Avaliação dos alunos deficientes visuais e videntes do Instituto de Cegos Padre Chico / Evaluation of the visually impaired and sighted students at the Instituto de Cegos Padre Chico

RESUMO Objetivo Avaliar o perfil dos alunos concluintes, deficientes visuais e videntes do Instituto de Cegos Padre Chico entre os anos 2011 e 2020. Métodos Entre janeiro e março de 2021, foi realizada uma análise documental dos alunos concluintes entre os anos de 2011 e 2020. Foram coletados dados relacionados à situação social, educacional, socioeconômica e oftalmológica. Os dados foram tratados no programa Microsoft Excel 2013 da Microsoft e analisados no software livre Bioestat, versão 5.0. Resultados Foram coletados os dados de 110 concluintes cegos, com baixa visão e videntes. Mais de 90% dos alunos declararam rendimento familiar equivalente a um salário-mínimo e meio. Do total da amostra, 52 alunos eram cegos; 38 tinham baixa visão, e 20 eram videntes. Dentre as 36 patologias identificadas entre os alunos, 57,78% levaram à cegueira e 42,22%, à baixa visão. Em alunos cegos, as patologias mais frequentes foram glaucoma congênito (32,69%) e amaurose congênita de Leber (11,53%); em alunos com baixa visão, foram glaucoma congênito e distrofias de retina (ambas em 10,53% da amostra). Conclusão É de suma importância a avaliação da saúde ocular para que o professor realize de forma mais rápida as práticas de ensino e alcance resultados satisfatórios na alfabetização de crianças com deficiência visual.

ABSTRACT Objective To evaluate the profile of visually impaired and sighted students at the Instituto de Cegos Padre Chico (ICPC) between 2011 and 2020. Methods Between January and March 2021, a document analysis of the students who completed the undergraduate course between 2011 and 2020. Data related to social, educational, socioeconomic, and ophthalmological situation were collected. The data were treated in Microsoft Excel 2013 and analyzed in the free software Bioestat, version 5.0. Results Retrospective data were collected from 110 blind, low-vision and sighted students who were graduating. More than 90% of the students declared family income equivalent to one and a half minimum wages. Of the total sample, 52 students were blind; 38 had low vision, and 20 were sighted students. Among the 36 pathologies identified among the students, 57.78% led to blindness, and 42.22%, to low vision. In blind students, the most frequent diagnosis was congenital glaucoma (32.69%) and Leber congenital amaurosis (11.53%); in low vision students, congenital glaucoma and retinal dystrophies (both in 11.53% of the population of this study). Conclusion The evaluation of the eye health is of vital importance for the teacher to perform teaching practices faster and achieve satisfactory results in the literacy of visually impaired children.

Delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale (RASS): Inattention and visuo-spatial impairment as potential screening domains.

OBJECTIVE: In the intensive care setting, delirium is a common occurrence; however, the impact of the level of alertness has never been evaluated. Therefore, this study aimed to assess the delirium characteristics in the drowsy, as well as the alert and calm patient. METHOD: In this prospective cohort study, 225 intensive care patients with Richmond Agitation and Sedation Scale (RASS) scores of -1 - drowsy and 0 - alert and calm were evaluated with the Delirium Rating Scale-Revised-1998 (DRS-R-98) and the Diagnostic and Statistical Manual 4th edition text revision (DSM-IV-TR)-determined diagnosis of delirium. RESULTS: In total, 85 drowsy and 140 alert and calm patients were included. Crucial items for the correct identification of delirium were sleep-wake cycle disturbances, language abnormalities, thought process alterations, psychomotor retardation, disorientation, inattention, short- and long-term memory, as well as visuo-spatial impairment, and the temporal onset. Conversely, perceptual disturbances, delusions, affective lability, psychomotor agitation, or fluctuations were items, which identified delirium less correctly. Further, the severities of inattentiveness and visuo-spatial impairment were indicative of delirium in both alert- or calmness and drowsiness. SIGNIFICANCE OF RESULTS: The impairment in the cognitive domain, psychomotor retardation, and sleep-wake cycle disturbances correctly identified delirium irrespective of the level alertness. Further, inattentiveness and - to a lesser degree - visuo-spatial impairment could represent a specific marker for delirium in the intensive care setting meriting further evaluation.

Sport classification for athletes with visual impairment and its relation with swimming performance / Classificação esportiva para atletas com deficiência visual e sua relação com o desempenho na natação

Abstract The medical classification (MC) adopted for swimmers with vision visual impairment (VI) does not clearly elucidate the influence of vision loss on performance. In a documentary research, the final time in the 50-, 100- and 400-m freestyle events and MC (S11, S12 and S13) of national (n = 40) and international (n = 72) elite swimmers was analyzed. The analysis was performed using the Kruskal-Wallis test and Spearman’s correlation with 95% confidence (P < 0.05) and Cohen’s d was calculated. There was a large effect of MC on the final time in the 50-m (P = 0.034, d = 1.55) for national athletes and in the 50-m (P = 0.001, d = 2.64), 100-m (P = 0.001, d = 3.01) and 400-m (P = 0.001, d = 2.88) for international athletes. S12 and S13 classes were faster compared to S11 class for all international events, but only in the 50-m for the national event (P < 0.05). It was found a strong negative relationship between the final time and MC for international athletes (Spearman’s Rho ≥ 0.78). There was a significant influence of MC on the performance of swimmers in freestyle races, especially in international swimmers. Thus, having a visual residue seems to be sufficient for S12 and S13 swimmers to achieve similar performance.

Resumo A classificação médica (CM) adotada aos nadadores com deficiência visual (DV) não consegue elucidar claramente a influência da perda da visão no desempenho. Em uma pesquisa documental, analisou-se o tempo final de prova dos 50, 100 e 400m livre e a CM (S11, S12 e S13) de nadadores nacionais (n = 40) e internacionais (n = 72) de elite. Utilizou-se o teste de Kruskal-Wallis e a correlação de Spearman, com 95% de confiança (P < 0,05) e o tamanho do efeito d de Cohen foi calculado. Verificou-se um grande efeito da CM no tempo final de prova dos 50m (P = 0,034; d = 1,55) para atletas nacionais e dos 50m (P = 0,001; d = 2,64), 100m (P = 0,001; d = 3,01) e 400m (P = 0,001; d = 2,88) para atletas internacionais. As classes S12 e S13 foram mais rápidas comparadas à classe S11 em todas as provas internacionais, mas apenas nos 50m nas provas nacionais (P < 0,05). Foram encontrados fortes relacionamentos negativos entre o tempo final de prova e a CM para os atletas internacionais (Rho de Spearman ≥ 0,78). Houve uma significativa influência da CM no desempenho de nadadores nas provas do nado livre, especialmente em nadadores internacionais. Assim, ter um resíduo visual parece ser o suficiente para que os nadadores com baixa visão, nas classes S12 e S13, adquiram performance semelhante.

Correlations of Objective Metrics for Quantifying Dysfunctional Lens Syndrome With Visual Acuity and Phacodynamics.

PURPOSE: To study the relationship between objective metrics for quantifying crystalline lens dysfunction with visual impairment and phacodynamics parameters in age-related nuclear cataracts. METHODS: A total of 51 eyes (34 patients) with age-related nuclear cataract had phacoemulsification. The Dysfunctional Lens Index (0 to 10 points) was measured by a ray-tracing aberrometry (iTrace Visual Function Analyzer; Tracey Technologies, Houston, TX). The average lens density (0 to 100) was evaluated using a rotating Scheimpflug system (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany), and the nuclear opalescence score was subjectively assessed using the Lens Opacities Classification System III (LOCS III). The different parameters for evaluating crystalline lens dysfunction were correlated with preoperative corrected distance visual acuity (CDVA) and cumulative dissipated energy (CDE). RESULTS: There was a negative linear correlation between the Dysfunctional Lens Index and the LOCS III nuclear opalescence and Scheimpflug-measured average density (r =-0.728 and r = -0.771, respectively; both P < .01). The preoperative CDVA was correlated with the Scheimpflug-measured lens nuclear density value (r = 0.612, P < .01) and Dysfunctional Lens Index score A (r =-0.670, P < .01). The CDE was more strongly correlated with Dysfunctional Lens Index and Scheimpflug-derived average density (r =-0.744 and r = 0.700, respectively; both P < .01) than with LOCS III nuclear opalescence (r = 0.646, P < .01). CONCLUSIONS: The Dysfunctional Lens Index was correlated with the Scheimpflug-measured average density, subjective lens grading, and preoperative CDVA. This metric also presented the highest correlation with phacodynamics. Correlation with other clinical measures related to visual quality and impairment are still needed. [J Cataract Refract Surg. 2017;33(2):79-83.].

Visual impairment.

This chapter can guide the use of imaging in the evaluation of common visual syndromes: transient visual disturbance, including migraine and amaurosis fugax; acute optic neuropathy complicating multiple sclerosis, neuromyelitis optica spectrum disorder, Leber hereditary optic neuropathy, and Susac syndrome; papilledema and pseudotumor cerebri syndrome; cerebral disturbances of vision, including posterior cerebral arterial occlusion, posterior reversible encephalopathy, hemianopia after anterior temporal lobe resection, posterior cortical atrophy, and conversion blindness. Finally, practical efforts in visual rehabilitation by sensory substitution for blind patients can improve their lives and disclose new information about the brain.

Permanent Ocular Injury Following Paintball Pellet Hit: A Medicolegal Case.

Paintball is a ubiquitous recreation, with severe and occasionally irreversible injuries. In this study, a rare medicolegal case of paintball-related closed globe blunt ocular injury was described. An 18-year-old boy who was hit in his right eye by a paintball pellet presented with severe eye pain and blurred vision. Ophthalmologic examinations showed lid edema, conjunctival hyperemia, conjunctival laceration, subconjunctival hemorrhage, corneal edema, anterior vitreous hemorrhage, congested sclera, commotio retinae, vitreous hemorrhage, retinal hemorrhage, macular edema, and macular hole. After maximum medical improvement, the patient who sustained incurable maculopathy and decreased visual acuity was referred to the legal medicine center for appraisal of the impairment. AMA Guides was used to assess the impairment of the functional vision. Despite his monocular visual defect, the patient was rated in the range of mild vision loss namely AMA class 1 with 22 percentage visual system impairment.

Patients with ocular symptoms referred for electrodiagnosis: how many of them suffer from myasthenia gravis?

The aim of this study was the diagnosis of patients with isolated ocular manifestations (ptosis and/or diplopia) referred for electrophysiological evaluation to the electrodiagnostic laboratory of a University Neurological Department. Examination was performed either in inpatient status or in outpatient basis. We analyzed the clinical, electrophysiological and other laboratory data in 79 subjects. Myasthenia gravis (MG) was diagnosed in 38 %, 45.6 % in other diseases (Graves disease, blepharospasm, IIId cranial verve palsy, multiple sclerosis, stroke, etc.), while in 16.5 %, the cause remained unidentified. Symptoms fluctuation was significantly more frequent in the myasthenic patients, compared to patients with other diseases. The presence of both diplopia and ptosis are more likely due to MG rather than other pathology.

Visual disability rates in a ten-year cohort of patients with anterior visual pathway meningiomas.

PURPOSE: To examine the visual outcome of anterior visual pathway meningioma (AVPM) patients followed for at least one year. METHODS: Data were collected on demographics, clinical course and management. Visual disability was classified at the first and last examination as follows: I--no visual disability; II--mild visual defect in one eye; III--mild visual defect in both eyes; IV--loss of driver's license; V--legally blind. RESULTS: Eight-one AVPM patients had their tumor originate in the clinoid process in 23 (28%), sphenoid-wing area in 18 (22%), cavernous sinus in 15 (19%), tuberculum sellae in 8 (10%), and mixed in 17 (21%). On last examination, 46 patients (57%) had good visual acuity in one or both eyes (Class I or II) and 17 (21%) were mildly affected in both eyes. The rate of Class IV disability was 16%, and Class V disability was 6%. CONCLUSIONS: Attention needs to be addressed to the considerable proportion of patients with AVPM (22% in this study) who may lose their driver's license or become legally blind. Occupational therapists should play an important role in the multidisciplinary management of those patients to help them adapt to their new physical and social situation. IMPLICATIONS FOR REHABILITATION: Anterior visual pathway meningiomas (AVPMs) are commonly not life-threatening but they can lead to profound visual disability, especially when the tumor originates in the tuberculum sellae and cavernous sinus. Particular attention should be paid to visual acuity and visual field deficits, as these can profoundly affect the patient's quality of life including ability to drive and activities of daily living. The interdisciplinary management of patients with AVPM should include the neurosurgeon, neuro-ophthalmologist and occupational therapist. Also, early intervention by the occupational therapist can help patients adapt to their current physical and social situation and return to everyday tasks more rapidly.

Visual impairment registration: evaluation of agreement among ophthalmologists.

PURPOSE: To evaluate consistency among consultant ophthalmologists in registration of visual impairment of patients with glaucoma who had a significant visual field component to their visual loss. METHOD: Thirty UK NHS consultant ophthalmologists were asked to grade data sets comprising both visual acuity and visual fields as severely sight impaired, partially sight impaired, or neither. To assess intra-consultant agreement, a group of graders agreed to repeat the process. RESULTS: Kappa for inter-consultant agreement (n=30) for meeting the eligibility criteria for visual impairment registration was 0.232 (95% CI 0.142-0.345), the corresponding inter-class correlation score was 0.2 (95% CI 0.172 to 0.344). Kappa for intra-consultant agreement (n=16) ranged from 0.007 to 0.9118. CONCLUSIONS: When presented with the clinical data necessary to decide whether patients with severe visual field loss are eligible for vision impairment registration, there is very poor intra- and inter-observer agreement among consultant ophthalmologists with regard to eligibility. The poor agreement indicates that these criteria are open to significant subjective interpretation that may be a source of either under- or over-registration of visual impairment in this group of patients in the UK. This inconsistency will affect the access of visually impaired glaucoma patients to support services and may result in inaccurate recording of the prevalence of registerable visual disability among glaucoma patients with severe visual field loss. More objective criteria with less potential for misclassification should be introduced.

Association between visual field defects and quality of life in the United States.

PURPOSE: To investigate the association between visual field defects and quality of life in the United States population. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 5186 participants in the 2005 through 2008 National Health and Nutrition Examination Survey 40 years of age and older without a self-reported history of age-related macular degeneration or prior refractive surgery who had undergone frequency doubling technology perimetric testing. METHODS: Frequency doubling technology perimetry was performed in both eyes. Results from the better eye were used to categorize subjects as normal or having mild, moderate, or severe visual field loss. Subjects completed surveys about their visual and physical functioning ability. MAIN OUTCOME MEASURES: Disability pertaining to 6 vision-related activities, 2 visual function questions, and 5 physical functioning domains. RESULTS: Eighty-one percent of subjects had normal visual fields and 10%, 7%, and 2% demonstrated mild, moderate, and severe visual field defects, respectively. Subjects with greater severity of visual field defects had greater difficulty with vision-related activities. Subjects with severe visual field defects demonstrated the greatest odds of difficulty with all 6 activities. The 2 activities impacted most adversely were daytime driving in familiar places (odds ratio [OR], 12.4; 95% confidence interval [CI], 6.1-25.1) and noticing objects off to the side when walking (OR, 7.7; 95% CI, 4.7-12.7). Subjects with severe visual field defects had greater odds of worrying about eyesight (OR, 3.4; 95% CI, 2.0-5.8) and being limited by vision in the time spent on daily activities (OR, 5.1; 95% CI, 3.0-8.5). Subjects with severe visual field defects demonstrated the greatest odds of difficulty with 3 physical function domains, including activities of daily living (OR, 2.45; 95% CI, 1.37-4.38), instrumental activities of daily living (OR, 2.45; 95% CI, 1.37-4.38), as well as leisure and social activities (OR, 3.29; 95% CI, 1.87-5.77). CONCLUSIONS: Greater severity of visual field abnormality was associated with significantly greater odds of disability with vision-related function and physical function. These findings support the necessity of routine screening to find those who may benefit from therapy to prevent progressive glaucomatous vision loss.

Clinical grading of post-LASIK ectasia related to visual limitation and predictive factors for vision loss.

PURPOSE: To evaluate and characterize the main clinical features of post-laser in situ keratomileusis (LASIK) ectasia, propose a grading system based on visual limitation, and identify predictive factors related to the degree of visual loss. SETTING: Vissum Corp., Alicante, Spain. DESIGN: Retrospective case series. METHODS: This study comprised consecutive eyes with corneal ectasia after LASIK from 1996 to 2010. Main outcomes were post-LASIK ectasia corrected distance visual acuity (CDVA), CDVA loss, spherical equivalent (SE), and the corneal bulge (delta K). These outcomes were correlated with the residual stromal bed, ablation depth, ablation ratio (ablation depth:pachymetry), corneal depth (flap + ablation depth), and corneal ratio (corneal depth:pachymetry) to characterize their role in the severity of the disease. RESULTS: The mean post-LASIK ectasia CDVA, CDVA loss, SE, and delta K were 0.20 logMAR ± 0.18 (SD), -0.13 ± 0.15 logMAR, -3.80 ± 3.86 diopters (D), and 4.77 ± 4.23 D, respectively. The ablation ratio had the strongest correlation with post-LASIK ectasia CDVA (ρ = 0.477 and P<.001), whereas the corneal ratio had the strongest correlation with the post-LASIK ectasia SE and delta K (ρ = -0.614 and ρ = 0.453, respectively: P<.001). The ablation ratio was the main predictive factor for post-LASIK ectasia CDVA loss (relative risk, 2.04; P=.049). CONCLUSIONS: The grading system based on visual limitation was consistently represented by differences in CDVA loss, SE, and delta K. A high amount of tissue removed by the refractive procedure was associated with greater corneal biomechanical destabilization, increased corneal steepening, and a worse prognosis.

Ophthalmic manifestations of paranasal sinus disease: a clinical grading system.

BACKGROUND: Ophthalmic complications are common manifestations of paranasal sinus disease. We propose a clinical grading system to standardize the category, treatment, and outcome of these complications. METHODS: Forty-two patients with paranasal sinus disease-induced ophthalmic complications were included in the study. The patients were categorized according to their clinical presentation: Grade I, patients with anatomical disturbance; Grade II, patients with ophthalmic functional involvement; Grade III, patients with orbital infection; and Grade IV, patients with visual impairment. RESULTS: The age of the patients ranged from 8 to 65 years (mean = 30 years). Overall, 36% patients had ophthalmologic manifestations with anatomical disturbance (Grade I), 26% had functional disturbance (Grade II), 26% had orbital infections (Grade III), and 12% had visual loss (Grade IV). The cause of the ophthalmic manifestations was allergic fungal sinusitis in 50%, chronic rhinosinusitis in 36%, acute sinusitis in 10%, and mucocele in 4%. The most common ophthalmic manifestation was proptosis (36%), followed by orbital infection (26%), functional involvement (26%), and visual impairment (12%). The patients underwent functional endoscopic sinus surgery and medical treatment when indicated. The outcome in Grades I, II, and III was favorable; the outcome in Grade IV was not favorable. CONCLUSION: This simple clinical grading system provides a useful tool for assessing the overall status of ophthalmic complications of Acute and chronic paranasal sinus disease at the initial clinical assessment and for subsequent management of these complications.

Glistenings in a large series of hydrophobic acrylic intraocular lenses.

PURPOSE: To evaluate the incidence and severity of glistenings in hydrophobic acrylic intraocular lenses (IOLs) and assess the potential correlation between glistenings and clinical and demographic factors. SETTING: Service d'Ophtalmologie, Centre Hospitalier et Universitaire Bordeaux, Bordeaux, France. METHODS: Eligible patients received an AcrySof IOL between September 2000 and December 2007 and had a routine ophthalmic visit between January 2007 and March 2008. The incidence and severity of glistenings were graded subjectively and analyzed in relation to patient age and sex, length of follow-up, IOL model, IOL power, neodymium:YAG laser capsulotomy, corrected distance visual acuity (CDVA), spherical equivalent (SE), and selected ocular and systemic diseases and medications. RESULTS: Glistenings occurred in 157 (60.4%) of the 260 eyes; they were absent in 103 eyes (39.6%). Glistenings were of grade 1 severity in 87 eyes (33.5%) and of grade 2 severity in 70 eyes (26.9%). CONCLUSIONS: The results suggest a potential association between the incidence of glistenings and IOL power and glaucoma, but not between glistenings and age, sex, IOL model, length of follow-up, CDVA, SE, or most ocular and systemic diseases and medications.

[Efficacy and complications of a mini-trabeculectomy technique]. / Efficacité et complications d'une technique de mini-trabéculectomie ajustable.

OBJECTIVE: To assess the outcome and the complication rate of an adjustable mini-trabeculectomy in medically uncontrolled glaucoma. PATIENTS AND METHODS: This study retrospectively evaluated the medical records of 40 patients undergoing primary mini-trabeculectomy. All patients were followed at least 24 months, with a mean follow-up of 60.85 +/- 37.7 months. Visual acuity, intraocular pressure (IOP), visual field (MD, Humphrey), number of antiglaucoma medications, intra- and postoperative complications, postoperative procedures (laser suture lysis, 5-fluorouracil subconjunctival injections, or a new trabeculectomy) were analyzed. RESULTS: Preoperative IOP was 23.2 +/- 6.48 mmHg (range, 13-53 mmHg) with 2.42 +/- 0.74 (range, 1-4) antiglaucoma medications. At last examination, after 60.85 +/- 37.7 months (mean +/- standard deviation; minimum 24 months) of postoperative follow-up, IOP was 12.55 +/- 2.12 mmHg with 0.42 +/- 0.78 antiglaucoma medications (p<0.001 compared to preoperative IOP and p<0.001 compared to the number of medications); 85% and 92.5% of patients had IOP reduced by 30% or more and a final IOP less than 16 mmHg with or without antiglaucoma medications, respectively, and 52.5% had one or more scleral flap sutures released by laser. Postoperative complications were infrequent: flat anterior chamber with choroidal detachment (2.5%) and iris incarceration in the trabeculectomy site (2.5%). Seven patients had an encapsulation of the filtering bleb (17.5%) after a mean follow-up of 34.33 +/- 33 days after surgery. Four patients (10%) had cataract surgery during the 2 years following trabeculectomy. A significant decrease in visual acuity was observed after surgery (p=0.018); nevertheless, there was no statistically significant difference between preoperative and postoperative MD (-10.46+/-9.37 dB and -10.65+/-4.36 dB, respectively; p=0.971, for 23 patients). CONCLUSION: Adjustable mini-trabeculectomy controlled postoperative filtration. Easy to perform, this surgical technique seemed to be safe and effective, and it reduced the rate of early postoperative complications in the surgical management of patients with glaucoma.

[Phenotype of the visual system in oculocutaneous and ocular albinism]. / Phänotyp des visuellen Systems bei okulokutanem und okulärem Albinismus.

In spite of albinism being one of the visual impairments which has been known for over a century, it has only been known for a few decades that albinism is correlated to severe cerebral morphological developmental alterations. The increasing knowledge about the role of melanin in the development and orientation of cerebral neurons not only renders more insight into albinism, but also a greater insight in the physiological neuronal and cerebral development in man. Concerning the morphological and visual phenotype there are new clinical findings which enlarge the known spectrum of albinism. In a representative group of 506 persons with oculocutaneous and ocular albinism who are in care at the Department of Ophthalmology at the University of Saarland (UKS), we present a staging of morphological findings of the iris, retinal pigment epithelium and macula, and of the optic nerve head which has been in use for 10 years. Albinism may present with a remarkably mild ocular phenotype and a near to normal functional phenotype. We present correlations between molecular genetic types of albinism, ocular phenotype and visual function. Of great importance concerning later visual acuity is the dysplasia of the optic nerve head (ONH), which is a frequent finding in albinism. The appearance of the ONH should always be included in any clinical description of an albinism patient. It is highly possible that due to a moderate phenotype there are still many patients who have not been diagnosed yet. Visual acuity of 30/20 to 20/20 and no nystagmus do not rule out albinism. In addition, when performing albino VEPs in phenotypically normal children with infantile strabismus, small ONHs, but normal visual acuity and no nystagmus, the classical atypical chiasmal crossing is sometimes found. Therefore, the number of persons having undiagnosed albinism is probably quite high, perhaps there even is a very broad transition zone from normal to albinotic.

[Spectacle lenses in sports: optimization of the imaging properties based on physiological aspects]. / Brillengläser im Sport: Optimierung der Abbildungseigenschaften unter physiologischen Aspekten.

The goal of correction spectacles is to create a sharp image on the retina by the combined optical system of the eye and the spectacle lens for a given ametropia. As a matter of principle, in this optical system an aberration free correction can be achieved in the optical centre of the spectacle lens, but not over the entire range of gaze angles. In spectacle optics large angles play an important role, different from paraxial optics where only rays close to the axis with small angles of incidence are relevant. This generates additional aberrations, the so-called oblique astigmatism, which can only be compensated at the expense of the spherical power. Therefore, every spectacle lens represents apart from the main visual point-, a more or less good compromise. For sports lenses in the currently used curved frames, an additional challenge arises from the fact that their orientation in front of the eye is generally not perpendicular to the principal gaze direction but tilted. In this article the imaging properties of such tilted sports lenses are discussed, and it is described why this results in a minor quality without a specific consideration of the obliqueness. The fact that tilted sports spectacles are also able to possess an improved correction behaviour for all gaze angles is due to individual mathematical optimization methods. The aim of the present article is, based on the underlying physical and physiological effects, to point out the advantages of individually optimized sports spectacle lenses in comparison to tilted lenses generated without applying this sophisticated computational method.

Intra-oral findings and general health conditions among institutionalized and non-institutionalized elderly in Greece.

BACKGROUND: The aim of the study was to record the findings from intra-oral examination and the general health conditions encountered in a group of Greek individuals 65 years of age or older. PATIENTS AND METHODS: The study subjects were derived from the elderly attending 12 randomly selected community centres located in Athens and neighbouring municipalities, consisting the non-institutionalized study group and from the elderly living in three ecclesiastical nursing homes, consisting the institutionalized study group. The research data comprised information from the subjects' interviews, self-defined health status, medical records and intra-oral examination on the following variables: sex, age, general health condition, dentate or not, use of dentures and oral conditions. Fisher's exact two-sided test was used for statistical analysis. RESULTS: Overall, 316 patients were examined; 120 male (38%), 196 female (62%), mean age 78 years (range: 65-99). Of those, 150 were non-institutionalized (59 male, 91 female) and 166 institutionalized (61 male and 105 female). The vast majority (90%) of the patients had at least one general health problem, for which they were taking daily medication. Twenty-three different medical conditions were recorded. The most frequent medical problems were hypertension (56%), cardiovascular problems (41%), depression/anxiety (39%), arthritis (18.5%) and visual problems (16%). The vast majority of the study patients (79%) were edentulous, while 33% were not wearing or using their dentures. Almost half of them (47%) had at least one oral condition. Twenty-seven different oral conditions were recorded. The most frequent oral findings were denture-induced stomatitis (17.2%), dry mouth (14.6%), atrophy of tongue papillae (10.5%), fissured tongue (9.8%) and haemangioma (6.8%). No cases of malignant lesions were observed. CONCLUSIONS: The present study confirms that in this particular age group, general health problems are frequent, variable, coexistent, necessitating the daily administration of multiple medications, while oral examination by a specialist is an essential part of the multidisciplinary medical care in this group of individuals.

Regional patterns of sight-threatening diabetic macular edema.

PURPOSE: To define regional patterns of macular thickening in diabetic macular edema (DME). DESIGN: Retrospective case series. SETTING: Retina practice. PATIENT POPULATION: Fifty-two normal eyes of 48 patients and 100 eyes of 80 patients with DME. EXPERIMENTAL PROCEDURE: We measured retinal thickness for nine zones and total macular volume using the 3.5-mm display of an optical coherence tomograph (OCT). We determined the normal ranges of values for zones, and then normal ranges of values for the difference in thickness between each pair of zones, termed comparisons. main outcome measures: Frequencies of increased zonal thickness, increased total macular volume, and abnormalities in zonal comparisons. RESULTS: We found the following abnormalities: increased total macular volume 49% (49/100), increased foveal zone thickness 46% (46/100), increased inner parafoveal zone thickness (average 42.2% for the four zones), and increased outer zone thickness (average 34.3% for the four zones). Abnormal two-zone comparisons were found in 1027 of the 7200 possible comparisons (14.3%). Of these abnormal comparisons, the fovea was thicker relative to another zone in 26%; the four inner parafoveal zones were thicker relative to other zones in 8.7% to 15.2% (average 13.0%); and the four outer zones were thicker relative to other zones in 3.9% to 7.6% (average 6%). Eighty-eight percent (88/100) of the eyes chosen on clinical grounds as needing focal laser photocoagulation were detected. CONCLUSION: A broader concept of OCT abnormality, which includes abnormalities in zonal relationships, may improve automated detection of DME compared with clinical judgment.

Sine Amsler Charts: a new method for the follow-up of metamorphopsia in patients undergoing macular pucker surgery.

PURPOSE: To evaluate our new method for the follow-up of metamorphopsia in patients with a macular pucker. METHODS: Sine Amsler Charts (SAC) are a set of eight modified Amsler charts where we have replaced the straight lines by sine curves of the same frequency but with different amplitudes (grades I-VIII). The patient first examines a regular Amsler chart with the affected eye; subsequently the SAC are presented in random order to the fellow eye. With this eye the patient then selects the SAC with the amplitude that best corresponds to the metamorphopsia observed with the affected eye. After 30 min the test was repeated. A comparison of pre- and postoperative SAC scores was made in 63 patients. The correlations between preoperative visual acuity, membrane type, leakage on fluorescein angiography, preoperative SAC score, postoperative SAC score and postoperative visual acuity were analyzed. RESULTS: Preoperative repeat testing with the SAC revealed 100% reproducibility in the grading of metamorphopsia. Postoperative SAC was unchanged in 16% of cases, one grade lower in 54%, two grades lower in 21% and more than two grades lower in 7%. Postoperative visual acuity was unchanged (i.e., within two EDTRS lines of the preoperative value) in 49% of cases, improved in 48% and decreased in 3%. A decrease in SAC score with a two-line increase in visual acuity occurred in 43% of cases. CONCLUSION: The SAC examination is a reproducible and rapid method for the comparison of the preoperative and postoperative metamorphopsia in patients undergoing pucker surgery and it may serve as an additional outcome measure.