Prism therapy and visual rehabilitation in homonymous visual field loss.

PURPOSE: Homonymous visual field defects (HVFD) are common and frequently occur after cerebrovascular accidents. They significantly impair visual function and cause disability particularly with regard to visual exploration. The purpose of this study was to assess a novel interventional treatment of monocular prism therapy on visual functioning in patients with HVFD of varied etiology using vision targeted, health-related quality of life (QOL) questionnaires. Our secondary aim was to confirm monocular and binocular visual field expansion pre- and posttreatment. METHODS: Twelve patients with acquired, documented HVFD were eligible to be included. All patients underwent specific vision-targeted, health-related QOL questionnaire and monocular and binocular Goldmann perimetry before commencing prism therapy. Patients were fitted with monocular prisms on the side of the HVFD with the base-in the direction of the field defect creating a peripheral optical exotropia and field expansion. After the treatment period, QOL questionnaires and perimetry were repeated. RESULTS: Twelve patients were included in the treatment group, 10 of whom were included in data analysis. Overall, there was significant improvement within multiple vision-related, QOL functioning parameters, specifically within the domains of general health (p < 0.01), general vision (p < 0.05), distance vision (p < 0.01), peripheral vision (p < 0.05), role difficulties (p < 0.05), dependency (p < 0.05), and social functioning (p < 0.05). Visual field expansion was shown when measured monocularly and binocularly during the study period in comparison with pretreatment baselines. CONCLUSIONS: Patients with HVFD demonstrate decreased QOL. Monocular sector prisms can improve the QOL and expand the visual field in these patients.

Using a community-based health survey as a tool for informing local health policy.

BACKGROUND: The Speak to Your Health! community survey is a biennial community-based survey designed and implemented by the Prevention Research Center of Michigan whose central mission is to strengthen the capacity of the community to improve health. METHOD: The survey was developed collaboratively by the university and community partners that comprise the Prevention Research Center of Michigan and focuses on health and social issues at the heart of the community of Genesee County, Michigan. FINDINGS: The results of this survey have been used to shape policy changes and strategic planning at the county health department and in local health intervention programs. CONCLUSIONS: This project has demonstrated that useful quantitative data for addressing local public health policy and planning can be collected using the principles of community-based research.

Worldwide geographical distribution of ophthalmology publications.

International peer-reviewed publications form the basis of evidence-based medicine and are one of the main indicators of ophthalmology research activity. This paper examines the origins of such articles in relation to geographical location, population demographics and economic research profiles. Publications from five ophthalmology journals over 5 years were analysed using the Medline/Pubmed search engine. Country of origin was ascertained based on the address of the corresponding author. Worldwide ophthalmology research output was analysed in relation to population demographics and research expenditure. In total, 7,754 articles from 67 countries from 2002 to 2006 were analysed. The overall number of articles published increased by over 29% during this period. The United States (US) produced the greatest number of articles. Singapore produced the most publications per 10(6) population. There was a relationship between gross domestic product (GDP) greater than $20,000 and population-adjusted output. The US followed by the United Kingdom and Japan were the greatest gross contributors. Population-adjusted figures revealed that Singapore, Iceland and Australia were the most prolific nations. There was a relationship between GDP and the top-ranked population-adjusted countries. The top 10 most productive population-adjusted countries spend relatively more on research and development than the top 10 gross contributors.

Importance of fundoscopy in refractive surgery.

PURPOSE: To examine the incidence, treatment, and outcomes of retinal lesions before and after refractive laser surgery. SETTING: Private refractive surgery practice. METHODS: A retrospective review was conducted of patients attending the laser clinic over a 3-year period. Examined were the incidence, type, management, and outcomes of the posterior segment abnormalities encountered. RESULTS: Fifty two (1.1%) of 4800 patients had posterior segment pathology requiring intervention. Forty-five cases (0.86%) were detected preoperatively and had a mean refraction of -4.5 diopters (D) +/- 3.0 (SD). Seven cases (0.14%) were detected postoperatively at a mean follow-up of 19 +/- 18.3 months; none had preoperative pathology. The mean refraction in this group was -4.4 +/- 2.3 D. Ninety-five percent had myopic prescriptions. All maintained best corrected visual acuity postoperatively. The incidence of retinal detachment was 0.03% per year in the myopic candidates; however, no cases occurred after the refractive procedure. CONCLUSION: Dilated fundus examination is an integral part of optimum clinical care in refractive patients, and shared preoperative assessment by a retinal specialist is advisable in those with predisposing retinal pathology.