Seeing computer use in a whole new light

If your work or pleasure involves countless hours staring at your computer screen, you may be a likely candidate for Computer Vision Syndrome (CVS) -- a 'complex of eye and vision problems related to near work which are experienced during or related to computer,' as defined by the American Optometric Association.

Vision screening in Jamaican children

OBJECTIVE: To determine the prevalence of vision impairment in Jamaican pre-school children. METHODS: A national sample of Jamaican children at the end of the pre-school years was identified using the quarterly Jamaican Labour Force Survey. Each year, this survey identifies 500 pre-school children (1 percent of the national population) using a two-stage stratified random sampling process based on electoral divisions. Over two successive years, a 1 percent and a 0.5 percent sample of children were identified (n=750). A total of 302 children had their distance and near visual acuity assessed. Information on socio-economic status and the parental perception of children's vision was obtained by parental interview. RESULTS: 10.4 Percent of the children were identified as being in need of further ophthalmological referral using the American Academy Screening Guidelines. 4.1 percent of the children were diagnosed as having "low vision" according to the World Health Organization classification. 45.8 percent of the children were unable to identify letters and required lap-card use for evaluation of vision. No gender or socioeconomic differences were identified between those children requiring further ophthalmological assessment and those who did not (p<0.05). Parental perception of children's visual impairment was shown to be an unsatisfactory tool to assist in determining children at high risk for vision impairment. CONCLUSION: Based on the rates of children requiring further ophthalmological evaluation and the rates of low vision identified in this study, the abscence of identifiable risk factors and the inaccuracy of parental perception, all Jamaican pre-school children should be offered vision screening. The inability to identify letters demands that screening programmes must have facilities available for using lap-cards. (AU)

Incidence of open-angle glaucoma. The Barbados Eye studies

OBJECTIVE: To measure the 4-year risk of open-angle glaucoma (OAG) in a black population. DESIGN: Population-based cohort study with 4 years of follow up. SETTING: Simple random sample of residents of Barbados, West Indies, aged 40 years or older. PARTICIPANTS: A total of 3427 members of the cohort (85 percent of those eligible). MAIN OUTCOME MEASURE: Development of glaucoma visual field defects and optic disc damage, confirmed by automated perimetry, independent fundus photographic gradings, and standardized opthalmologic examinations. RESULTS: The 4-year risk of OAG in black participants was 2.2 percent (95 percent confidence interval, 1.7 percent-2.8 percent), based on 67 newly developed cases of OAG. Incidence rates increased from 1.2 percent at ages 40 to 49 years to 4.2 percent at ages of 70 years or more, tending to be higher in men than women (2.7 percent vs 1.9 percent). About half of the incident cases were undiagnosed previously, and the rest were receiving OAG treatment. Of the 67 new cases of OAG, 32 had intraocular pressure of 21 mm HG or less at baseline (1.2 percent incidence) and 35 had higher pressures (9 percent incidence). Risk was the highest among persons classified as having suspect OAG at baseline (26.1 percent), followed by those with ocular hypertension (4.9 percent and lowest in the remining population (0.8 percent). CONCLUSIONS: This longitudinal study provides new information on OAG risk, as well as the first incidence measurement in a black population. Although intraocular pressure increased risk, about half of the new cases had baseline pressures of 21 mm Hg or less. Results substantiate the high OAG risk in the population of African origin, especially in older adults; the relative role of intraocular pressure; and the considerable underdetecion of new disease after 4 years of follow-up. (AU)

Extraadrenal retroperitoneal paraganglioma causing malignant hypertension and permanent visual loss in an eleven-year-old-girl

We report a secretory paraganglioma in an eleven-year-old Trinidadian girl of East Indian descent who presented with malignant hypertension, proteinuria and modest elevation of urinary vanillylmandelic acid levels. The extraadrenal mass was surgically removed without complications. The patient has been normotensive without evidence of recurrence of disease but with persistent visual sequel two years later. This case reinforces the observation that extraadrenal retroperitoneal paragangliomas can be functionally very active and early computed tomography or other imaging procedure is necessary for rapid noninvasive evaluation, timely surgery and prevention of permanent morbidity.(Au)

An interesting case

A 78 year old female presented with a history of gradual loss of vision over a period of six months. There is a past history of breast carcinoma. She has been feeling generally unwell and has had significant weight loss. Work-up includes: * Complete ophthalmic and physical examinations * Blood investigations * Skull and chest X-rays * Fundal photography * Computed axial tomography scan of skull and brain (AU)

Health status of the elderly in the Marigot Health District, Dominica

The health status and the prevalence of hypertension, diabetes mellitus, glaucoma and visual disorders of 123 elderly people (56 men, 67 women) in the Marigot Health District, Dominica, were assessed by means of four questionnaires: collection of data from their medical records; physical examination, measurement of blood pressure, visual acuity and intra-ocular pressure (IOP); and testing for glucosuria. The overall health status was good, but 20 percent were dependent on care. 74 percent were independent in the activities in daily life, with only moderate limitations in activities. The health status decreased considerably in those over 75 years of age. There were slight perceived differences in health status between men and women. About 40 percent of the study population were known to be hypertensive, and another 13 percent had an elevated blood pressure on examination. Diabetes mellitus was present in 15 percent. 20 percent had a visual acuity of 0.1 or below, and 10 percent had an elevated IOP. During the study, a considerable number of new cases of hypertension, diabetes mellitus and elevated IOP were diagnosed. 50 percent of the study population who were on medication used this more than as prescribed. This study indicates a high prevalence of the secondary complications of hypertension, diabetes mellitus, cataract, glaucoma and osteo-arthritis that cause disability and dependency in the elderly population. Education, diagnosis at an early stage and appropriate treatment of these disorders may prevent or delay their development. We suggest the development of a programme oriented approach of primary health care for the elderly to support this.(AU)

Prevalence of ocular complications of diabetes mellitus and their impact on quality of life for patients attending the Port of spain General Hospital, Trinidad

This study measured the amount of disability due to impaired vision in diabetic patients attending the outpatient clinics of Port-of-Spain General Hospital, Trinidad. Visual function and ocular disease were assessed using an E chart and direct dilation fundoscopy. Disability was measured using a modified version of the Lambert Health Survey Questionnaire, a broad measure of disability originally designed for use in a London inner-city borough. Questions unrelated to visual impairment were removed and others rewarded to be more applicable to a Caribbean population. Impairment was assessed in four areas: ambulation and mobility, body care and movement, sensory and motor and social activities. Disability was defined as activity restrictions consequent upon disease or impairment. Point prevalence of disability was measured at 63 percent. Prevalence of severe visual impairment defined as one eye visual acuity of 6/60 or less was 37.5 percent and proliferative retinopathy was seen in 28.1 percent. Impairment in sensory and social activities was more common than in ambulation and body care which were only reported by patients with very poor vision. Overall more women than men reported disability though that reported by men was on average more severe. This apparent paradox may be partly explained by the greater willingness of women to report impairment, men only doing so when it becomes severe. Patients reporting greatest disability also had the worst visual function and ocular disease. These results show that diabetics suffer significant disability due to visual impairment and indicate those areas in which impairment is most common (AU)

Cerebral sinovenous thrombosis in a patient with paroxysmal nocturnal haemoglobinuria

Paroxysmal nocturnal haemoglobinuria may be complicated by life-threatening thrombosis. A patient who presented with the classical clinical picture of cerebral sinus thrombosis is described. Management of the condition is discussed. (AU)

The prevalence of childhood disability and related medical diagnosis in Clarendon Jamaica

In a population-based survey in a defined area in the parish of Clarendon, Jamaica, the prevalence of six types of childhood disabilities was sought. All children aged 2-9 years who screened positive for disability, with 8 per cent of children screening negative (out of a total of 5,468 children), were assessed by a physician and a psychologist. Disabilities were categorised by types and levels of severity. The estimated prevalence rate for all types and levels of disabilities was 93.9 per 1,000 children and for serious disability was 24.9 per 1,000. The rates for specific disabilities showed wide variation (cognitive, 81/1,000; speech, 14/1,000; visual, 11/1,000; hearing, 9/1,000; motor, 4/1,000; seizure, 2/1000). Of the disabled children, 70 per cent had only one disability, 23 per cent had two and 6 per cent had three or four disabilities. If disability is to be seen as a major outcome of a range of interacting factors, then these prevalence rates, taken with the specific aetiologies, would provide a framework for planning preventive and rehabilitative interventions. (AU)

Service needs of children with disabilities in Jamaica

We investigated the service needs of children attending a medical assessment as part of a two stage survey of 2 to 9-year-old children in mid and south Clarendon, Jamaica. Parents were asked about symptoms relating to six different disabilities: visual, hearing, speech, motor, cognitive and fits. Following medical and psychological assessment, a diagnosis of mild, moderate, severe or no disability was made. For children with disabilities, the frequencies of five possible types of intervention recommended by the physician were analysed and related to the prevalence of the six disabilities in the parish. To estimate the needs of the Jamaican child population the figures were extrapolated based on an estimate of 1 million children under the age of 15 years. These needs were then compared with places in existing services. Of the disabled children, 62 percent needed special education, 29.5 percent needed community-based services, 21 percent needed spectacles, 21 percent needed specialist referral, and 6 percent required medical treatment. Although the vast majority of these needs are not met, many more could be met in the community if existing health and education personnel are trained in basic techniques of screening and assessment. (AU)

The Barbados eye study: design and progress report - abstract

The Barbados Eye Study is determining the prevalence and risk factors of major causes of visual loss in a random sample of the population between ages 40 and 84 years. All participants have visual acuity (VA) measurements, applanation tonometry, computerized perimetry, lens gradings, fundus photography, glycosylated haemoglobin, interview, blood pressure and anthropometry. Persons with positive test results and a 10 percent sample of all participants also have an opthalmologic examination, additional threshold perimetry and tonometry. The study also has a longitudinal component, the glaucoma follow-up study, which provides continuing care and evaluation for newly detected cases of glaucoma and suspect glaucoma. Recruitment of the intended sample size of 4,000 persons is expected to end in 1991. By November 1990, 3,095 persons had completed data collection with a participation of 87 percent of those eligible. Preliminary findings show a prevalence of visual impairment (VA < 20/40 in the better eye) of 11.5 percent, age-related cataract, age-related maculopathy, open-angle glaucoma and diabetic retinopathy were main causes of decreased VA. Blindness prevalence (VA < 20/200 in the better eye) was 3.2 percent; open-angle glaucoma and age-related cataract were the major causes of blindness. Results suggest a high prevalence of open-angle glaucoma as found in an earlier pilot project. Hypertension and diabetes mellitus were also very frequent in this population (AU)

A comparison of efficacy of the key informant and community survey methods in the identification of childhood disabilities in Jamaica

A comparison of the efficacy of the key informant and the community survey methods for identifying children with disability was carried out in the Jamaican component of an international epidemiological study of children disability. Approximately 130 key informants were exposed to a two-day workshop giving information on sign of disability, aspects of the project, and available services. Questionnaires were given to enable the informants to refer children and they were reminded six months later. In the survey method, eight community workers completed a house-to-house survey of all families and administered the 10-question screen with probes on 5475 children, 2 to 9 years old. Seventeen referrals were made by the key informants; of these, two were found to have disabilities. Of the 821 children who tested positive on the 10-question screen on the house-to-house survey, 193 had disabilities. We concluded that the key informant method would not be a satisfactory way of identifying cases of childhood disability. (AU)

Diabetic retinopathy and visual loss in a Jamaican population

Opthalmic assessment was performed on a random sample of 178 black Jamaican diabetics. Retinopathy was present in 69 percent. Severe visual loss (V.A.<5/200or

Salmon-patch hemorrhages after central retinal artery occlusion in sickle cell disease

In two patients with sickle cell disease (one hemoglobin SC and one hemoglobin SS), central retinal artery occlusion developed. In one case, the occlusion followed a retrobular injection of lidocaine hydrochloride. Although the central retinal artery reperfused in each patient, many secondary peripheral retinal ateriolar occlusions remained. During the subsequent days, multiple salmon-patch hemorrhages developed in the distribution of these occluded arterioles. In one patient, the salmon-patch hemorrhages evolved into atrophic schisis cavities. These unusual cases allowed us to document the origin of salmon-patch hemorrhages after peripheral retinal arteriolar occlusions. The development of the hemorrhages was a delayed phenomenon that occurred hours to days after the initial vascular occlusion. Reperfusion of the damaged ischemic vessels with a blowout of the walls of the vessels seems the most likely explanation for this phenomenon. (Au)

Ocular findings in sickle cell-haemoglobin O Arab disease

The ocular findings in 2 patients with sickle cell-haemoglobin O Arab disease are described. One patient had proliferative sickle cell retinopathy with extensive autoinfarction of lesions. Sickle cell-haemoglobin O Arab disease must be added to the list of conditions that may be associated with proliferative sickle cell retinopathy (AU)

Mycetoma of the palpebral conjunctiva caused by allescheria boydii (monosporium apiospermum)

Mycetoma of the left upper palpebral conjunctiva due to allescheria boydii is reported in a 44-year-old male Negro gardener. The infection was associated with symblepharon and corneal scarring. This appears to be the fourth reported case of mycotic infection of the eye caused by allescheria boydii and the first in which the organism had produced a mycetoma of the conjunctiva (AU)