Hospital Ophthalmology Clinic Research Articles

Perceptions of blindness related to smoking: a hospital-based cross-sectional study

Smoking is associated with several serious eye diseases. Awareness of smoking and blindness, and its potential to act, as a stimulus to assist stopping smoking has not been investigated. A cross-sectional survey using a structured interview of adult patients attending district general hospital ophthalmology, general surgery, and orthopaedic clinics. The interview investigated the awareness and fear of blindness for three established smoking-related diseases, and a distractor condition (deafness), and the likelihood that smokers would quit on developing early signs of each condition. Response was 89.1% (358/402). In all, 183 (51.1%) of responders were male and 175 (48.9%) female. Only 9.5% of patients believed that smoking was definitely or probably a cause of blindness, compared with 92.2% for lung cancer, 87.6% for heart disease, and 70.6% for stroke. Patients ranked their fear of each of the five conditions, scoring five for the most feared and one for the least feared. Patients were significantly (P<0.01) less fearful of blindness (mean score 2.80) than lung cancer (3.89), heart disease (3.58), and stroke (3.35). About one-half of smokers stated that they would definitely or probably quit smoking if they developed early signs of blindness or the three established smoking-related conditions, with no significant differences in proportions for these four conditions. The findings suggest that awareness of the risk of blindness from smoking is low, but that the fear of blindness is as compelling a motivation to quit as fear of lung cancer, heart disease, and stroke. The link between smoking and eye disease should be publicised to help reduce smoking prevalence.

A retrospective review of the associations between amblyopia type, patient age, treatment compliance and referral patterns.

To review presenting ages, referral sources, amblyopia type and treatment compliance in children attending a typical public hospital ophthalmology clinic with no formal amblyopia screening program in place. One hundred and twenty-seven children attending the outpatients clinics of The Children's Hospital at Westmead for amblyopia management between January 2001 and May 2003 were reviewed. Presenting age, amblyopia type, referral source, treatment prescribed and compliance achieved were analysed using means, 95% confidence intervals (CI), and Mantel-Haenszel chi2 statistic. General practitioners and paediatricians provided most referrals. The mean presenting age was 32.9 (95% CI 29.0-36.9) months. There was no significant association between presenting age and amblyopia type (chi2 = 6.00, P = 0.11, d.f. = 3), but a trend was found with deprivation amblyopia identified earliest, and pure anisometropic amblyopia identified latest (chi2 = 5.65, P = 0.02, d.f. = 1). Compliance to patching did not differ significantly between sexes, with calculated aggregate compliance of 67.3% (95% CI: 59-75%) for boys and 66.3% (95% CI: 60-73%) for girls. Compliance to patching also did not differ significantly between amblyopia types (chi2 = 3.61, P = 0.3, d.f. = 3). Compliance was best among younger and older children, and worst among those aged 15-30 months. There was no association between patching compliance and treatment duration. Amblyopia is a preventable form of blindness. A multidisciplinary approach must be taken. Resources and education should be targeted at general practitioners and paediatricians who have the greatest opportunities to perform amblyopia screening. Teachers are an important resource in identifying cases missed at previous informal screening opportunities. Amblyopia treatment must be intensified and individualized between the ages of 15-30 months when compliance is poorest.

Consanguineous marriage resulting in homozygous occurrence of X-linked retinoschisis in girls

Purpose To investigate a family afflicted with X-linked retinoschisis and to determine the pedigree leading to such an occurrence. Design Observational case series. Methods Visual acuities were measured at The Aga Khan University Hospital Ophthalmology clinic. Slit-lamp examination, direct and indirect ophthalmoscopies were performed on each of the seven members of this family. The pedigree was established by appropriate questioning about the rest of their family. Results The pedigree revealed the homozygosity of the four daughters for the XLRS mutations borne out of the consanguineous marriage between an affected father and a carrier mother. Conclusions This is the first report showing that consanguineous marriages lead to homozygous pairing of XLRS genes in female children, as concluded after a MEDLINE search.

The Decreasing Prevalence of Uveitis Associated with Juvenile Rheumatoid Arthritis

We studied the prevalence and characteristics of chronic uveitis in a population of children diagnosed with juvenile rheumatoid arthritis (JRA). Uveitis is one of the most important, potentially debilitating extra-articular manifestations of JRA and has been observed in as many as 20% of cases. The medical records of 230 patients diagnosed with JRA and treated at a tertiary care hospital ophthalmology clinic between 1992 and 2000 were retrospectively reviewed. Seventeen patients (7.4%) were found to have clinical features of uveitis. There was a preponderance of female patients (16/17) and pauciarticular disease (13/17). Only 12 of 17 were ANA positive. Six had uveitis at diagnosis. Patients who were receiving naproxen had less incidence of uveitis compared with those receiving other nonsteroidal antiinflammatory drugs. Despite a relatively low prevalence of uveitis, complications occurred in about 24% (4/17) of the patients, even with adequate treatment and close monitoring. The prevalence of uveitis in JRA seems to be decreasing and may be secondary to the increased use of naproxen. However, routine ophthalmologic screening should be continued in patients with JRA to avoid potential complications of chronic uveitis.

Efficacy of Latanoprost Additive Therapy on Uncontrolled Glaucoma

Purpose: To assess the efficacy of latanoprost as additive therapy in patients with open-angle glaucoma and an intraocular pressure (IOP) deemed to be too high on maximum tolerated medical therapy. Study Design: Prospective case series. Methods: Consecutive patients with open-angle glaucoma, presenting to the Gulhane Military Medical Hospital Ophthalmology Clinic from May 1999 to September 2000 were enrolled. The effect of latanoprost on IOP was followed during a period of 12 months. The criterion for success was defined as having an IOP reduction of at least 20% from baseline or a final IOP of less than 22 mm Hg. Several clinical pretreatment variables (age, gender, ocular laterality, type of glaucoma, number of antiglaucomatous medications at study entry, pretreatment IOP) were analyzed for a significant effect on the efficacy of latanoprost additive therapy. Main Outcome Measure: IOP. Results: Sixty-five eyes of 35 patients were included. The mean baseline IOP ± SD was 23.3 ± 2.0 mm Hg. Two patients (5.71%) developed ocular allergy in the first month requiring cessation of latanoprost. In the remaining 61 eyes of 33 patients, IOP was significantly reduced compared with baseline measurements with a mean IOP reduction of 6.1 ± 1.8 (26.1%), 6.0 ± 2.2 (25.3%) and 5.5 ± 2.4 (23.2%) mm Hg at the 1-, 3- and 6-month follow-up controls, respectively (p < 0.001). Successful outcome was obtained in 50 (76.9%), 46 (70.7%) and 38 (58.4%) of 65 eyes at the 1-, 3- and 6-month visits, respectively. During the period from 6 to 12 months, 28 eyes underwent either a combined procedure (cataract extraction + intraocular lens implantation + trabeculectomy; 8 eyes) or only trabeculectomy (20 eyes) because of uncontrolled IOP; 4 eyes underwent the combined procedure because of visually significant cataract, and 8 eyes were lost to follow-up. Sixteen out of 21 eyes followed for more than 12 months with the same medications continued to have a successful outcome, and the mean IOP of 18.8 ± 3.7 mm Hg was significantly different from baseline (p < 0.001). None of the pretreatment variables was a significant prognostic factor for failure of latanoprost additive therapy. Conclusion: This study supports the use of latanoprost additive therapy in patients with elevated IOP already receiving maximum-tolerated medical therapy.

Demographic and clinical characteristics of patients with diabetes presenting to an urban public hospital ophthalmology clinic

Objective This study aims to describe the clinical and sociodemographic characteristics of patients with diabetes who are newly presenting to an inner city public hospital eye clinic. This study also aims to determine the prevalence and severity of ocular morbidity in this population at time of presentation and to assess the adequacy of the ophthalmic surveillance to which this population was exposed before presentation. Design A clinic-based, cross-sectional study. Participants A total of 118 consecutive patients with diabetes participated. Method During a 2-month interval, all patients with diabetes newly presenting to the Los Angeles County King-Drew Medical Center eye clinic were recruited who were at risk for diabetic eye complications according to American Diabetes Association criteria. Each patient underwent a standardized interviewer-administered questionnaire and a comprehensive ophthalmic examination. Results Of the 118 patients, 65 (55%) were Hispanic and 51 (43%) were African American. Forty-six percent had a grade school education or less, 91% were unemployed, and 64% had no health insurance. Type two diabetes was predominant (91%), including 24 (22%) of new onset. Thirty-six patients with diabetes (31%) reported duration of diabetes greater than 10 years at time of presentation. At time of presentation, 62% had clinically apparent ophthalmic disease, whereas 40% had advanced ocular disease, including 6.8% of the sample that were legally blind. Sixty-nine patients (58.5%) reported never having had a dilated fundus examination, whereas 31 (63%) of the 49 patients reporting a previous dilated examination were last examined more than 2 years before presentation. Timing of ophthalmic examination was classified as appropriate for 38 patients (32%), marginal for 20 patients (17%), and inappropriate for 60 patients (51%). Conclusion In the setting of an inner city county hospital eye clinic, where the patient population is predominately minority and of low socioeconomic status, ophthalmic surveillance of high-risk patients with diabetes is inadequate and advanced disease often is present at initial presentation. Strategies must be developed to increase the routine use of eye services within this population.

Motion perimetry identifies nerve fiber bundlelike defects in ocular hypertension.

To determine whether patients with ocular hypertension (OHT) have elevated motion perimetry thresholds. Motion perimetry uses a customized computer graphics program to detect the ability to identify a coherent shift in position of 50% of dots in a defined circular area against a background of fixed dots. Motion size threshold is defined as the smallest circular area in which dot motion is detected. Subjects respond by touching the area of the computer monitor with a light pen where motion stimuli are perceived. Reaction times (milliseconds) to stimuli and localization error (number of pixels from target center) are also obtained for each trial. University hospital ophthalmology clinic. Twenty-seven patients with OHT and 27 age-matched normal subjects. One eye was tested in each subject. Random dot motion stimuli size thresholds and total deviation probability plot data, reaction times, and spatial localization errors. The patients with OHT had more abnormal test points in the total deviation probability plot analysis compared with the controls (P < .001, chi 2). The abnormal test points were concentrated in the superior and inferior nasal regions. Six subjects had nerve fiber bundlelike defects to motion stimuli. Six subjects (5 overlapping with the probability plot analysis) had abnormal glaucoma hemifield test results. The patients with OHT also had significantly greater localization errors. Motion threshold perimetry may be a more sensitive method to detect visual field abnormalities in OHT than conventional automated perimetry.

Spontaneous Ulcerative Keratitis in Immunocompromised Patients

We studied the occurrence of ulcerative keratitis in five eyes of four patients who were examined at the University of Maryland Hospital ophthalmology clinic over a 12-month period. All were young women who were intravenous drug abusers, with no known predisposing factors for ulcerative keratitis. Two patients had acquired immunodeficiency syndrome (AIDS), one was human immunodeficiency virus (HIV)-positive, and the fourth refused HIV testing. One had a corneoscleral limbus to corneoscleral limbus keratitis; three had inferiorly located corneal ulcers (bilateral in one patient with AIDS). Corneal cultures disclosed Capnocytophaga species in the corneoscleral limbus to corneoscleral limbus keratitis. The remaining ulcers were polymicrobial; cultures of three grew Candida albicans, cultures of two grew alpha-hemolytic streptococci, cultures of two grew Staphylococcus aureus, and culture of one grew Pseudomonas aeruginosa. Treatment with topical fortified antibiotics and antifungal agents resulted in complete healing in all four inferiorly located ulcers. The corneal ulcer became perforated and the eye was eviscerated. Histopathologic analysis of the eviscerated specimen disclosed acute keratitis with necrosis and no microorganisms.

Meningioma of the maxillary sinus.

Extracranial meningiomas are described as being relatively rare, with the majority arising from the meningeal layers of the optic nerve in the orbit.¹ A review of the English literature revealed reports of lesions occurring in the frontal and posterior ethmoid sinuses, but most likely as local extensions from an intracranial source. There has been 1 case only reported of primary meningioma occurring in the maxillary sinus.¹ <h3>Report of a Case</h3> In July, 1961, a 53-year-old white male factory worker consulted the Rhode Island Hospital Ophthalmology Clinic with a 2 year history of progressive, painless obstruction of the right nostril and an 8 month painless, nonpulsatile, outward and upward protrusion of the right eye combined with constant lacrimation. There had been no weight loss, epistaxis, or headache. He noted only occasional episodes of diplopia, but did admit to some recent blurring of vision. Examination revealed proptosis with a visual