Use Of Spectacles Research Articles

Results following secondary intraocular lens implantation in children

Placement of a secondary intraocular lens (IOL) in a child may be considered in children with congenital monocular cataracts who have had complete opacities removed early in life and who later become contact lens intolerant, in eyes that have received trauma which precluded placement of a primary IOL, and in young adults who have bilateral aphakia who become resistant to use of contact lenses or spectacles. Clinical records of all children in our practice who received a secondary IOL between January 1988 and December 1994 were reviewed. Indications, biometry, type of procedures, preoperative and postoperative acuity, refractive error, binocular status, and complications were studied. During the 7-year period, 242 cataract operations were performed. Fifty-nine eyes received a lens implant, and 28 of these were secondary implants. There was a mean interval between the initial cataract operation and the procedure for the secondary implant of 77 months. The mean follow-up was 35 months (range, 3 to 71) for the 28 eyes that received a secondary implant. Two received anterior chamber implants. Eight eyes had insufficient capsular support for an IOL. Six implants were placed in the posterior chamber and required suture fixation to the sclera. Twenty of 28 eyes had a measurable improvement in visual acuity. Only 1 eye had a decrease in visual acuity of 2 lines. Fifteen patients (54%) had a final refraction within 1.50 diopters of the fellow eye, and 75% were within 3.00 diopters. During the follow-up period, 2 eyes developed glaucoma. One had a transient pressure elevation, and the second has required 2 filtration procedures. Three patients required a Nd: YAG capsulotomy. Six patients demonstrated Worth fusion at distance and near, but only 3 patients demonstrated 200 seconds of arc or better stereo acuity. Placement of contemporary-style, secondary intraocular lenses in children and young adults appears to provide a safe and effective alternative for correction of aphakia in children who become contact lens or spectacle-intolerant.

Visual acuity and use of eyeglasses after implantation of a diffractive multifocal lens

The implantation of a diffractive multifocal lens (dMIOL) as alternative to a monofocal lens is justified if after surgery there is practically no need to wear glasses. 31 patients had an implantation of a total of 35 dMIOLs (3M 815 LE). We evaluated the visual acuity, the refractive data and the patients' attitude to wearing glasses. The average age was 67.0 +/- 11.8 years. Follow up took place after 18.7 +/- 5.4 months. The mean value of the uncorrected distance acuity was 0.59 +/- 0.17 and the corrected distance acuity 0.96 +/- 0.13. The uncorrected near acuity amounted to Jg 2.40 +/- 0.94, best distance correction was Jg 1.49 +/- 0.55. The patients still accepted an average of 0.68 +/- 0.37 dpt for the best near correction (near vision over the diffractive near focus) and thus achieved Jg 1.46 +/- 0.55. At the best distance correction plus 3.5 dpt, the near visual acuity was improved to 1.03 +/- 0.17. 54.8% of the patients indicated that they did not use glasses at all. 32.3% stated that they only used glasses for reading. 9.7% wore bifocals all the time, and 3.2% always used glasses for the distance. Regarding distance vision, the dMIOL is equivalent to monofocal lenses. Without any correction the results of the dMIOLs for the near vision are superior to monofocal lenses. Glasses can be dispensed with if the uncorrected visual acuity of the operated eye is at least 0.6 Jg 2-3 after surgery and the other eye too, does not need any correction. In case the postoperative visual acuity is worse, good visual acuity of the other eye may render glasses unnecessary. Part of the patients put up with a correctable loss of visual acuity in order not to become dependent on glasses. The need to wear glasses may be decreased considerably by implanting a dMIOL in both eyes and by avoiding postoperative refraction errors.

Quantitative Videographic Analysis of Blinking in Normal Subjects and Patients With Dry Eye

To study patterns of eye blinking in normal subjects and patients with dry eye. We developed an automated, noninvasive blink monitor that permits quantitative analysis of 6 parameters of blinking. We used this method under normal conditions and then examined the effects on the patterns of blinking in patients with dry eye; several steps in this method were designed to exacerbate or ameliorate ocular surface desiccation. The mean (+/-SD), maximum, and coefficient of variation of the interblinking time in normal subjects and patients with dry eye were 4.0 +/- 2.0 and 1.5 +/- 0.9 seconds, 8.9 +/- 4.0 and 4.2 +/- 2.4 seconds, and 55% +/- 21% and 65% +/- 24%, respectively. Those values for the blinking time were 0.20 +/- 0.04 and 0.27 +/- 0.16 seconds, 0.35 +/- 0.12 and 0.99 +/- 1.30 seconds, and 23% +/- 9% and 46% +/- 34%, respectively. The use of artificial tears or spectacles with moist panels and moist inserts tended to normalize the patterns of blinking in the patients with dry eye, whereas exposure to wind made them more abnormal. Our technique permitted a rigorous analysis of blinking that was previously unavailable. We have shown that local ocular surface conditions alone can significantly affect patterns of blinking. This method should be applicable to studying psychologic and any other factors that may influence blinking.

Comparison of a diffractive bifocal and a monofocal intraocular lens

Purpose: To compare a Pharmacia diffractive bifocal intraocular lens (IOL) with a monofocal lens of the same design without the diffractive grating.Setting:. Multicenter study.Methods: This randomized, prospective study comprised 70 patients with a monofocal IOL and 79 with a diffractive bifocal IOL. Follow-up was 5 to 6 months. Near and distance visual acuities, contrast sensitivity, patient satisfaction, and spectacle use were evaluated.Results: All patients achieved a best corrected visual acuity of 0.5 or better; 80% in the monofocal and 71 % in the bifocal group had a best corrected visual acuity of 1.0 or better. Without correction, 93% of the bifocal and 9% of the monofocal group could read J3 or better. With distance correction, 99% and 4%, respectively, could read J3 or better. Contrast sensitivity was slightly lower in the bifocal group at distance and near for all spatial frequencies. In the bifocal group, 46% never used spectacles for near tasks. Overall satisfaction was rated good by 86% of the monofocal and 85% of the bifocal group.Conclusions: The diffractive bifocal IOL performed well at distance and near. Patients who no longer require spectacles will benefit significantly from a bifocal IOL, but many with a bifocal IOL in one eye will require spectacles for the fellow eye.

Fixation Switch Diplopia

Objective: To present guidelines for the diagnosis and management of switch Background: Adults with a history of strabismus since childhood may experience acquired diplopia if a change in their refractive error or use of spectacles encourages with their nondominant eye. This is referred to as fixation switch diplopia. If correctly diagnosed, this seldom-recognized cause of acquired diplopia in adults can almost always be successfully treated with the proper optical management. Patients: A retrospective review was carried out for all patients with the diagnosis of switch diplopia who were seen in my private practice. Results: A review of patient records identified 16 patients with switch In four patients, the switch in was spontaneous owing to the development of myopia in the previously preferred eye in patients with mild contralateral amblyopia. Six patients developed diplopia owing to their monovision (one eye optically corrected for distance and the other eye presbyopic). In six patients, switch diplopia occurred because a noncycloplegic subjective refraction was performed in the presence of amblyopia, resulting in an unbalanced refractive correction. In all 16 patients, symptoms were eliminated when proper optical correction was instituted to encourage with the dominant eye. Conclusions: Fixation switch diplopia is a cause of acquired diplopia in adults with a history of strabismus since childhood. It can usually be successfully treated with proper optical management.

Prevalence of spectacle and contact lens wear in the UK fire service

Despite the fact that firefighting has been shown to be a visually demanding occupation, the present visual standards for firefighters prohibit the use of spectacles or contact lenses operationally. To determine the proportion of the UK fire service currently using spectacles and contact lenses, and how many may benefit from optical correction, a questionnaire was distributed. This contained 30 questions and was sent to 1550 firefighters. The data from 1064 returned questionnaires have been analysed. The results show that approximately 20% of those serving in the fire service have used an optical correction at some time in their lives. When not working, approximately 6% of firefighters wear spectacles for distance vision and 15% wear them for reading. Only 0.4% of firefighters use contact lenses. Half of this contact lens wearing group use their lenses while on operational duty. In total, approximately 2% of firefighters use an optical correction for operational duties. The results indicate that a high visual standard at the time of entry into an occupation cannot guarantee good vision throughout an individual's career. In addition, an estimated 11,000 firefighters in the UK, who have spectacles or contact lenses, do not use them for operational duties. The present visual standards prevent this group of firefighters from obtaining their optimal visual performance at work.

Prevalence of spectacle and contact lens wear in the UK fire service

Despite the fact that firefighting has been shown to be a visually demanding occupation, the present visual standards for firefighters prohibit the use of spectacles or contact lenses operationally. To determine the proportion of the UK fire service currently using spectacles and contact lenses, and how many may benefit from optical correction, a questionnaire was distributed. This contained 30 questions and was sent to 1550 firefighters. The data from 1064 returned questionnaires have been analysed. The results show that approximately 20% of those serving in the fire service have used an optical correction at some time in their lives. When not working, approximately 6% of firefighters wear spectacles for distance vision and 15% wear them for reading. Only 0.4% of firefighters use contact lenses. Half of this contact lens wearing group use their lenses while on operational duty. In total, approximately 2% of firefighters use an optical correction for operational duties. The results indicate that a high visual standard at the time of entry into an occupation cannot guarantee good vision throughout an individual's career. In addition, an estimated 11 000 firefighters in the UK, who have spectacles or contact lenses, do not use them for operational duties. The present visual standards prevent this group of firefighters from obtaining their optimal visual performance at work.

Clinical evaluation of a five-zone refractive multifocal intraocular lens

Purpose: To evaluate the clinical performance of a five-zone refractive multifocal intraocular lens (AMO, model MPC-25NB, Array®).Methods: We performed a retrospective clinical trial of 31 cataract patients (mean age 64.3 years). The parameters studied were intraoperative and postoperative complications, distance and near visual acuity, spectacle use, decreased number of corneal endothelial cells, contrast sensitivity, percentage of glare disability, near binocular vision, and depth of focus.Results: Intraoperatively, iris damage occurred in two eyes (4.2%), vitreous loss in one eye (2.1 %), and consecutive rupture of Zinn's zonule and vitreous in one eye (2.1 %). Postoperatively, posterior capsule opacification was observed in two eyes (4.2%), temporary intraocular pressure increase in one eye (2.1 %), and cystoid macular edema in one eye (2.1%). Uncorrected distance visual acuity of 20/40 or better was achieved by 34 of 37 eyes (91.9%) with less than 1.5 diopters of preoperative keratometric astigmatism; best corrected distance acuity of 20/20 or better was achieved by 41 of 45 eyes (91.1 %). Near visual acuity with distance correction of 20/40 or better was achieved by 29 of 43 eyes (67.4%). These data were compared retrospectively with data from control patients who received monofocal lenses, and no significant differences in the decreased number of corneal endothelial cells were found. Mean contrast sensitivities were within normal range for all spatial frequencies. Percentage of glare disability and near binocular vision were within normal limits.Conclusions: Eyes implanted with the five-zone refractive multifocal lens showed better near visual acuity than control eyes and compared favorably in other aspects of visual function, indicating that these lenses are effective and safe.

Biosocial variables and auditory acuity as risk factors for non-fatal childhood injuries in Greece.

To examine whether biosocial variables and auditory acuity are risk factors for injuries among children. Children with injuries who presented at the emergency clinics of one of the two university hospitals for children in Athens, Greece between December 1993 and April 1994. 144 children aged 5-14 years, residents of Athens, were brought to the emergency clinics for a moderate to severe injury. For each of these children one hospital control, matched for age and sex, and one classmate control similarly matched were identified. A standard interview form was completed for all 432 children and acouometric and tympanometric examinations were performed in each of them. Analysis was done through conditional logistic regression. The likelihood of an accident was higher in children of younger fathers (odds ratio (OR) = 0.7, p = 0.04), children of mothers with non-professional jobs (OR = 1.9, p = 0.03) as well as in children of higher birth order (OR = 1.7, p = 0.01), in those with predominantly other than parental daily supervision (OR = 2.6, p = 0.001), and those with a history of previous accident (OR = 1.3, p = 0.002). Somatometric factors, school performance, use of corrective eyeglasses and subnormal auditory acuity were not found to be risk factors, but auditory imbalance and abnormal tympanograms were positively related to the risk of childhood injury (OR = 2.6, p = 0.02; and OR = 2.3, p = 0.08 respectively). the findings of this study underline the importance of attentive supervision and safety training of children living in modern cities; they also suggest that children with auditory imbalance and history of an accident are at higher injury risk and they should be targeted with specific intervention programs.

Musculoskeletal disorders among visual display terminal workers: individual, ergonomic, and work organizational factors.

A number of individual, ergonomic, and organizational factors of presumed importance for the occurrence of musculoskeletal disorders were investigated in a group of 260 visual display terminal (VDT) workers. The cross-sectional study utilized medical and workplace investigations as well as questionnaires. The results were subjected to a multivariate analysis in order to find the major factors associated with various upper-body muscular problems. Several such factors were identified for each investigated type of musculoskeletal problem. Some were related to the individual: age, gender, woman with children at home, use of spectacles, smoking, stomach-related stress reactions, and negative affectivity. Organizational variables of importance were opportunities for flexible rest breaks, extreme peer contacts, task flexibility, and overtime. Identified ergonomic variables were static work posture, hand position, use of lower arm support, repeated work movements, and keyboard or VDT vertical position.

Eye discomfort and work with visual display terminals.

The aim of this study was to investigate the relationships between eye discomfort symptoms and work with visual display terminals among routine office workers. Three hundred and twenty-seven office workers and their work stations were investigated by means of questionnaires and worksite investigations. The data were subjected to multivariate logistic regression analyses. The occurrence of eye discomfort increased as the extent of VDT work increased, as did the specific symptoms of sensitivity to light and smarting, gritting feeling, or redness. The use of spectacles during visual display terminal work, age, stomach stress reaction, distances between the eye and different visual task objects, as well as the vertical position of the terminal also influenced certain symptoms. Having (i) the terminal at about eye level during prolonged terminal work, (ii) using monofocal glasses during terminal work in situations with large distance variations to visual task objects, or (iii) being elderly with prolonged terminal work and reporting stomach stress all led to increased odds ratios for certain eye discomfort symptoms. The use of a visual display terminal in routine office work is associated with an increased occurrence of certain eye discomfort symptoms. This association is affected also by the presence of certain other individual and ergonomic factors.

The incidence and prevention of ocular injuries in orthodontic practice.

A postal survey was conducted to determine the use of eye protection and incidence of ocular trauma in orthodontic practice. One-hundred-and-fifty-nine NHS orthodontic consultants and 203 specialist orthodontic practitioners were surveyed. Two-hundred-and-forty-one (66.5 per cent) replies were received. Some form of eye protection was routinely worn by 66.8 per cent of orthodontists, 64.3 per cent of patients, but only 33.6 per cent of DSAs. Eye protection was not offered to DSAs in 31.9 per cent of practices or to patients in 22.1 per cent. Forty-three per cent of orthodontists reported instances of ocular injury in their practices. The majority of these injuries (n = 104) occurred during debonding or trimming acrylic. Other incidents involved ligating materials, intra-oral polishing, and acid etching. Most injuries (83.5 per cent) were treated in the surgery without any long-term effects. The routine use of goggles or spectacles with side-pieces and plastic lenses, which conform to British Standard BS 2092, is recommended for staff and patients during all operative procedures in orthodontic practice.

Excimer laser photorefractive keratectomy: 12 months' follow‐up

To report the results of 12 months' follow-up of patients with myopia treated with excimer laser photorefractive keratectomy. A prospective study of patients undergoing excimer laser photorefractive keratectomy for myopia was commenced in September 1991. The study included 50 eyes (38 patients) with preoperative myopia of -1.50 to -6.00 dioptres and a maximum astigmatism of 0.75 dioptres. Forty-six (92%) of the 50 eyes had an uncorrected acuity of 6/6 or better at 12 months, and 49 eyes (98%) had 6/12 or better. No patients had lost their best corrected acuity at 12 months. Forty-five eyes (90%) were within 0.50 dioptres of emmetropia and 47 eyes (94%) were within 1.00 dioptre of emmetropia. Excimer laser photorefractive keratectomy is a safe and predictable procedure for low to moderate myopia. It will increasingly be offered to patients as an alternative to the use of spectacles and contact lenses.

Multifocal and bifocal implants.

Removal of cataract with intraocular lens implantation has been a well-accepted treatment for the past two decades. The development of monofocal intraocular lens technology has represented a significant advance over earlier treatments of cataract and, since the advent of widespread implantation of these lenses, most patients with cataract can achieve good postsurgical vision with the use of bifocal spectacles.

Myopia and Cataract-Reply

In Reply. —We appreciate the interest raised by our article. Liu et al cite our findings of an association between gout medications and mixed cataract, and summarize their previously reported findings among 53 patients using allopurinol. In our study, the use of any type of gout medication was investigated. Such use was found to be related to mixed cataract, our largest case group, but our results do not exclude associations of gout medications with individual cataract types. Dr Johnson comments on possible mechanisms to explain our finding of an association between use of eyeglasses before age 20 years and mixed cataract. Although our study obtained data on use of sunglasses, as suggested by Dr Johnson, no significant relationships with cataract were found. We agree with him that analyses exploring associations of risk factors with mixed cataract subgroups are of interest. Such analyses are ongoing and will be included in a

Myopia and Cataract

To the Editor. —While controversy swirled over the association between exposure to the short-wavelength region of sunlight (UVB, 290 to 320 nm) and increased risk of cataract, I smugly assumed that my lifelong use of eyeglasses for correction of myopia protected my lenses from this damaging radiation. This assumption was based on the fact that glass absorbs UVB radiation. Now Leske et al 1 suggest that myopia, as indicated by eyeglass use before age 20 years, is associated with increased risk of mixed cataract. They specified the composition of their mixed group in terms of the four permutations of posterior subcapsular, cortical, and nuclear cataracts. Each subgroup contained 91 or more subjects, and I wonder if individual risk assessments were performed. Small subgroup size may obscure the assessment of risk. On the other hand, if risk were concentrated in one or two subgroups, association with eyeglass use may be significant.

The Erotic Travelogue: The Scopophilic Pleasure of Race vs. Gender

JUDITH ROOF The Erotic Travelogue: The Scopophilic Pleasure of Race vs. Gender Let me commence with an overview of our trip. We begin our journey in one of the Parisian brothels desciibed by Ana'is Nin in the Delta of Venus. The brothel is just like home, the safe place of norisk exotic simulation; it is a secure theatre where one pays to watch the burlesque, the striptease, the parade of the deformed, and the humiliation , cruelty, and death of others.1 The point of homogeneity and imagined difference, the btothel is the control center of our excess like the "house of illusions" in Genet's The Balcony. Like Madame Irma, we watch and understand the desire for power implicit in our scopophilia. Continuing our journey with Nin's erotica and the film Emmanuelle, we will next arrive at exotic ports where, with the ptivilege accorded camera-laden tourists, we will continue out hazaidless confrontation with racial, ethnic, and sexual difference. In the threatening illusion of heterogeneity produced by our voluntaiy but controlled immersion in foreign cultures, we will ask why erotica often takes the form of a travelogue , why stories of travel are erotic, and how travel, like the brothel, is a form of safe scopophilia that neatly distances, objectifies, and colonizes the multiple sexual, racial, and ethnic differences regularly constructed as the sexual other in soft-core pornography. On the next leg of out journey, we will withdraw from immediate contact with indigenous cultures to the brothel-like safety of our colonizer 's homes where we can enjoy watching the erotics of the exotic as they, under our direction and scrutiny, vigorously reassert our own noArizona Quarterly Volume 47 Number 4, Winter 1991 Copyright © 1991 by Arizona Board of Regents issn 0004- 1610 Judith Roof tions of sexual difference among themselves. In this new theatre of homological difference, we will explore how watching the colonized other perform our own sad reiterations of sexual dominance enables the voyaging scopophile to dismiss the threat of all differences as they dissolve into the comforting habitual management of a heterosexual imperialism. But all is not well on the next part of the trip as we invariably encounter violence abroad, a violence appended to the process of domesticating multiple differences. Still following Nin and Emmanuelle, we discover, near the end of our trip, that our voyeurism becomes a scopophilia of sadism. At this climactic point, we watch as a controlling Western white male turns native males into sadistic enforcers of a heterosexual hegemony. We will investigate how this scopophilia of the theatre of sadism evinces an insecurity about power in the face of too many insistently un-neutralized differences. We will query why overt violence arises at this point in the story—why the drastic end ofconflict with differences results in punishment—in a violent reappropriation of the other for the self. We will end our trip back in the becalmed erotics of a smugly selfsatisfied domestication, the end product of a pornographic commodification of violence. We'll go back to the boudoir, to our self-secured seat in the theatre of pleasure where the dominant eye might just as easily turn on us. THE BROTHEL/THEATRE Anaïs Nin's collection of erotica, the Delta of Venus, begins, perceptively , in a bordello-like Peruvian theatre, where the Brazilian temptress Anita seduces a charismatically attractive Hungarian baron. The most desired performer in the show, Anita is an exotic dancer whose oversized organs, beauty, and provocativeness stir male spectators into a frenzy, especially when, after her stage dance, she performs fellatio on the members of the audience. Commencing with this performative matrix , Nin's collection of stories sets forth the literal connection between theatre and brothel—among staged spectacle, licensed voyeurism, the commodification of sexual display, and the voyeur's investment in sexual self-reification. But Nin's stories, which are in many ways a metadiscourse of pornography, emphasize an additional but crucial element The Erotic Travelogue in the erotic mix: an understanding of the sexual spectacle's use of multiple, exotic differences. Nin characteristically recites lists ofracial, sexual, anatomical, and ethnic distinctions—skin color, language, class, national origin; the size, color, and configuration...

Should eye protection be worn when performing necropsies?

One hundred necropsies were performed by four junior pathologists wearing safety spectacles. The number of blood splashes on the spectacle surfaces were counted after each necropsy. Splashes were found after 22 necropsies (range 10-34%), with higher numbers being seen among the more junior grades of pathologist. This suggests that the use of safety spectacles should be considered by all pathologists performing necropsies.

Acanthoma fissuratum

Acanthoma fissuratum secondary to the use of spectacles is a rare clinical finding associated with an ill-fitting frame. An interesting case is presented to highlight such a problem. Surgical excision of such lesions is recommended with advice to the patient regarding the suitable fitting of spectacles.

The Lens Opacities Case-Control Study

The Lens Opacities Case-Control Study evaluated risk factors for age-related nuclear, cortical, posterior subcapsular, and mixed cataracts. The 1380 participants were ophthalmology outpatients, aged 40 to 79 years, classified into the following groups: posterior subcapsular only, 72 patients; nuclear only, 137 patients; cortical only, 290 patients; mixed cataract, 446 patients; and controls, 435 patients. In polychotomous logistic regression analyses, low education increased risk (odds ratio [OR] = 1.46) and regular use of multivitamin supplements decreased risk (OR = 0.63) for all cataract types. Dietary intake of riboflavin, vitamins C, E, and carotene, which have antioxidant potential, was protective for cortical, nuclear, and mixed cataract; intake of niacin, thiamine, and iron also decreased risk. Similar results were found in analyses that combined the antioxidant vitamins (OR = 0.40) or considered the individual nutrients (OR = 0.48 to 0.56). Diabetes increased risk of posterior subcapsular, cortical, and mixed cataracts (OR = 1.56). Oral steroid therapy increased posterior subcapsular cataract risk (OR = 5.83). Females (OR = 1.51) and nonwhites (OR = 2.03) were at increased risk only for cortical cataract. Risk factors for nuclear cataract were a nonprofessional occupation (OR = 1.96), current smoking (OR = 1.68), body mass index (OR = 0.76), and occupational exposure to sunlight (OR = 0.61). Gout medications (OR = 2.48), family history (OR = 1.52), and use of eyeglasses by age 20 years, which is an indicator of myopia (OR = 1.44), increased risk of mixed cataract. The results support a role for the nutritional, medical, personal, and other factors in cataractogenesis. The potentially modifiable factors suggested by this study merit further evaluation.