Risk Of Visual Impairment Research Articles

Dépistage précoce des troubles visuels : expérience du service départemental de la Protection maternelle et infantile dans les Hauts-de-Seine

Introduction Early medical examinations performed in 2-, 4-, 9-, and 24-month-olds need to set up a technique adapted to infants and children. The aim of this study was to describe the technique and the results of screening performed by physicians of the Hauts-de-Seine district in 2004. Patients and methods Over 1 year, 17 participating centers of the Maternal and Infant Welfare department of the Hauts-de-Seine district (France) included 1366 children at the 9- and 24-month medical consultation. This standardized procedure looked for personal and family risk factors and sought to detect ocular anomalies, strabismus, and amblyopia. Depending on the results, the patient was oriented toward appropriate care. Results At inclusion, only 10% of the children had already consulted an ophthalmologist with insufficient numbers in the risk groups although the difference between groups was significant. Of the children included, 30.2% had a family history of visual impairment and 7% a personal risk. During the examination, a risk of visual impairment was suspected for 12.5% of the children. At the end of the consultation, 39.7% of the children were oriented to an ophthalmic consultation, with the history or the results of the examination. One of these children out of two underwent a consultation. Finally, 31 children were prescribed corrective glasses compared to only eight wearing glasses initially and 65 children were followed up as opposed to only seven children before the study. Conclusion This screening has led to quadrupling the number of children wearing corrective lenses and monitoring the others presenting visual abnormalities, confirming the advantages of early visual screening for children under 3 years of age.

Low Vision and Blindness Among Midlife and Older Adults

The number of midlife and older adults with visual impairment is expected to double by the mid-2020s. There has been little research on low vision and blindness in the nursing literature to date. Existing studies tended to be qualitative and preliminary in nature and most had small sample sizes. The risk of visual impairment increases with age and is a common comorbidity among the aged chronically ill.

New developments in the management of juvenile idiopathic arthritis-related uveitis

Chronic anterior uveitis is the most important extra-articular complication of juvenile idiopathic arthritis. It is more frequent in the early-onset forms, with a higher prevalence in the oligoarticular subtype, and bilateral in most cases. The risk for visual impairment is still relevant due to sight-threatening complications, such as band keratopathy, cataract, glaucoma and cystoid macular edema. To date, treatment is not standardized and involves a complex decision-making process. Among several steroid-sparing immunosuppressive options, low-dose methotrexate is still the most diffuse treatment. Mycophenolate mofetil is another potential choice, although it is less effective in chronic anterior uveitis than in posterior or intermediate uveitis. TNF-α antagonists, the new generation of agents increasingly frequently used in autoimmune and rheumatic conditions, have demonstrated effectiveness in open-label studies, although no large, randomized, controlled trials have been reported so far. Although inflix...

Les hémangiomes caverneux intra-orbitaires

Cavernous hemangioma is the most frequent primary vascular orbital tumor in adults. This slowly evolving lesion is usually located behind the ocular globe, between the extrinsic muscles. It leads to axial exophthalmia. Surgical treatment is indicated when there is a risk of visual impairment. The prognosis is related to the size of the lesion and its extension. CT scan is rather unspecific, but MRI is highly sensitive and specific in case of progressive painless exophthalmia.

Risk of Visual Impairment in Children with Congenital Toxoplasmic Retinochoroiditis

Risk of Visual Impairment in Children with Congenital Toxoplasmic Retinochoroiditis

Drug-resistant tuberculosis: controversies and challenges in pediatrics

Tuberculosis remains one of the top two causes of death caused by a single infectious disease worldwide, despite curative therapy. Children with tuberculosis are especially difficult to detect, since acid fast bacilli smears and cultures are usually negative and clinical signs are nonspecific or lacking. Multidrug-resistant tuberculosis, or tuberculosis resistant to at least isoniazid and rifampin, has emerged in most areas of the world over the past 20 years. Treatment of multidrug-resistant tuberculosis is more expensive and difficult. The second-line tuberculosis medications required for treatment are more toxic and less efficacious than standard treatment. These medications are not readily available in many areas of the world where drug resistance is most common. Fluoroquinolones are one of the most promising classes of second-line medications, but are not generally recommended for use in children. Ethambutol is recommended in the initial treatment of tuberculosis in children treated in areas where there is a risk of drug-resistant disease and the susceptibility of the source case is not known. Some experts have been hesitant to use ethambutol due to the risk of visual impairment associated with the drug and the difficulties in monitoring vision in young children. Pediatric drug formulations are not available for most antituberculosis medications, even the first-line tuberculosis drugs. Treatment of children exposed, infected or ill with multidrug-resistant tuberculosis is reviewed with special emphasis on second-line drugs, including recommended dosage, available formulations and necessary monitoring. While new cases of multidrug-resistant tuberculosis have decreased in most developed countries over the past 10 years, cases continue to increase in many developing countries and among immigrants from high-risk areas. Tuberculosis and multidrug-resistant tuberculosis are serious threats requiring worldwide strategies to control and treat. Better diagnostic tests, medications, public health strategies and vaccines will all be needed to eliminate tuberculosis.

Incidence of blindness and low vision in a sample population: The Priverno Eye Study, Italy

Purpose To study the incidence of blindness and low vision over a 7-year period. Design Population-based cohort study. Participants The survivors of the original cohort of 860 persons from Priverno, Italy, aged 45 to 69 years, were reexamined. Of the 760 eligible survivors, 619 (81.4%) had a 7-year follow-up visit. Methods Baseline and follow-up examinations included the collection of anamnestic and ophthalmologic data by the same observers using the same methods and classification criteria to minimize sources of variability. Main outcome measures Best-corrected visual acuity (VA) measured at 4 m by standardized logarithmic chart was expressed as the logarithm of the minimum angle of resolution (logMAR). World Health Organization definitions of blindness and low vision were adopted (respectively, VA > 1.3 logMar and VA > 0.6 to 1.3 logMar in the better eye or in either eye). Participants at risk for visual impairment were those without blindness or low vision in one or both eyes at baseline; participants at risk for one-eye visual impairment were those without blindness or low vision in both eyes at baseline. Results A total of 33 participants were defined as incident cases of visual impairment. The overall incidence figures for blindness, low vision, one-eye blindness, and one-eye low vision were respectively 0.2% (95% confidence interval [CI], 0.0–0.9), 1.3% (95% CI, 0.7–2.6), 1.2% (95% CI, 0.6–2.4), and 2.9% (95% CI, 1.8–4.6). Conclusions This study provides population-based estimates of the incidence of visual impairment in an adult, free-living European population. With respect to the younger participants, older subjects at baseline were at higher risk for incident visual impairment, the main causes of which were cataract, myopia, and diabetic retinopathy. The incidence of visual impairment in the subgroup aged 55 to 64 years at baseline was significantly higher than that found in Beaver Dam 5-year study and similar to that found in Beaver Dam 10-year Study, when the same definitions were adopted. This difference may be partially explained by social and cultural habits of the female samples, but many other factors may play a role.

Lowering the risk of visual impairment and blindness

Lowering the risk of visual impairment and blindness

Anterior hyaloidal fibrovascular proliferation

Anterior hyaloidal fibrovascular proliferation was first described in phakic eyes with florid proliferative diabetic retinopathy after standard three-port pars plana vitrectomy. Severe vision-threatening complications of this entity are the development of complicated cataracts, vitreous hemorrhage, traction retinal detachment, ciliary body detachment, and finally phthisis bulbi. It was a recent observation that anterior hyaloidal fibrovascular proliferation can occur after uncomplicated extracapsular cataract extraction with an intraocular lens implant in proliferative diabetic eyes. After cataract surgery the course of the disease process seems to be much less severe; however, there is a risk of visual impairment and it may be useful to detect anterior hyaloidal fibrovascular proliferation early to treat it most effectively. The most important differential diagnosis of anterior hyaloidal fibrovascular proliferation after cataract extraction is rubeosis capsulare. Rubeosis capsulare develops with direct spread from iris neovascularization and thus the distinction between the two entities is made by observing whether the neovascularization is visible on the anterior or posterior surface of the posterior lens capsule.

The five-year incidence of blindness after introducing a screening programme for early detection of treatable diabetic retinopathy.

The incidence of moderate visual impairment and blindness due to diabetic retinopathy was studied 5 years after introducing a screening system for early detection of treatable retinopathy. Photocoagulation was performed in patients with clinically significant macular oedema, severe preproliferative, and proliferative retinopathy. Eighty-eight percent of 470 Type 1 and 88% of 388 Type 2 diabetic patients were still available for follow-up. In the Type 1 group, the five-year incidence of blindness and moderate visual impairment were 0.5% and 1.2%, respectively. Corresponding figures for the Type 2 diabetic patients were 0.6% and 1.7%, respectively. The majority of patients with loss of vision had severe retinopathy at baseline. Among those who entered the screening programme with no or mild retinopathy, loss of vision occurred in only one of the Type 1 and four of the Type 2 diabetic patients. It is concluded that the risk for visual impairment and blindness due to diabetes can be substantially reduced by using programmes for early detection of and effective treatment of diabetic retinopathy.

Visual Evoked Potentials and Visual Prognosis Following Perinatal Asphyxia

Twenty-five children born at term with perinatal asphyxia were studied at age 2.5 to 4.5 years to evaluate visual function and to determine the prognostic value of postnatal assessments of visual outcome. Postnatal assessments included several visual evoked potentials and electroretinograms in the first week of life. Follow-up assessments included flash and pattern visual evoked potentials, visual evoked potential threshold measurements, and clinical eye examinations. Nineteen children had normal visual function, three were visually impaired, and three remained blind. A strong association was found between normal, abnormal, or absent visual evoked potentials in the early postnatal period and long-term visual outcome (P less than .0001). Other perinatal indicators of asphyxia, including neurologic status, Apgar scores, and arterial pH values, were poor predictors of visual outcome. The risk of visual impairment was limited to those survivors with neurodevelopmental deficits.

Pseudotumor Cerebri (Benign Intracranial Hypertension): Etiopathogenesis, Diagnosis, And Management

Pseudotumor Cerebri (Benign Intracranial Hypertension): Etiopathogenesis, Diagnosis, And Management

Polymyalgia rheumatica

PMR is a self-limited syndrome of neck, shoulder, and pelvic girdle myalgias accompanied by a very high erythrocyte sedimentation rate in persons who are otherwise apparently healthy. Such patients may have giant cell arteritis, but the risk of visual impairment is low (15%) unless evidence of temporal (giant cell) arteritis develops, in which case 53% of these patients will have visual problems. Patients with polymyalgia rheumatica should be treated with small doses of corticosteroids (prednisone, 10 mg per 24 hr) unless overt evidence of temporal or cranial (giant cell) arteritis develops. In these cases the initial doses of prednisone should be 40–60 mg per 24 hr.