Eye Care Physicians Research Articles

Occurrence of pigment precipitates after small incision cataract surgery

Purpose: To assess the incidence of pigment precipitates and potential association with glaucoma, diabetes, and/or intraocular lens (IOL) optic center thickness in patients having small incision cataract surgery and foldable IOL implantation.Setting: Eye Care Physicians of Michigan, Jackson, Michigan, USA.Methods: A retrospective data analysis was conducted of patients with a preoperative diagnosis of glaucoma or diabetes or in whom pigment precipitates had been reported after cataract surgery. Group 1 consisted of 23 patients in whom pigment precipitates had been reported and Group 2, 92 patients in whom no precipitates were reported. Two statistical models were used to analyze preoperative, demographic, surgical, and postoperative variables and determine potential correlations. An overall incidence of the occurrence of pigment precipitates was calculated based on the total number of patients with foldable IOLs.Results: The incidence of pigment precipitates was 0.35% (n = 23/6519). Mean time to occurrence was 5.5 months: No between-group differences were found in pathologies or other demographics or postoperative variables. Intraocular lens size and implantation correlated with the occurrence of pigment precipitates.Conclusion: The development of pigment precipitates after foldable IOL implantation did not appear to be affected by the presence of glaucoma or diabetes. Newer, slimmer IOL styles and refined insertion techniques were associated with a lower occurrence of precipitates.s

An anatomic index for the severity of ocular injuries.

Ocular injuries are a frequent cause of monocular blindness and cause disfigurement and discomfort. We developed a measure of severity for eye injuries using a multi-attribute utility (MAU) model. The severity index scoring was applied to eye injuries that presented at hospitals in Wisconsin, U.S.A. The resulting distribution of severities was compatible with that seen by general eye care physicians. A severity scale provides a means of comparing the severity of injuries from a wide variety of traumatic sources (e.g. automobile crashes, combat injuries, occupational accidents, etc.) and is useful in evaluating preventive and public health measurements.

Teaching Ophthalmology in Medical Schools

To the Editor. —In 1989 a questionnaire was sent to the heads of 110 ophthalmology units who are members of the Association of University Professors of Ophthalmology. One hundred eight replies described the status of ophthalmic education in American medical schools. Seven schools had no curriculum in ophthalmology. Most other schools have ophthalmologists who may teach basic science courses, clinical transition courses, and ophthalmoscopy labs and conduct structured rotations for students in their third or fourth years. Curriculum teaching hours vary widely and goals range from teaching students to be primary eye care physicians to teaching them to simply recognize and refer all eye problems. Many of the curricula that do exist have ambitious programs that include large numbers of teachers. Others have only a few devoted faculty members who share their time and patients with interested students. Despite our effort to teach ophthalmology it is likely that only about

Micromachined structures in ophthalmic microsurgery

The revolution in sensing technology, combined with pressing needs for improved health care through the application of new methods and tools, is producing exciting developments in vision care. Artificial retinas realized in three-dimensional integrated circuit technology [1] and synthetic neural networks which distribute signals in optimum order [2] have been reported. We have a dual approach to improve vision care where one effort concentrates upon improving the accuracy and thus dexterity of the microsurgeon through teleoperated manipulators, and the other deals with advanced sensors and transducers which provide increased capabilities and reduced trauma. Development of a three-degree-of-freedom teleoperated surgical device with force-torque sensing using available technology is currently underway. This device is capable of coarse manipulation by man or robot and represents the first design step in down-sizing surgical tools through the use of microdynamical systems manipulators. Specifications for this device have been partially reported elsewhere [3]. We have measured additional parameters and developed specifications which will enable micromachinists to begin work on tools including high-speed cutters, forceps and infusion systems. Eye-care surgical tools are usually single-function devices and are still predominantly hand-formed stainless steel with shaft diameters of approximately 900μm. Typical tool tip displacements range from 200–250 μm with forces felt by the microsurgeon at the tool ranging from 6 to 150 g. We are defining requirements for silicon micromachined tools to realize a 15–20 increase in current performance by locating sensors at more optimum locations to measure down-sized parameters including position, speed, fight intensity, temperature and pressure. To realize these next-generation devices, we are focusing several diverse efforts in the fields of micromachined structures and microrobotics. We report here the current status of development efforts in the following areas: (a) parameters measured in our laboratory and used for specifying device resolution, range of linear and angular actuation, ranges of force and torque sensed and device weight for three-degree-of-freedom (3-DOF) devices; and (b) definition of, and device specifications for, sensors and transducers which represent advances in tooling for microsurgeons with emphasis on eye-care physicians.