| 1. |
- 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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| 2. |
- 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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| 3. |
- 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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| 4. |
- 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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| 5. |
- Aspberg, Johan, et al.
(författare)
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Screening for open-angle glaucoma and its effect on blindness
- 2021
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Ingår i: American Journal of Ophthalmology. - : Elsevier BV. - 1879-1891 .- 0002-9394. ; 228, s. 106-116
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate the effect of population screening on low vision and blindness from open-angle glaucoma.DESIGN: Retrospective cohort study.STUDY POPULATION: A very large population based screening for glaucoma was conducted in Malmö, Sweden, from 1992 to 1997. A total of 42 497 subjects were invited, of which 32 918 were screened and 9579 non-responders, i.e. did not participate.METHODS: The records of glaucoma patients who had visited the Department of Ophthalmology at Malmö University Hospital, from Jan 1, 1987, to Dec 31, 2017, were reviewed. Patients diagnosed at or after the screening were assessed for moderate or severe vision impairment, which we call low vision, or blindness by the WHO definition. We corrected for selection bias by creating a group of potential screening participants from a comparison group of clinical patients.MAIN OUTCOME MEASURE: Risk ratio of the cumulative incidence for bilateral low vision or blindness caused by glaucoma in screened patients compared with the potential participants.RESULTS: The cumulative incidence of blindness was 0.17% in the screened population versus 0.32% among the potential participants; and for low vision 0.25% versus 0.53%. The risk ratio (95% CI) between the two was 0.52 (0.32-0.84) for blindness and 0.46 (0.31-0.68) for low vision. There were no differences in the proportion of potential confounders between the comparison group and the non-responders.CONCLUSIONS: Our results suggest that population screening may reduce bilateral low vision and blindness from glaucoma by about 50%.
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| 6. |
- Bengtsson, Boel, et al.
(författare)
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A visual field index for calculation of glaucoma rate of progression.
- 2008
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Ingår i: American Journal of Ophthalmology. - : Elsevier BV. - 1879-1891 .- 0002-9394. ; 145:2, s. 343-353
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To present a new perimetric index for calculating the rate of glaucomatous progression and to compare its performance with the traditional mean deviation index (MDI). DESIGN: Experimental study describing a device and retrospective cohort study. METHODS: We developed a new visual field index, the glaucoma progression index (GPI), intended to be less affected by cataract than the MDI by calculating age-corrected defect depth at test points identified as significantly depressed in pattern deviation probability maps. The valid operating range for pattern deviation analysis was estimated. When exceeding this range, the total deviation probability maps were used for identification of significantly depressed points. The GPI is expressed in percentage, where 100% represents a normal visual field and 0% represents a perimetrically blind field, and is plotted vs patient age. Rate of progression, presented as yearly change in the GPI, is calculated by linear regression analysis. We conducted a pilot evaluation in three groups of patients: 1) eyes with developing cataract, 2) eyes without cataract, and 3) eyes in which cataract surgery was performed in the middle of the series. RESULTS: The cut-off for pattern deviation was, at mean deviation, worse than -20 decibels (dB) in fields in which the eighty-fifth percentile of the total deviation value was significantly depressed. In the first group (n = 45), the measured rate of progression was greater with the MDI than with the GPI (P < .0001). The mean loss per year was 3.6%/year for the MDI and 2.1%/year for the GPI. In the second group (n = 42), the rate of progression did not differ between the MDI and the GPI (P = .52); the means were 2.7%/year and 2.6%/year, respectively. In the third group (n = 44), the confidence limits for the rate of progression were significantly smaller with the GPI than with the MDI (P = .04). CONCLUSIONS: Glaucoma progression rates calculated using the GPI seem to be considerably less affected by cataract and cataract surgery than rates based on the traditional MDI.
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| 7. |
- Bitner, Hanna, et al.
(författare)
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Frequency, Genotype, and Clinical Spectrum of Best Vitelliform Macular Dystrophy: Data From a National Center in Denmark
- 2012
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Ingår i: American Journal of Ophthalmology. - : Elsevier BV. - 1879-1891 .- 0002-9394. ; 154:2, s. 403-412
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To estimate the prevalence, genotype, and clinical spectrum of Best vitelliform macular dystrophy (Best disease). DESIGN: Retrospective epidemiologic and clinical and molecular genetic observational study. METHODS: SETTING: National referral center. PARTICIPANTS: Forty-five individuals diagnosed with Best disease. OBSERVATION PROCEDURES: Retrospective review of patients diagnosed according to clinical findings and sequencing of BEST1. Patients with recently established molecular genetic diagnosis were followed up including multifocal electroretinography (mfERG), spectral-domain optical coherence tomography (SD-OCT), and fundus autofluorescence (FAF) imaging. MAIN OUTCOME MEASURES: BEST1 mutations, SD-OCT and FAF findings, mfERG amplitudes, prevalence estimate of Best disease. RESULTS: BEST1 mutations described previously in Danish patients with Best disease are reviewed. In addition, we identified a further 8 families and 1 sporadic case, in whom 6 BEST1 missense mutations were found, 4 of which are novel. The mutation c.904G>T (p.Asp302Asn) was identified in members of 4 unrelated families. Structural alterations ranged from precipitate-like alterations at the level of the photoreceptor outer segments (OS) to choroidal neovascularization. The extent of the former correlated with the reduction of retinal function. A prevalence estimate of Best disease in Denmark based on the number of diagnosed cases was 1.5 per 100 000 individuals. CONCLUSIONS: Our data expand the mutation spectrum of BEST1 in patients with Best disease. Alterations of the OS overlying lesions with subretinal fluid are similar to those seen in central serous retinopathy and may indicate impaired turnover of OS. Our frequency estimate confirms that Best disease is one of the most common causes of early macular degeneration. (Am J Ophthalmol 2012;154:403-412. (c) 2012 by Elsevier Inc. All rights reserved.)
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| 8. |
- Gyllencreutz, Emelie, et al.
(författare)
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Ophthalmologic Findings in Fetal Alcohol Spectrum Disorders : A Cohort Study From Childhood to Adulthood
- 2020
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Ingår i: American Journal of Ophthalmology. - : Elsevier. - 0002-9394 .- 1879-1891. ; 214, s. 14-20
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate whether ophthalmologic findings in children with fetal alcohol spectrum disorders (FASD) persist into young adulthood.DESIGN: Prospective cohort study.METHODS: Thirty children (13 female) adopted from eastern Europe to Sweden in the 1990s and diagnosed with FASD by a multidisciplinary team at the median age of 7.9 years were followed up by the same team 13-18 years later. Visual acuity (VA), refraction, stereoacuity, strabismus, ocular media, and fundus were investigated.RESULTS: Median VA in right/left eye (OD/OS) was 20/32/20/32 (0.2/0.2 logMAR) in childhood and 20/22/20/20 (0.05/0.0 logMAR) in adulthood. Median (range) refraction OD/OS was +0.88/+1.25 (-8.75 to +4.75/-9.38 to +5.25) spherical equivalent diopter (D) in childhood and -0.25/-0.25 (-12 to +2.75/-13.25 to +2.63) in adulthood. Astigmatism (≥1 D) was the most common refractive error, in 13 (40%) and 14 (47%) subjects, respectively. Defective stereoacuity (>60 arc second) was noted in 20 subjects (67%) in childhood and 22 (73%) in adulthood. Heterotropia occurred in 12 subjects (40%) in childhood and 13 (43%) in adulthood. Increased tortuosity of the retinal vessels was found in 8 (27%) subjects in childhood vs 11 (37%) in adulthood. Optic nerve hypoplasia was recorded in 3 children and in 4 young adults.CONCLUSIONS: Ophthalmologic findings such as refractive errors, strabismus, and fundus abnormalities are frequent in children with FASD and persist into early adulthood. The facial features characteristic of FAS diminish with age, making a dysmorphology evaluation in adulthood less reliable. An ophthalmologic examination is an important part of the evaluation of FASD in childhood as well as in young adulthood.
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| 9. |
- Heijl, Anders, et al.
(författare)
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Effects of Argon Laser Trabeculoplasty in the Early Manifest Glaucoma Trial.
- 2011
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Ingår i: American Journal of Ophthalmology. - : Elsevier BV. - 1879-1891 .- 0002-9394. ; 152:5, s. 842-848
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To analyze reduction of intraocular pressure (IOP) by argon laser trabeculoplasty (ALT) in the Early Manifest Glaucoma Trial and factors influencing the effect of such treatment. DESIGN: Cohort study based on 127 patients from the treatment group of the Early Manifest Glaucoma Trial, a randomized clinical trial. METHODS: Patients randomized to the treatment arm of the Early Manifest Glaucoma Trial received a standard treatment protocol (topical betaxolol hydrochloride followed by 360-degree ALT) and then were followed up prospectively at 3-month intervals for up to 8 years. One eye per patient was included in the analyses. We investigated the relationship between IOP before ALT and subsequent IOP reduction and other factors that might have influenced the effect of ALT, including stage of the disease, trabecular pigmentation, presence of exfoliation syndrome, and treating surgeon. RESULTS: The mean ± standard deviation IOP before ALT and after betaxolol treatment was 18.1 ± 3.9 mm Hg, and the mean ± standard deviation short-term IOP reduction 3 months after ALT was 2.8 ± 3.9 mm Hg (12.6 ± 20.5%). The IOP before ALT strongly affected IOP reduction (P < .001); each 3-mm Hg higher IOP before ALT value was associated with an additional mean IOP reduction of approximately 2 mm Hg. The treating surgeons also had a significant impact on IOP reduction (P = 0.001), with mean values ranging from 5.8 to -1.3 mm Hg. CONCLUSIONS: In this cohort, which included many patients with low IOP levels, IOP before ALT markedly influenced the IOP reduction induced by ALT, seen as a much larger decrease in eyes with higher IOP before ALT. The treating surgeon also had a significant impact on ALT outcome.
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| 10. |
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