Functional Ophthalmic Factors Associated With Extreme Prematurity in Young Adults.

Importance: Children born preterm (<37 weeks' gestation) have a higher risk of visual impairment and ocular morbidities compared peers born at full term. However, the long-term ocular sequelae in adulthood for those born extremely preterm (EP), who have the highest risk of neonatal retinopathy, are unknown. Objective: To evaluate visual function and ocular morbidity in young adults born EP compared with controls born full term. Design, Setting, and Participants: This prospective cohort study of a geographically based birth cohort in the UK and Ireland born from March 1 through December 31, 1995, included 128 participants aged 19 years (born at 22-25 weeks' gestation) and 65 age-matched controls born at full term. Statistical analysis was performed from March 1, 2020, to November 26, 2021. Exposures: Participants underwent eye examinations as part of a comprehensive outcome evaluation. Main Outcomes and Measures: Best-corrected visual acuity, refractive status, contrast sensitivity, color vision, prevalence of strabismus and nystagmus, and patient-reported visual function, measured using the Health Utilities Index Mark 3. Results: The study comprised 128 participants (256 eyes; 68 female participants [53%]; mean [SD] age, 19.3 [0.5] years) and 65 age-matched controls born at full term (130 eyes; 40 female participants [62%]; mean [SD] age, 19.2 [0.5] years). Compared with control eyes, the mean (SD) best-corrected visual acuity among eyes in the EP group was significantly worse (monocular vision: -0.06 [0.14] logMAR in the control group vs 0.14 [0.38] logMAR in the EP group; P < .001; binocular vision: -0.14 [0.15] logMAR in the control group vs 0.06 [0.37] logMAR in the EP group; P < .001). Participants in the EP group had a significantly higher prevalence of strabismus (36% [46 of 127] vs 0%; P < .001), abnormal ocular motility (15% [19 of 125] vs 0%; P < .001), and nystagmus (13% [16 of 127] vs 0%; P < .001) than the control group. No significant differences between participants in the EP group and controls were observed for refractive error, contrast sensitivity, color vision, or patient-reported visual function. Among the participants in the EP group, 48% of eyes (120 of 250) had no retinopathy of prematurity (ROP), 39% (98 of 250) had ROP not requiring neonatal treatment, and 13% (32 of 250) received cryotherapy or laser ablation for ROP. Within the EP group, there was no significant difference in binocular visual function parameters, prevalence of ocular morbidity, and patient-reported visual function by neonatal ROP status. Conclusions and Relevance: Extreme prematurity is associated with an increased prevalence of visual and ocular deficits in young adulthood; this study suggests that, for individuals born EP, visual and ocular deficits appear to be partially independent of ROP status in the neonatal period but reports similar overall visual function.

The Role of Botulinum Toxin in the Management of Ophthalmoplegia Secondary to Miller Fisher Syndrome.

Miller Fisher syndrome is an acute demyelinating polyneuropathy classically presenting with ataxia, areflexia, and ophthalmoplegia. The authors report the case of a 27-year-old female, who presented with limb weakness and double vision following a prodromal pharyngitis. Ophthalmic examination revealed fluctuant ophthalmoplegia eventually consistent with bilateral sixth cranial nerve palsies, prompting investigation for anti-ganglioside antibodies, which returned positive. Due to disabling diplopia, the patient was treated with botulinum toxin, with a resulting favourable reduction in the size of strabismus. Four months following her presentation, the patient was orthophoric and resumed normal activities.

The effects of absence of stereopsis on performance of a simulated surgical task in two-dimensional and three-dimensional viewing conditions.

BACKGROUND: Stereopsis is believed to be advantageous for surgical tasks that require precise hand-eye coordination. We investigated the effects of short-term and long-term absence of stereopsis on motor task performance in three-dimensional (3D) and two-dimensional (2D) viewing conditions. METHODS: 30 participants with normal stereopsis and 15 participants with absent stereopsis performed a simulated surgical task both in free space under direct vision (3D) and via a monitor (2D), with both eyes open and one eye covered in each condition. RESULTS: The stereo-normal group scored higher, on average, than the stereo-absent group with both eyes open under direct vision (p<0.001). Both groups performed comparably in monocular and binocular monitor viewing conditions (p=0.579). CONCLUSIONS: High-grade stereopsis confers an advantage when performing a fine motor task under direct vision. However, stereopsis does not appear advantageous to task performance under 2D viewing conditions, such as in video-assisted surgery.

Clinical predictors of in-hospital mortality in acutely decompensated heart failure-piecing together the outcome puzzle.

The substantial public health impact of hospitalization for acute decompensated heart failure, from an economic and clinical perspective, has generated substantial interest in understanding predictors of risk in this syndrome. Utilization of classification and regression tree (CART) analysis on the Acute Decompensated Heart Failure National Registry (ADHERE) dataset has provided important risk stratification from readily available clinical variables. Increasingly, high-risk patients were identified by combination of blood urea nitrogen level of 43 mg/dL, serum creatinine level of 2.75 mg/dL, and systolic blood pressure less than 115 mm Hg, which were all independent predictors of high risk for in-hospital mortality. On the basis of these 3 variables, acutely decompensated heart failure patients can be readily stratified into groups at low, intermediate, and high risk for in-hospital mortality, with mortality risks ranging from 2.1% to 21.9%. Although risk stratification alone cannot improve outcomes, identification of patients at high and low risk may improve resource utilization and better focus the intensity of care according to outcome.

Current guidelines for treatment of heart failure: 2006 update.

Several pivotal clinical trials have generated new knowledge regarding drug therapy for heart failure. Thus, the Heart Failure Society of America (HFSA) and the American College of Cardiology-American Heart Association (ACC-AHA) guidelines were updated in 2006 and 2005, respectively. We review the evidence from these trials and summarize the changes to the HFSA and ACC-AHA guidelines. Based on data from these studies, the new guidelines include broader, stronger recommendations for beta-blocker therapy, and strong recommendations for angiotensin II receptor blockers. The aldosterone antagonists, spironolactone and eplerenone, are also included in the guidelines. Pharmacists should have a basic level of familiarity with the new guidelines on heart failure and the evidence from recent clinical studies. They should be able to relate how this information contributes to the evolving understanding of treatment strategies for heart failure.