Ocular Biometrics of Myopic Eyes With Narrow Angles.

PURPOSE: The purpose of this study was to compare the ocular biometrics between myopic patients with and without narrow angles. METHODS: Patients with a stable myopic refraction (myopia worse than -1.00 D spherical equivalent) were prospectively recruited. Angle status was assessed using gonioscopy and biometric measurements were performed using an anterior segment optical coherence tomography and an IOLMaster. RESULTS: A total of 29 patients (58 eyes) were enrolled with 13 patients (26 eyes) classified as having narrow angles and 16 patients (32 eyes) classified as having open angles. Baseline demographics of age, sex, and ethnicity did not differ significantly between the 2 groups. The patients with narrow angles were on average older than those with open angles but the difference did not reach statistical significance (P=0.12). The central anterior chamber depth was significantly less in the eyes with narrow angles (P=0.05). However, the average lens thickness, although greater in the eyes with narrow angles, did not reach statistical significance (P=0.10). Refractive error, axial lengths, and iris thicknesses did not differ significantly between the 2 groups (P=0.32, 0.47, 0.15). CONCLUSIONS: Narrow angles can occur in myopic eyes. Routine gonioscopy is therefore recommended for all patients regardless of refractive error.

Glaucoma versus red disease: imaging and glaucoma diagnosis.

PURPOSE OF REVIEW: The use of ophthalmic imaging for documentation and diagnosis of ocular disease is rising dramatically. Optical coherence tomography (OCT), confocal scanning laser tomography (CSLT), scanning laser polarimetry (SLP) and photographic imaging of the optic nerve head (ONH) are currently used to document baseline characteristics of the ONH and for diagnosing glaucoma and glaucoma progression secondary to loss of retinal nerve fiber layer (RNFL). Imaging modalities typically provide information on ONH and RNFL characteristics which are outside of the normal (relative to normative databases) in red lettering or boxes, whereas ONH and RNFL characteristics within the normal range are presented in green. RECENT FINDINGS: As imaging modalities have become more sophisticated and are validated in research studies, clinicians have come to rely upon data from these imaging devices to aid in differentiating between normal and glaucomatous states of the ONH and RNFL - typically by examining if the data are green or red suggesting normal or abnormal. However, normative databases can sometimes be flawed relative to atypical ONH or RNFL morphologies and imaging can provide artifacts which do not represent true ocular disease but secondary to limitations of imaging technology. SUMMARY: Ophthalmic imaging is an important adjunct to clinical diagnosis but the results from imaging devices need to be assessed critically relative to artifacts of imaging and the limitations of the technology and its normative databases.

Stereotactic radiosurgery in the treatment of a dural carotid-cavernous fistula.

Because of the success of stereotactic radiosurgery (SRS) in the treatment of cerebral arteriovenous malformations (AVMs), SRS is being applied to the treatment of carotid-cavernous dural arteriovenous fistulas (CCDAVFs) when these lesions are not accessible endovascularly. We report a patient with a CCDAVF that could not be accessed endovascularly on 2 attempts, whose fistula was successfully closed with SRS, a less invasive modality than endovascular embolization. Further experience with SRS in this role will be necessary to determine its utility.

Successful fluoride plebiscite in the township of Deniliquin, New South Wales, Australia.

OBJECTIVES: This article describes the strategies adopted to influence the outcome of a plebiscite held in March 2004 in favor of water fluoridation in Deniliquin, a rural town in New South Wales, Australia. METHODS: The health promotion strategies undertaken included the following: a) the skillful use of media to educate the community on the benefits of water fluoridation; b) disseminating contemporary local data to demonstrate oral health disparities with neighboring fluoridated townships; and c) a well-established lobbying machine to mobilize the community. RESULTS: Out of a total population of 5,280 on the electoral roll, 4,539 residents voted, giving a response rate of 86 percent. The wording of the plebiscite was "Do you support the addition of fluoride to Deniliquin town water supply?" There were 2,533 "yes" votes (55.8 percent), 1,879 "no" votes (41.4 percent), and 127 spoiled votes (2.8 percent). CONCLUSIONS: The council resolved to implement water fluoridation and the residents received fluoridated water in January 2005.

Simultaneous bilateral angle closure glaucoma in a patient with giant cell arteritis.

PURPOSE: To report a case of bilateral angle closure in a patient with giant cell arteritis. DESIGN: Observational case report. METHODS: Review of clinical, photographic, and biopsy data of a 53-year-old patient who presented with bilateral angle closure glaucoma and was found to have giant cell arteritis. RESULTS: A temporal artery biopsy revealed near transmural focal scarring of the media with disruption of the internal elastic lamina consistent with giant cell arteritis in a patient with bilateral angle closure glaucoma. CONCLUSIONS: Acute angle closure glaucoma is a relatively uncommon form of glaucoma and its relationship, if any, with giant cell arteritis is unknown. This is the first reported case of giant cell arteritis presenting with bilateral acute angle closure glaucoma.

Abnormal foveal morphology in ocular albinism imaged with spectral-domain optical coherence tomography.

OBJECTIVES: To evaluate the spectrum of foveal architecture in pediatric albinism and to assess the utility of spectral-domain optical coherence tomography (OCT) in ocular imaging of children with nystagmus. METHODS: Spectral-domain OCT imaging was performed on study subjects in 3 groups: subjects with ocular albinism (OA) or suspected OA with foveal hypoplasia, with nystagmus, and with or without iris transillumination; a subject with oculocutaneous albinism and Hermansky-Pudlak syndrome; and control subjects. Dense volumetric scans of each fovea were captured using standard and handheld spectral-domain OCT devices. Images were postprocessed and scored for the presence and configuration of each retinal layer across the fovea. RESULTS: High-quality spectral-domain OCT images obtained from each subject revealed a range of abnormalities in subjects with OA or suspected OA and the subject with oculocutaneous albinism and Hermansky-Pudlak syndrome: persistence of an abnormal, highly reflective band across the fovea, multiple inner retinal layers normally absent at the center of the fovea, and loss of the normally thickened photoreceptor nuclear layer at the fovea when compared with that in control subjects. The optic nerve was elevated in multiple eyes of subjects with OA or suspected OA and the subject with oculocutaneous albinism and Hermansky-Pudlak syndrome. CONCLUSIONS: A spectrum of foveal morphological abnormalities is seen in subjects with OA or suspected OA, which in some cases contrasted with previous studies using time-domain OCT. These OCT findings clarify the morphology of foveal hypoplasia seen clinically. This imaging modality may be useful in evaluating children.