Parents’ Expectations Regarding Their Childrens’ Eye Care
American Journal of Ophthalmology
2003;136:797–804
To determine what expectations parents have about their childrens’ eye care, Dawn et al. conducted a qualitative, cross-sectional pilot study.
Interviews were done with 48 parents of pediatric ophthalmology patients. Content analysis of the interview transcripts yielded 35 different expectation areas for eye care, which were further classified into six groups: 1) communication, 2) interpersonal manner, 3) doctor’s skill, 4) examination and testing, 5) logistics and 6) other.
The six areas most frequently identified by parents as the single most important expectation were 1) clinical competence, 2) interaction with child, 3) education/training, 4) explanation in clear language, 5) information about diagnosis and 6) personal connection.
Parents of pediatric ophthalmology patients expressed expectation areas in the communication group more frequently than any other group. However, when asked to identify their single most important expectation area, more than half of parents identified clinical competence.
Radial Optic Neurotomy for Central Retinal Vein Occlusion
American Journal of Ophthalmology
2003;136:814–819
Weizer et al. reviewed their initial experience with radial optic neurotomy as treatment for retinal vein occlusion.
Five patients (four with central retinal vein occlusion and one with hemiretinal vein occlusion) were included in this interventional case series of pars plana vitrectomy with radial optic neurotomy. BCVA, presence of macular edema, perfusion status and time to venous phase of the angiogram were reviewed retrospectively.
Mean preoperative visual acuity was 4/200. Preoperatively, the vein occlusion was perfused in one, nonperfused in one and indeterminate in three. Mean follow-up time was 4.5 months. Mean postoperative visual acuity was 20/400 at last follow-up.
Four patients had improvement in visual acuity and one worsened. Two patients improved to 20/80 postoperatively. In four cases, disc congestion improved and intraretinal hemorrhage reabsorbed more quickly than would be expected without treatment. Time to the venous phase of fluorescein angiography improved slightly in three cases postoperatively. Perfusion status as determined by fluorescein angiography was not significantly altered postoperatively. One patient had resolution of macular edema postoperatively as shown by volumetric optical coherence tomography. One patient developed choroidovitreal neovascularization and one developed iris neovascularization postoperatively, both of which responded to panretinal photocoagulation.
The authors conclude that radial optic neurotomy may improve visual acuity in eyes with CRVO, although choroidovitreal neovascularization from the neurotomy site can occur, and they note that further study is needed to determine radial optic neurotomy’s role in the management of CRVO.
Evaluation of Minimally Invasive Therapies for Clinically Complete Retinal Artery Occlusion
Archives of Ophthalmology
2003;121:1377–1381
Mueller et al. evaluated commonly used, minimally invasive treatments for clinically complete, nonarteritic retinal artery occlusion (CRAO). The outcome measure was BCVA at initial and last visit.
The study included 71 patients. Methods of treatment were acetylsalicylate (62 percent); systemic acetazolamide (62 percent); ocular massage (45 percent); isovolemic hemodilution (31 percent); oral pentoxifylline (27 percent); beta-blocker eye drops (11 percent); anterior chamber paracentesis (8 percent) and subcutaneous heparin (6 percent). Multivariate stepwise regression did not identify any single or combination treatment as a significant factor for improvement of BCVA. In summary, commonly used minimally invasive treatments do not improve the material course of this disease.
The Incidence of Polypoidal Choroidal Vasculopathy
Archives of Ophthalmology
2003;121:1392–1396
Sho et al. carried out a study to determine the incidence, demographic features and clinical characteristics of polypoidal choroidal vasculopathy in Japanese patients.
PCV is characterized by a peculiar form of choroidal neovascularization in the inner choroid associated with persistent recurrent serous leakage and hemorrhage in the macula in the elderly. Indocyanine green angiography clearly demonstrates this disorder.
Among 471 eyes of 418 consecutive patients with presumed neovascular age-related macular degeneration, 23 percent (110 eyes of 100 patients) were diagnosed with PCV and 77 percent (318) were diagnosed with neovascular AMD.
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American Journal of Ophthalmology reviews are edited by Thomas J. Liesegang, MD. Archives reviews are edited by William F. Mieler, MD.
Round-Up of Other Journals
Angioscomtomas in the Striate Cortex of Squirrel Monkeys
The Journal of Neuroscience
2003;23:5984–5997
Helmholtz discovered 135 years ago that scotomas corresponding to the Purkyne retinal tree can be plotted in the visual field. In a study of squirrel monkeys, Adams and Horton demonstrate that scotomas can be detected in the striate cortex.
In this study, the researchers detected angioscotomas in nine of 12 normal adult animals by staining flatmounts for cytochrome oxidase activity after enucleation of one eye. They appeared as thin profiles in layer 4C radiating from the blind spot representation.
The investigators noted that the representation of angioscotomas in V1 provides an “intriguing glimpse” of the role played by visual experience in the development of the cortex, in which the development proceeds according to an innate plan that is refined by sensory stimulation after birth. Additionally, angioscotomas can be considered as a local form of amblyopia, which itself represents a classic example of how visual experience can influence the development of the cortex.
They stated they look forward to future reports from colleagues describing the presence of angioscotomas in the cortex of other species.
Out of the Mouth of Babes: A Possible Source of Stem Cells
Proceedings of the National Academy of Sciences of the United States of America
2003;100:5807–5812
In the search to discover high-quality human postnatal stem cells from accessible resources to conduct stem-cell research, Miura et al. have found a potential source: “baby” teeth.
In this study, the investigators collected incisors from 7- to 8-year-old children. They found that a naturally occurring exfoliated deciduous tooth is similar in some ways to an umbilical cord, in that it contains stem cells that may offer a unique stem-cell resource for potential clinical applications. The stem cells from the children’s teeth were identified as highly proliferative, clonogenic cells capable of differentiating into a variety of cell types, including neural cells, adipocytes and odontoblasts.
Additionally, after in vivo transplantation, the stem cells induced bone formation, generated dentin and survived in mouse brain along with expression of neural markers.
The investigators conclude that this study establishes the foundation for further studies to determine the efficacy of using these stem cells in cellular-based therapies and they call for more research as to the biological significance of these findings.
Acarbose Treatment for Patients With Impaired Glucose Tolerance
The Journal of the American Medical Association
2003;290:486–494
Findings from a leading diabetes study provide evidence that treating patients who have impaired glucose tolerance with acarbose, an alpha-glucosidase inhibitor, is associated with a significant reduction in the incidence of cardiovascular disease and hypertension. The study by Chiasson et al. is the first prospective intervention study to demonstrate this finding.
Previously, the STOP-NIDDM (Noninsulin-Dependent Diabetes Mellitus) trial—an international, multicenter, randomized, double-blind, placebo-controlled study—demonstrated that decreasing postprandial plasma glucose levels with acarbose (Precose) reduced the risk of diabetes.
In this arm of the study, decreasing postprandial hyperglycemia was associated with a 49 percent relative risk reduction in the development of cardiovascular events and a 2.5 percent absolute risk reduction. The major reduction was in the risk of myocardial infarction. Acarbose also was associated with a 34 percent relative risk reduction in the incidence of new cases of hypertension and a 5.3 percent absolute risk reduction.
The authors conclude that these findings support the hypothesis that postprandial hyperglycemia constitutes a risk factor for cardiovascular disease and illustrates the need for screening and treating patients with impaired glucose tolerance.
Multifocal Electroretinopathy as a Function of Age
Investigative Ophthalmology & Visual Science
2003;44:1783–1792
A report by Seiple et al. issues a caveat that not all multifocal electroretinograms can be interpreted in the same way.
Indeed, a regression analysis by the investigators—looking at 62 normally sighted individuals aged 21 to 81—showed significant linear relationships of amplitude and timing measures with age. Specifically, the rates of losses were 10.5 percent per decade for peak-to-peak amplitude, 11.7 percent per decade for scalar product amplitude and 9.5 percent per decade for a-scale. The rate of amplitude reduction was highest in the central 3 degrees. Age had less influence on implicit time measures.
The authors state that these findings are consistent with losses of photoreceptors in older retinas. However, findings of cone loss in the area tested with the multifocal electroretinograms were inconsistent. They conclude that the findings from this study emphasize the need for appropriate age-matched normative data for accurate multifocal electroretinogram amplitude interpretation in older adults.
