Does Ophthalmology Need Philosophy?

Although ophthalmology has made significant progress and awareness about eye care and the accessibility of health technology has increased, there are still aspects that might be improved. One of the ways to achieve improvement is philosophical investigation of some reasoning and behavior styles in ophthalmology. Philosophy means love of wisdom, and the philosophical approach can contribute to increasing the wisdom of ophthalmologists. Logical fallacies currently affecting the decisions of ophthalmologists can be reduced. "ontology" can contribute to a better understanding of "the nature of reality". A detailed inquiry about the basic concepts concerning ophthalmology may support better reasoning styles. Reflecting on epistemological questions such as "What is true knowledge?", justifying information, and having a skeptical attitude may help to make decisions with more accurate information. The philosophy of science is concerned with the detailed investigation, questioning, and understanding of ophthalmologists' scientific activities and may form the missing link between ophthalmology and philosophy. Moreover, the claim that philosophy's contribution to science is of no interest to scientists warrants consideration. The philosophers of science Karl Popper and Thomas Kuhn have made significant contributions to the perception of science that are still valid today. Karl Popper proposed that a demarcation between science and pseudo-science might be made through the concept of "falsification". According to this concept, a statement is scientific if it can be tested and falsified using valid methods. Thomas Kuhn stated that major scientific changes (i.e., revolutions) occur through paradigm shifts. Although the areas of moral philosophy/ethics/bioethics have generated useful ideas and practices for the improvement of the art of medicine, bioethics in particular deserves to be questioned philosophically by physicians living in real life. Ophthalmologists can develop more beneficial and realistic ophthalmology education, research, diagnosis, treatment, and rehabilitation practices by utilizing the basic methods of philosophy.

Shade matching performance of normal and color vision-deficient dental professionals with standard daylight and tungsten illuminants.

STATEMENT OF PROBLEM: The lighting conditions of the environment and visual deficiencies such as red-green color vision deficiency affect the clinical shade matching performance of dental professionals. PURPOSE: The purpose of this study was to evaluate the shade matching performance of normal and color vision-deficient dental professionals with standard daylight and tungsten illuminants. MATERIAL AND METHODS: Two sets of porcelain disc replicas of 16 shade guide tabs (VITA Lumin) were manufactured to exact L*a*b* values by using a colorimeter. Then these twin porcelain discs (13 mm x 2.4 mm) were mixed up and placed into a color-matching cabinet that standardized the lighting conditions for the observation tests. Normal and red-green color vision-deficient dental professionals were asked to match the 32 porcelain discs using standard artificial daylight D65 (high color temperature) and tungsten filament lamp light (T) (low color temperature) illuminants. The results were analyzed by repeated-measures ANOVA and paired and independent samples t tests for the differences between dental professionals and differences between the illuminants (alpha=.05). RESULTS: Regarding the sum of the correct shade match scores of all observations with both illuminants, the difference between normal vision and red-green color vision-deficient dental professional groups was not statistically significant (F=4.132; P=.054). However, the correct shade match scores of each group were significantly different for each illuminant (P<.005). The correct shade matching scores of normal color vision dental professionals were significantly higher with D65 illuminant (t=7.004; P<.001). Color matching scores of red-green color vision-deficient dental professionals (approximately 5.7 more pairs than with D65) were significantly higher with T illuminant (t=5.977; P<.001). CONCLUSIONS.: Within the limitations of this study, the shade matching performance of dental professionals was affected by color vision deficiency and the color temperature of the illuminant. The color vision-deficient group was notably unsuccessful with the D65 illuminant in shade matching. In contrast, there was a significant increase in the shade matching performance of the color vision-deficient group with T illuminant. The lower color temperature illuminant dramatically decreased the normal color vision groups' correct shade matching score.

Severity and frequency of restless legs syndrome in patients with familial Mediterranean fever.

OBJECTIVE: Restless legs syndrome (RLS) is a common sensory motor disorder. RLS an urge to move the extremities that may be accompanied by dysesthesias, and significantly affects quality of life of affected patients. The frequency of RLS is higher in different systemic inflammatory diseases. Familial Mediterranean fever (FMF) is an inherited inflammatory disease characterized by attacks of polyserositis, arthritis, and fever. The prevalence of RLS in patients with FMF is unknown. This study aimed to evaluate the prevalence rate of RLS in a sample of patients with FMF and compare this prevalence with that of a matched normal population. METHOD: A total of 60 patients with FMF and 60 healthy controls were studied. All participants underwent a neurological examination. Diagnostic criteria as proposed by the International Restless Legs Syndrome Study Group (IRLSSG) were used to define RLS. The IRLSSG rating scale for the severity of RLS was applied to determine the severity of symptoms. RESULTS: The prevalence of RLS was not significantly different between patients and controls. Although the mean International Restless Legs Syndrome Rating Scale (IRLSRS) scores tended to be higher in patients compared with controls, this difference was not significant. When each item of the severity scale was compared between the two groups, significantly higher scores were found in some items of the IRLSRS in patients with FMF compared with controls. CONCLUSION: According to this result, RLS symptoms in patients with FMF were more frequent and lasted longer than those in controls.

Unilateral clinical anophthalmia with optic nerve hypoplasia in the fellow eye.

We present the clinical and radiologic findings of two cases of clinical anophthalmia in one eye and optic nerve hypoplasia in the other eye. We propose possible causes of this rare finding.

Risk factors for amblyopia in congenital anterior lens opacities.

PURPOSE: We sought to identify the features of congenital anterior lens opacities (CALOs), which are associated with increased risk for amblyopia. METHODS: We undertook a retrospective study of 59 patients with CALO from 3 clinical practices. The following variables were examined: type (polar, subcapsular, or pyramidal), location (central, paracentral, or peripheral), diameter, presence of adherent iris tissue, anisometropia (spherical equivalent), unilateral versus bilateral, and presence or absence of amblyopia. Pearson chi-square and independent sample t-tests were conducted to evaluate if any of the aforementioned variables were independently associated with amblyopia. Relative risk was then calculated for significantly related variables (P < 0.05). RESULTS: Amblyopia was present in 17 of 59 patients (28.8%). Patients with amblyopia had a mean anisometropia of 1.23 diopters whereas nonambyopic patients had a mean anisometropia of 0.25 (P = 0.023). The relative risk for amblyopia with anisometropia of one diopter or greater was 6.5 (95% confidence interval = 3.79-7.45). The mean cataract size in the amblyopic eyes was 1.22 mm (range, 0.7-2.0 mm). Mean cataract size in the nonamblyopic eyes was 0.95 mm (range, 0.5-2.0 mm). This difference in mean cataract size was significant with independent sample t-tests (P = 0.02); however, this difference did not remain significant with logistic regression. Cataract size was not a significant relative risk factor for amblyopia. CONCLUSIONS: Our overall incidence of amblyopia was 28.8%. The only variable associated with increased relative risk for amblyopia in this group of patients was anisometropia. Patients with CALO who have anisometropia of 1 diopter or greater are 6.5 times more likely to develop amblyopia.

Long-term results of hang-back medial rectus recession.

PURPOSE: To report long-term results with the hang-back technique for medial rectus muscle recession. METHODS: Medical records of 341 consecutive patients who underwent unilateral or bilateral hang-back medial rectus recession were reviewed. The amount of recession was based on the size of the esotropia as measured at near fixation. Patients were divided into two groups according to age at onset of esotropia: patients <1 year comprised group 1 and patients > or = 1 year comprised group 2. Surgical outcomes were analyzed for all patients included in the study. RESULTS: A total of 189 patients met the inclusion criteria. In group 1 patients (n=32), average deviation improved from 48.3 prism diopters (PD) preoperatively to 1.1 PD postoperatively. Eleven patients required a second procedure: 9 with recurrent esotropia and 2 with consecutive exotropia. Average time to second procedure was 27.4 months. In group 2 patients (n=157), average deviation improved from 29.6 PD preoperatively to 1.1 PD postoperatively. Twenty-one patients required a second procedure: 20 with recurrent esotropia and 1 with consecutive exotropia. Average time to second procedure was 22.7 months. CONCLUSION: The hang-back technique represents a safe, effective alternative to conventional medial rectus recession.

Topiramate induced bilateral angle-closure glaucoma: low dosage in a short time.

PURPOSE: The aim of this article is to create awareness among medical colleagues regarding the severe ophthalmic side effects associated with topiramate use. METHODS: A case of severe acute bilateral angle closure glaucoma with visual blurring after oral topiramate therapy. RESULTS: This case was successfully managed by discontinuing topiramate and by starting anti-glaucoma medication. Intraocular pressure, acute transient myopia, and anterior chamber depth were normalized. CONCLUSIONS: It is important for clinicians to recognize these conditions and educate patients about these serious adverse effects when prescribing topiramate.

A novel heterozygous deletion within the 3' region of the PAX6 gene causing isolated aniridia in a large family group.

Paired box gene 6 (PAX6) is the causative gene of aniridia. It is a dominantly inherited eye abnormality characterized by partial or complete absence of the iris. The PAX6 gene is located on chromosome 11p13 and contains 14 exons. It is expressed mainly in the developing eye and central nervous system. Submicroscopic copy number variations are common in the human genome. Submicroscopic deletions may cause several human diseases, either by disrupting coding sequences or by eliminating regulatory elements essential for expression of the gene in question. Over the past several years, array-based comparative genomic hybridization has become an increasingly useful tool for both identifying normal cytogenetic variations and characterizing chromosomal abnormalities associated with developmental delays and cancer. Our results support the notion that assessing copy number variation of the PAX6 gene itself and also of flanking regions, may contribute to the molecular diagnosis of aniridia.