier.com/locate/visres Cone contributions to signals for accommodation and the relationship to refractive error Frances J. Rucker ¤, Philip B. Kruger Schnurmacher Institute for Vision Research, State University of New York, State College of Optometry, 33 West 42nd Street, New York, NY 10036, USA Received 18 February 2005; received in revised form 7 April 2006 Abstract The accommodation response is sensitive to the chromatic properties of the stimulus, a sensitivity presumed to be related to making use of the longitudinal chromatic aberration of the eye to decode the sign of the defocus. Thus, the relative sensitivity to the long- (L) and middle-wavelength (M) cones may inXuence accommodation and may also be related to an individual’s refractive error. Accommodation was measured continuously while subjects viewed a sine wave grating (2.2 c/d) that had diVerent cone contrast ratios. Seven conditions tested loci that form a circle with equal vector length (0.27) at 0, 22.5, 45, 67.5, 90, 120, 145 deg. An eighth condition produced an empty Weld stimulus (CIE (x,y) co-ordinates (0.4554, 0.3835)). Each of the gratings moved at 0.2 Hz sinusoidally between 1.00 D and 3.00 D for 40 s, while the eVects of longitudinal chromatic aberration were neutralized with an achromatizing lens. Both the mean level of accommo- dation and the gain of the accommodative response, to sinusoidal movements of the stimulus, depended on the relative L and M cone sen- sitivity: Individuals more sensitive to L-cone stimulation showed a higher level of accommodation (p D 0.01; F D 12.05; ANOVA) and dynamic gain was higher for gratings with relatively more L-cone contrast.
    [Show full text]
  • 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.
    [Show full text]
  • Pediatric Pharmacology and Pathology
    7/31/2017 In the next 2 hours……. Pediatric Pharmacology and Pathology . Ocular Medications and Children The content of th is COPE Accredited CE activity was prepared independently by Valerie M. Kattouf O.D. without input from members of the optometric community . Brief review of examination techniques/modifications for children The content and format of this course is presented without commercial bias and does not claim superiority of any commercial product or service . Common Presentations of Pediatric Pathology Valerie M. Kattouf O.D., F.A.A.O. Illinois College of Optometry Chief, Pediatric Binocular Vision Service Associate Professor Ocular Medications & Children Ocular Medications & Children . Pediatric systems differ in: . The rules: – drug excretion – birth 2 years old = 1/2 dose kidney is the main site of drug excretion – 2-3 years old = 2/3 dose diminished 2° renal immaturity – > 3 years old = adult dose – biotransformation liver is organ for drug metabolism Impaired 2° enzyme immaturity . If only 50 % is absorbed may be 10x maximum dosage Punctal Occlusion for 3-4 minutes ↓ systemic absorption by 40% Ocular Medications & Children Ocular Medications & Children . Systemic absorption occurs through….. Ocular Meds with strongest potential for pediatric SE : – Mucous membrane of Nasolacrimal Duct 80% of each gtt passing through NLD system is available for rapid systemic absorption by the nasal mucosa – 10 % Phenylephrine – Conjunctiva – Oropharynx – 2 % Epinephrine – Digestive system (if swallowed) Modified by variation in Gastric pH, delayed gastric emptying & intestinal mobility – 1 % Atropine – Skin (2° overflow from conjunctival sac) Greatest in infants – 2 % Cyclopentalate Blood volume of neonate 1/20 adult Therefore absorbed meds are more concentrated at this age – 1 % Prednisone 1 7/31/2017 Ocular Medications & Children Ocular Medications & Children .
    [Show full text]
  • Congenital Ocular Anomalies in Newborns: a Practical Atlas
    www.jpnim.com Open Access eISSN: 2281-0692 Journal of Pediatric and Neonatal Individualized Medicine 2020;9(2):e090207 doi: 10.7363/090207 Received: 2019 Jul 19; revised: 2019 Jul 23; accepted: 2019 Jul 24; published online: 2020 Sept 04 Mini Atlas Congenital ocular anomalies in newborns: a practical atlas Federico Mecarini1, Vassilios Fanos1,2, Giangiorgio Crisponi1 1Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Cagliari, University of Cagliari, Cagliari, Italy 2Department of Surgery, University of Cagliari, Cagliari, Italy Abstract All newborns should be examined for ocular structural abnormalities, an essential part of the newborn assessment. Early detection of congenital ocular disorders is important to begin appropriate medical or surgical therapy and to prevent visual problems and blindness, which could deeply affect a child’s life. The present review aims to describe the main congenital ocular anomalies in newborns and provide images in order to help the physician in current clinical practice. Keywords Congenital ocular anomalies, newborn, anophthalmia, microphthalmia, aniridia, iris coloboma, glaucoma, blepharoptosis, epibulbar dermoids, eyelid haemangioma, hypertelorism, hypotelorism, ankyloblepharon filiforme adnatum, dacryocystitis, dacryostenosis, blepharophimosis, chemosis, blue sclera, corneal opacity. Corresponding author Federico Mecarini, MD, Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Cagliari, University of Cagliari, Cagliari, Italy; tel.: (+39) 3298343193; e-mail: [email protected].
    [Show full text]