Corneal vascularization.

Corneal vascularization is an important clinical event that requires careful management. Vessel penetration can serve to heal a threatening inflammatory process, cause opacification and loss of vision, induce graft rejection, or serve as a warning of corneal distress. The latter condition is particularly common in contact lens wearers. Practitioners should be aware of the subtle signs of early neovascularization, and work toward its remission. Acute vessel penetration is a difficult clinical situation to manage. Quiescent vessels in the cornea must be explained by history and managed with either monitoring or intervention.

The ocular signs and symptoms of chronic fatigue syndrome.

BACKGROUND: Chronic Fatigue syndrome (CFS) is a relatively newly defined clinical entity that affects multiple systems including the ocular system. These effects have not been well documented. METHODS: 25 consecutive CFS patients were evaluated and the ocular signs and symptoms were described. RESULTS: Significant ocular symptoms were present in all 25 patients. The most common clinical findings were abnormalities of the preocular tear film and ocular surface (19 patients) and reduced accommodation for age (18 patients). CONCLUSIONS: CFS affects the ocular system in many ways. Eye care practitioners should pay particular attention to accommodative needs, ocular surface disease and tear film dysfunction when examining these patients. Further research into the pathophysiology of these ocular findings may lead to a better understanding of the pathophysiology of CFS.

Corneal staining characteristics after sequential instillations of fluorescein.

Twenty-one healthy noncontact lens-wearing subjects were screened for the presence of corneal staining with fluorescein after sequential instillations of the vital stain (Phase I). These staining characteristics were further explored by monitoring the results of sequential instillations of fluorescein at 2-h intervals over a 12-h period (Phase II) and by patching 1 eye overnight and observing corneal staining after sequential instillations of fluorescein in the morning after patch removal (Phase III). In Phase II more eyes stained in the early morning. Throughout the day the most common staining areas were inferior and nasal. In Phase III, 9 of 12 patched eyes presented with fluorescein staining, as did 7 of the 12 unpatched eyes. Corneal staining after sequential instillations of fluorescein is more likely to be observed early in the day and is not reduced by overnight patching.

Corneal staining after sequential instillations of fluorescein over 30 days.

The corneal staining patterns of 6 healthy female subjects were monitored Monday through Friday for 4 consecutive weeks using daily sequential instillations of fluorescein. The patterns showed that in these subjects there was no predictable pattern of staining, that each subject had different staining characteristics, and that corneal staining varied day to day.

Contact lens considerations in surface and subsurface aqueous environments.

Contact lenses can be a practical and visually efficient corrective modality in aqueous surface and subsurface environments. Even though contact lenses have many advantages for the ametropic individual, in certain situations there may also be disadvantages such as the risk of lens loss, ocular injury, or infection. In order to be able to wear contact lenses in these environments both prescribing practitioners and contact lens wearers must know when the risks of contact lens wear in these environments are minimal. In addition, they must know what precautions to take to minimize risks.

Monovision.

Monovision has been a controversial contact lens correction modality for over 30 years. This paper addresses the major issues and concerns and considers them in the light of patient safety, visual efficiency and practitioner liability.

Disposable contact lenses vs. contact lens maintenance for extended wear.

We compared a disposable extended wear contact lens modality with conventional extended wear over a 6-week period. To do so, we refit 31 patients who had successfully worn conventional extended wear contact lenses for more than 1 year. One eye was fit with the AcuvueR disposable contact lens, and a new extended wear lens of the type the patient had been wearing was placed on the other eye. At weekly intervals the disposable lens was discarded and a new disposable lens inserted. At the same time, the conventional lens on the fellow eye was cleaned, disinfected, and reinserted. After 6 weeks the ocular response, subjective impressions, and condition of the lenses in the two eyes were compared. Both lenses were then cultured. Three subjects had to discontinue disposable lens wear because of adverse reactions to trapped cellular debris and corneal microcysts. Although the results were not statistically significant, the Acuvue lens appeared to perform better than or equal to the conventional lens in biomicroscopic observation, visual acuity measurement, and subjective patient preference. Eighty-seven percent of patients preferred to continue with the disposable system. There were no differences found in the type or degree of microbial contamination of the lenses.

Is there a better "comfort drop"?

45 hydrogel lens-wearing patients with healthy eyes and symptoms of dryness when wearing their lenses were asked to compare the effect of 10 different drops to reduce their symptoms of dryness. The drops were used in a random and blind fashion. Although there were great variations in individual responses, as a group these subjects preferred nonpreserved drops to reduce their symptoms of dryness.

Clinical experience with the Tangent Streak RGP bifocal contact lens.

Eighty-one screened presbyopic subjects were fitted with the Tangent Streak Bifocal (TSB) rigid gas permeable contact lens. Sixty subjects received lenses, and of this group, 42 (70%) have worn the lens successfully for 6 months or longer. Failures mainly resulted from discomfort and occasionally, reduced visual quality. Successful subjects were particularly pleased with their crisp vision at distance and near. The TSB may be the lens of choice for those presbyopic patients who require high definition visual quality at distance and near.

Investigation of the Alges bifocal.

A prospective study was undertaken to evaluate the success rate in fitting the Alges bifocal contact lens, and to determine which subject characteristics were associated with success. Fifty-eight presbyopic subjects with healthy eyes were included in the study. Thirteen subjects (22.4%) were screened out and discontinued after the fitting examination because of visual problems. Lenses were dispensed to 45 subjects (the dispensed group). Thirteen of these subjects were discontinued. Thirty-two subjects (71.1%) were considered successful after wearing their optimum lenses for 1 month. The successful group was interviewed by telephone after 3 months of wear. Two of these subjects were actually a "qualified" success. After 9 months, the successful group was again interviewed by telephone. Twenty-four subjects of the dispensed group were still considered to be optimally successful, five subjects were considered to be a "qualified" success and three subjects had discontinued lens wear. Our success rate for screened patients after 9 months was 64.4%. Two subject characteristics that were associated with success were a previous history of contact lens wear (p = 0.0065) and a near-point stereoacuity better than 100 s of arc with the Alges lens (p = 0.01).

Differentiation of corneal complications observed in contact lens wearers.

Corneal epithelial cystic formations and epithelial infiltrates are relatively common in contact lens patients. Accurate diagnosis of these conditions is needed for proper management of the patient, but the observation and differential diagnosis is hampered by the minute size and similar biomicroscopic appearance of these conditions. This paper presents a description of these subtle formations and the slit lamp techniques for differentiating epithelial microcysts, vacuoles, bullae, and infiltrates. The clinical significance of these conditions is also discussed.

Corneal staining after instillation of topical anesthetic (SSII).

The ocular surface of 74 subjects was assessed with the biomicroscope after sequential instillations of fluorescein (SSI) and again after a single instillation of Ophthetic that was followed by sequential instillations of fluorescein (SSII). Twenty-six eyes (17.6%) stained after SSI and 89 eyes (60%) stained after SSII. The use of Ophthetic seems to enhance the nonuniform penetration of fluorescein into the epithelium in specific regions of the cornea of some subjects. The clinical significance of this finding is unknown.