[Testing for visual deficits by the police among road users in Germany]. / Überprüfung visueller Defizite durch die Polizei bei Verkehrsteilnehmern in Deutschland.

BACKGROUND: The Professional Association of Ophthalmologists (BVA) estimates that at least 100,000s of traffic accidents with 10,000s of injuries and fatalities are caused by known and unknown visual disorders on German roads every year. Until now, however, the police have not had the opportunity to check for potential visual disorders on the spot in cases of conspicuous driving. In a pilot project of the police with the Eye Hospital of the Hannover Medical School (MHH), the aim was for the first time to extend the existing tests of the police by adapted "car-side" vision tests. MATERIAL AND METHOD: On-site evaluation of eye motility, pupil size and light reaction of car drivers as well as an orienting visual acuity test and an orienting confrontation visual field was performed. The practical performance of all examination modalities was previously coordinated and trained. RESULTS: The scope and type of individual examinations for estimating visual ability of car drivers were described and standardized. In addition to the visual characteristics, more familiar neurological tests, such as walking along a straight line were also recorded. The combined test evaluation results in an objective basis for the official decision of an immediate temporary withdrawal of the driving license, if necessary, and the initiation of further measures, such as an ophthalmological examination. With these innovations, the Lower Saxony police have revised their training concept for checking driving ability and issued it for implementation at the beginning of 2022, including the vision tests recommended by ophthalmologists. In the meantime, around 150 officers have been trained in Lower Saxony and are now authorized to carry out qualified driving ability tests. In this respect, a large number of corresponding traffic examinations have already been carried out and the continued driving of road users with significant visual deficits has been prevented. CONCLUSION: In this pilot project, the aim was for the first time to expand the common testing procedures of the traffic police for the detection of drivers who are dangerous to traffic, in addition to screening for alcohol, drugs and neurological deficits, to include specific tests for the detection of visual deficits. The corresponding training of police officers has been carried out across the board in Lower Saxony and Hamburg, and the measures are currently being applied as needed during traffic controls. In the future, the tested characteristics will be evaluated in a weighted score and will provide an objective basis for the police to decide whether to stop the driver in cases of deficits.

[Biochemical stress monitoring during cataract surgery; phenylephrine 10% shows no changes in serum-catecholamines in comparison with phenylephrine 5%]. / Biochemisches Stressmonitoring in der Kataraktchirurgie: Phenylephrin 10% zeigt im Vergleich mit Phenylephrin 5% keine Veränderung der Serum-Katecholamin-Werte.

BACKGROUND: There is a controversy about the concentration of topical phenylephrine recommended for diagnostic or therapeutic mydriasis. Phenylephrine 10% leads to a faster and more pronounced mydriasis but cardio-vascular side-effects like hypertension and arrhythmia have been reported. A maximal pupillary dilatation is a prerequisite for successful cataract surgery. The aim of this study was to evaluate the risk-benefit ratio of phenylephrine 10% in comparison to 5% in the daily practice of the cataract-surgery unit in our clinic by clinical assessment and monitoring of biochemical stress parameters. PATIENTS AND METHODS: 30 informed and consenting patients were randomly allocated to 2 groups of equal size. After a single application of 2 drops of phenylephrine 5% in group 1 and 10% in group 2 respectively and 1 drops of cyclopentolate 1% with neutral pupil (time 0), an ECG was recorded and blood pressure, pulse, oxygen-saturation and pupil size were measured. Simultaneously a blood-sample was taken and the serum-catecholamines adrenaline and noradrenaline were determined by HPLC (High Pressure Liquid Chromatography). These measurements were repeated after 5, 10 and 30 minutes. RESULTS: The mean pupil area after 30 minutes in group 1 was 31.97 (+/- 0.43) mm2 compared to 45.72 (+/- 0.39) mm2 in group 2. Our data showed no other significant variation between the groups: neither clinical monitoring nor catecholamine measurements showed concentration-dependent patterns in blood pressure development or serum levels. No systemic cardiovascular effects were observed. CONCLUSION: These results demonstrate that a controlled application of phenylephrine 10%--under observation of contraindications--yields no increased risk for the occurrence of cardio-vascular side-effects in comparison with phenylephrine 5%. Therefore, we recommend the use of phenylephrine 10% in the described dosage as routine medication for cataract surgery.