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- Mönestam, Eva, et al.
(författare)
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Impact of cataract surgery on the visual ability of the very old
- 2004
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Ingår i: American Journal of Ophthalmology. - : Elsevier. - 0002-9394 .- 1879-1891. ; 137:1, s. 145-155
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To compare the functional outcome of cataract surgery in terms of visual ability between patients ages younger than 84 years, 85 to 89 years, and 90+ years. Survival time will be estimated at 4 years. DESIGN: Population-based, observational case series. METHODS: We prospectively evaluated elderly cataract patients' self-assessed visual ability regarding reading, TV viewing, orientation ability, activities of daily life, satisfaction, and visual acuity (VA) before and approximately 3 months after cataract surgery. All patients operated on during a 1-year period from our geographically defined admitting area that participated with a questionnaire were included (n = 837). Survival was checked after 4 years. RESULTS: Before surgery, the most elderly were significantly more dissatisfied with their visual function (P =.007). Seventy-six percent of 85+ improved their subjective ability to read, and two-thirds of those unable to read newspaper print were able to read after surgery. A total of 79% of 90+ experienced improved postoperative ability to manage their daily lives. Best-corrected VA (BCVA) improved in 94% (90+ years of age), 90% (85 to 89 years of age), and 97% (younger than 84 years of age), respectively. After surgery, VA was significantly worse with increasing age, also after adjustment for ocular comorbidity (P <.0001). Patients with a BCVA improvement of less than 0.3 logarithm of the minimal angle of resolution units, patients with comorbidity, and patients aged 90+ had approximately 3 times the odds of being dissatisfied with vision after surgery. A total of 43% of 90+ years and 62% of 85 to 89 years were alive 4 years after surgery. CONCLUSIONS: Most patients aged 85 and older had improved visual ability, acuity, and satisfaction after cataract surgery. In terms of visual function, surgery of significant cataracts in the very old is beneficial also when life expectancy is taken in account.
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- Sahlin, Sven, et al.
(författare)
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Effect of eyelid botulinum toxin injection on lacrimal drainage
- 2000
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Ingår i: American Journal of Ophthalmology. - 0002-9394 .- 1879-1891. ; 129:4, s. 481-486
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:To determine the effect of eyelid botulinum toxin injection on the lacrimal drainage and to assess the use of botulinum toxin in dry eye conditions. METHODS: Prospectively, three test groups were examined and one lacrimal system investigated in each person in each group. Botulinum toxin A (3.75 IU) was injected into the medial part of 13 lower eyelids of 13 normal test subjects and the medial part of nine lower eyelids in nine patients with dry eyes. A dose of 2.5 IU was injected into the medial part of 10 lower eyelids and the medial part of 10 upper eyelids of 10 patients with dry eyes. The drop test was used to determine the lacrimal drainage capacity and the blink output, before and after the injection. The subjective effect of the botulinum toxin injection on eye comfort was investigated. RESULTS: Three weeks after lower eyelid botulinum toxin injection, the mean blink output was reduced to 64% (1.19 of 1.87, P < .001) and 70% (0.94 of 1.35, P < .001) of the baseline values in the groups of normal subjects and patients, respectively. After injection in both the upper and lower eyelid, the mean blink output was reduced to 38% (0.54 of 1.41, P < .001) of the baseline value. The patients with dry eyes reported an improved eye comfort in six of nine cases after injection in the lower eyelid and in seven of 10 cases after injection in both the upper and lower eyelid. Adverse effects included one case of increased discomfort for 3 weeks after injection. CONCLUSION: Injection of botulinum toxin into the medial part of the eyelids decreased the lacrimal drainage, suggesting a new way to treat dry eye conditions. Further studies are required to assess the clinical value of this treatment. Copyright (C) 2000 Elsevier Science Inc.
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- Sivaramakrishnan, V. C., et al.
(författare)
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Influence of convergence on vertical fusional vergence amplitude
- 2005
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Ingår i: American Journal of Ophthalmology. - 0002-9394 .- 1879-1891. ; 139:3 Suppl., s. S46-
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Deficiency in vertical fusional vergence amplitude (VFVA) is known to cause asthenopia and oculomotor imbalances. The measurement of VFVA however is confounded by its increase with convergence (Hara et al., 1998). A quantitative relationship between the two vergences is thus necessary to predict the VFVA at a given convergence angle. Here, we sought to derive such a relationship by measuring the VFVA at a range of convergence angles. Methods: 30 subjects (17–21 yrs) wearing red-green goggles fused a pair of red-green concentric circles projected on a computer monitor at a distance of 50 cms in a dark room. The horizontal and vertical separation between the red-green circles determined the convergence and vertical vergence demand respectively. The VFVA was measured at 8 equally spaced convergence demands ranging from 0.58° to 11.13°. The convergence demands were either systematically increased or randomly varied across different sessions. in each session, the convergence demand was kept constant while the vertical vergence demand was varied in steps of 0.03°. The maximum vertical vergence demand that could be fused determined the VFVA. Results: The subjects’ data was divided into four groups based on the range of convergence demands that could be fused. in all the groups, the VFVA increased linearly with the systematic increase in convergence demand (mean regression equation: y 0.15x 0.49). Randomizing the convergence demands did not show any significant change in this relationship (y0.12x 0.80). Conclusion: The VFVA increases linearly in the range of convergence demands tested. The linear regression equation derived could be used in a clinical setup to predict the VFVA at a given convergence angle
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- Adil, Mohammed Yasin, et al.
(författare)
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Meibomian Gland Morphology Is a Sensitive Early Indicator of Meibomian Gland Dysfunction
- 2019
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Ingår i: American Journal of Ophthalmology. - : ELSEVIER SCIENCE INC. - 0002-9394 .- 1879-1891. ; 200, s. 16-25
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate the relationship between meibomian gland (MG) morphology and clinical dry eye tests in patients with meibomian gland dysfunction (MGD). DESIGN: Cross-sectional study. SUBJECTS: Total 538 MGD patients and 21 healthy controls. METHODS: MG loss on meibography images of upper (UL) and lower lids (LL) was graded on a scale of 0 (lowest degree of MG loss) to 3. MG length, thickness, and interglandular space in the UL were measured. Clinical tests included meibum expression and quality, tear film break-up time, ocular staining, osmolarity, Schirmer I, blink interval timing, and Ocular Surface Disease Index (OSDI) questionnaire. RESULTS: Mean UL and LL meibogrades were significantly higher in MGD patients compared to controls (P amp;lt; .001 for UL and LL). The sensitivity and specificity of the meibograde as a diagnostic parameter for MGD was 96.7% and 85%, respectively. Schirmer I was significantly increased in MGD patients with meibograde 1 compared to patients with meibograde 0, 2, and 3 in the UL (P amp;lt; .05 ). MG thickness increased with higher meibograde (P amp;lt; .001). MG morphology correlated significantly but weakly with several clinical parameters (P amp;lt; .05). OSDI did not correlate with any MG morphologic parameter. CONCLUSIONS: Grading of MG loss using meibograde effectively diagnoses MGD. Compensatory mechanisms such as increased aqueous tear production and dilation of MGs make early detection of MGD difficult by standard clinical measures of dry eye, whereas morphologic analysis of MGs reveals an early stage of MGD, and therefore represents a complementary clinical parameter with diagnostic potential. (C) 2018 Elsevier Inc. All rights reserved.
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