[Hypertensive retinopathy--assessment]. / Opinii critice privind aprecierea retinopatiei hipertensive.

The authors intend to make a synthesis of several recent studies available on the Internet regarding hypertensive retinopathy. From the physiopathologic point of view, it is considered that the blood circulation at the level of the retina, choroid and optical nerve has distinct anatomo-physiological properties. It has a different response to the changes in the blood pressure, the result consisting of distinct individual types of the hypertensive disease which can be rendered evident during the optical fundus examination. The retina is considered to be one of the target organs in the hypertensive disease. Ascertaining the retinal changes has advanced from ophthalmoscopy to digital photography studied with appropriate software. The assessment of the hypertensive microangiopathy is subjected to a wide intra- and interobserver variability an accurate assessment requiring specialized software and standardized protocols. There is also a lack of consensus regarding the classification of hypertensive retinopathy and the usefulness of retinal examination in the assessment of cardiovascular risk. The Keith and Scheie staging scales are still in use, but they do not allow the clinician to differentiate slight or even moderate changes at the level of the retina of hypertensive patients. Furthermore, they do not correlate enough with the severity of the high blood pressure and they are not supported by the angiofluorography studies. There are not enough motives for the recommendation of a routine ophthalmoscopic examination for all hypertensive patients. It is required for patients with stage-3 hypertension. It is also recommended when the initial clinical signs are equivocal, as in borderline or fluctuating high blood pressure without any other obvious signs from the target organs, for diabetic patients, or in the presence of visual symptoms. The clinical implications of hypertensive retinopathy being unclear, many of the authors do not recommend ophthalmoscopic examination as a rule, or they don't consider the retinal signs as being useful for therapeutic decisions.

[Ophthalmologist and "computer vision syndrome"]. / Oftalmologul practician si "computer vision syndrome".

The authors had tried to collect the data available on the Internet about a subject that we consider as being totally ignored in the Romanian scientific literature and unexpectedly insufficiently treated in the specialized ophthalmologic literature. Known in the specialty literature under the generic name of "Computer vision syndrome", it is defined by the American Optometric Association as a complex of eye and vision problems related to the activities which stress the near vision and which are experienced in relation, or during, the use of the computer. During the consultations we hear frequent complaints of eye-strain - asthenopia, headaches, blurred distance and/or near vision, dry and irritated eyes, slow refocusing, neck and backache, photophobia, sensation of diplopia, light sensitivity, and double vision, but because of the lack of information, we overlooked them too easily, without going thoroughly into the real motives. In most of the developed countries, there are recommendations issued by renowned medical associations with regard to the definition, the diagnosis, and the methods for the prevention, treatment and periodical control of the symptoms found in computer users, in conjunction with an extremely detailed ergonomic legislation. We found out that these problems incite a much too low interest in our country. We would like to rouse the interest of our ophthalmologist colleagues in the understanding and the recognition of these symptoms and in their treatment, or at least their improvement, through specialized measures or through the cooperation with our specialist occupational medicine colleagues.