Assessment of the Effectiveness of Obstructive Sleep Apnea Treatment Using Optical Coherence Tomography to Evaluate Retinal Findings.

Retinal findings may change in patients with obstructive sleep apnea syndrome (OSAS). The present study aims to evaluate several retinal findings, such as macula layer thickness, the peripapillary retinal nerve fiber layer, and the optic nerve head in patients with OSAS, using optical coherence tomography (OCT); it also aims to monitor the result of several types of treatment of OSAS with OCT. A prospective comparative study was designed. Patients were recruited at a Sleep Unit of a University Hospital and underwent comprehensive ophthalmological examinations. Following exclusion criteria, fifty-two patients with OSAS were finally included. Patients were examined by OCT twice: once before treatment, and again after six months of treatment. In mild-moderate patients, where retinal swelling had been demonstrated, retinal thicknesses decreased [fovea (p = 0.026), as did inner ring macula (p = 0.007), outer ring macula (p = 0.015), and macular volume (p = 0.015)]. In severe patients, where retinal atrophy had been observed, retinal thickness increased [fovea (p < 0.001)]. No statistically significant differences in efficacy between treatments were demonstrated. In conclusion, OCT can evaluate the retina in patients with OSAS and help to monitor results after treatment. In severe OSAS, retinal thickness increased six months after treatment.

An Update on Corneal Biomechanics and Architecture in Diabetes.

In the last decade, we have witnessed substantial progress in our understanding of corneal biomechanics and architecture. It is well known that diabetes is a systemic metabolic disease that causes chronic progressive damage in the main organs of the human body, including the eyeball. Although the main and most widely recognized ocular effect of diabetes is on the retina, the structure of the cornea (the outermost and transparent tissue of the eye) can also be affected by the poor glycemic control characterizing diabetes. The different corneal structures (epithelium, stroma, and endothelium) are affected by specific complications of diabetes. The development of new noninvasive diagnostic technologies has provided a better understanding of corneal tissue modifications. The objective of this review is to describe the advances in the knowledge of the corneal alterations that diabetes can induce.

Visual field defects and retinal nerve fiber imaging in patients with obstructive sleep apnea syndrome and in healthy controls.

BACKGROUND: To assess the retinal sensitivity in obstructive sleep apnea hypopnea syndrome (OSAHS) patients evaluated with standard automated perimetry (SAP). And to correlate the functional SAP results with structural parameters obtained with optical coherence tomography (OCT). METHODS: This prospective, observational, case-control study consisted of 63 eyes of 63 OSAHS patients (mean age 51.7 ± 12.7 years, best corrected visual acuity ≥20/25, refractive error less than three spherical or two cylindrical diopters, and intraocular pressure < 21 mmHg) who were enrolled and compared with 38 eyes of 38 age-matched controls. Peripapillary retinal nerve fiber layer (RNFL) thickness was measured by Stratus OCT and SAP sensitivities and indices were explored with Humphrey Field Analyzer perimeter. Correlations between functional and structural parameters were calculated, as well as the relationship between ophthalmologic and systemic indices in OSAHS patients. RESULTS: OSAHS patients showed a significant reduction of the sensitivity for superior visual field division (p = 0.034, t-student test). When dividing the OSAHS group in accordance with the severity of the disease, nasal peripapillary RNFL thickness was significantly lower in severe OSAHS than that in controls and mild-moderate cases (p = 0.031 and p = 0.016 respectively, Mann-Whitney U test). There were no differences between groups for SAP parameters. We found no correlation between structural and functional variables. The central visual field sensitivity of the SAP revealed a poor Pearson correlation with the apnea-hipopnea index (0.284, p = 0.024). CONCLUSIONS: Retinal sensitivity show minor differences between healthy subjects and OSAHS. Functional deterioration in OSAHS patients is not easy to demonstrate with visual field examination.

Implementación de estrategias interdisciplinarias para el retorno al trabajo: revisión de literatura / Implementation of interdisciplinary strategies for returning to work: literature review

Objetivo: analizar las estrategias interdisciplinarias implementadas en el retorno al trabajo de trabajadores que reportan enfermedad laboral y/o accidente de trabajo. Método: revisión de literatura que utiliza las palabras claves (tesauros): “Reubicación laboral”, “Reincorporación laboral”, “Trabajo”, “Estrategias” y “Terapia Ocupacional”, uso de boléanos AND y OR, búsqueda de la evidencia en las bases de datos: ProQuest, Ebsco, PubMed, Embase y Scopus, en el periodo 2006 - 2016. Resultados: los hallazgos muestran una selección de 20 artículos, encont rados principalmente en la base de datos de ProQuest. La estrategia interdisciplinaria más utilizada es la identificación de la exigencia del puesto de trabajo, las habilidades del trabajador y la evaluación del WRI (Entrevista del rol del trabajador) utilizada por Terapia Ocupacional. Conclusiones: las evaluaciones como estrategia del retorno al trabajo se centran en las capacidades y funciones físicas, con frecuencia no cuentan con el impacto psicosocial, conductual y ambiental como factores determinantes del rendimiento y capacidad laboral; es por esto que, con el uso de una evaluación basada en el desempeño ocupacional, los Terapeutas Ocupacionales lograrían evaluar de forma segura y efectiva la capacidad del trabajador para desempeñar tareas.

Objective: Analyze the interdisciplinary strategies implemented in the return to work of workers who report occupational illness and/ or work accident. Method: literature review using topics as: “job relocation,” “Return to work”, “Work”, “Strategies” and “Occupational Therapy”, using boolean AND and OR, search for evidence in the databases: ProQuest, EBSCO, PubMed, Embase and Scopus, in the period 2006 - 2016. Results: the findings show a selection of 20 items, found mainly in the ProQuest database. The interdisciplinary approach most commonly used is the identification of the requirements of the job and the skills of the worker and WRI (Worker role interview) assessment used by occupational therapy. Conclusions: assessments as return to work strategy focus on skills and physical functions, often they lack the psychosocial, behavioral and environmental impact as determinants of performance and working capacity; which is why using a web - based occupational performance evaluation, occupational therapists would achieve safely and evaluate effective worker’s ability to perform tasks.

Retinal and optic nerve evaluation by optical coherence tomography in adults with obstructive sleep apnea-hypopnea syndrome (OSAHS).

OBJECTIVE: To assess the peripapillary retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) morphologic parameters, and macular thickness and volume in patients affected by obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: This prospective, observational case-control study consisted of 96 eyes of 50 OSAHS patients (mean age of 50.9 ± 12.4 years, best-corrected visual acuity ≥ 20/20, refractive error less than 3 spherocylindrical diopters, and intraocular pressure <21 mmHg) who were enrolled and compared with 64 eyes of 33 age-matched controls. Peripapillary RNFL thickness, ONH parameters, macular thickness and volume were measured by optical coherence tomography (OCT). RESULTS: OSAHS patients showed a significant reduction of the nasal quadrant RNFL thickness (74.7 ± 15.8 µm) compared with those values observed in control patients (81.1 ± 16.6 µm, p=0.047, Student's t-test). No differences in peripapillary RNFL thickness were observed when dividing the OSAHS group in accordance with disease severity. Vertical integrated rim area (VIRA) (0.67 ± 0.41 mm(3) in OSAHS vs 0.55 ± 0.29 mm(3) in controls; p=0.043, Student's t-test), horizontal integrated rim width (HIRW) (1.87 ± 0.31 mm(2) in OSAHS vs 1.8 ± 0.25 mm(2) in controls; p=0.039, Student's t-test) and disc area (2.74 ± 0.62 mm(2) in OSAHS vs 2.48 ± 0.42 mm(2) in controls; p=0.002, Student's t-test) showed significant differences, all of them being higher in the OSAHS group. Severe OSAHS had significant higher disc area (2.8 ± 0.7 mm(2)) than controls (2.5 ± 0.4 mm(2); p=0.016, ANOVA test). Temporal inner macular thickness was significantly higher in mild-moderate OSAHS patients (270 ± 12 µm) than in severe OSAHS patients (260 ± 19 µm; p=0.021, ANOVA test). CONCLUSIONS: OSAHS patients showed decreased peripapillary nasal RNFL thickness, and increased ONH area and volume parameters when they were evaluated by OCT. These findings suggest that neuronal degeneration might be present in the retina of OSAHS patients, as previously observed in some neurodegenerative disorders.

Evaluation of in vitro efficacy of combined riboflavin and ultraviolet a for Acanthamoeba isolates.

PURPOSE: To evaluate in vitro the amoebicidal effects of riboflavin and ultraviolet A (UVA) collagen cross-linking. DESIGN: Experimental study, laboratory investigation. METHODS: Two different strains of Acanthamoeba species were tested identically. Four treatment groups were considered: group 1 consisted of 0.1% riboflavin and 30-minute UVA irradiation; group 2 consisted of 0.1% riboflavin and 60-minute UVA irradiation; group 3 consisted of no riboflavin and no UVA exposure; group 4 consisted of 0.1% riboflavin and no UVA exposure. The application of UVA was performed under the parameters used for in vivo corneal collagen cross-linking. RESULTS: In all cases, cysts and trophozoites were detected 24 hours after treatment at a radial distance from the center of the seeding point more than 5 mm, indicating that the amoebae were viable. All treated and untreated groups of amoebae from the 2 strains exhibited growth (radii of 14 to 15 mm in groups 1, 3, and 4; radius of 12 mm in group 2). The final morphologic features of the 2 strains of trophozoites that received treatment were similar to those of the initial seeding group and the untreated control group. CONCLUSIONS: The results obtained in our study show that a single dose (30 or 60 minutes) of cross-linking cannot achieve eradication in the 2 different Acanthamoeba strains examined. However, in vitro results do not always indicate in vivo efficacy, so future studies should test the validity of this treatment for Acanthamoeba keratitis.