Long-term follow-up of occlusion therapy in amblyopia.

OBJECTIVE: To determine whether the results of occlusion therapy for amblyopia are maintained into adulthood. DESIGN: Prospective, observational case series. PARTICIPANTS: Fifty-four patients, who were successfully treated in childhood for unilateral amblyopia by occlusion, were followed up to the age of 9 years, were evaluated in 1984 for long-term results 6.4 years on average after cessation of treatment, and accepted our invitation for reevaluation in 1999. METHODS: All patients were given a complete eye examination. The visual acuity (VA) was measured. RESULTS: The average period of follow-up was 21.5 years (range, 17.2-25.1 years). The mean age at the most recent examination was 29.0 +/- 2.1 years (range, 25.1-34). At this examination, a best-corrected visual acuity (BCVA) of 20/40 or better was achieved by 72.3% of the patients. The mean BCVA was 20/35 (20/25-20/70) at the end of occlusion therapy, 20/45 (20/20-20/300) in 1984, and 20/34 (20/15-20/100) at the present examination. Relative to the results at the end of therapy, BCVA at the present examination was maintained or improved in 66.7% of the patients. Relative to 1984, the BCVA in 1999 was maintained or improved in 87% of the patients. MAIN OUTCOME MEASURE: Visual acuity. CONCLUSION: Comparative evaluation of BCVA at a long-term follow-up examination, performed 21.5 years on average after cessation of occlusion therapy, showed that VA was maintained or improved in two thirds of patients who had been successfully treated by occlusion for unilateral amblyopia in childhood.

Long-term effect of hypermetropic anisometropia on the visual acuity of treated amblyopic eyes.

AIM: To evaluate the effect of the extent of hypermetropic anisometropia on the long term visual acuity results in amblyopic eyes following their treatment by occlusion. METHODS: The visual acuity of 86 patients, who had been treated for unilateral amblyopia by occlusion of the fellow eye and followed up at least to the age of 9 years, was examined 6.4 years, on average, after cessation of treatment. Patients were divided into two groups--those with a small amount of hypermetropic anisometropia, where the spherical equivalent difference between the eyes ranged between 0 and +1.50 dioptres, and those with a large amount of hypermetropic anisometropia, where the difference was +1.75 dioptres or greater. RESULTS: Deterioration of visual acuity after cessation of occlusion treatment occurred in 51% of the patients in the group with a small amount of anisometropia and in 75% of the patients in the group with a large amount. At cessation of treatment, the average visual acuity in both groups was 20/40+. At the long term follow up examination, however, the average visual acuity was 20/40- and 20/70, respectively. This difference was statistically significant. CONCLUSIONS: Hypermetropic anisometropia greater than 1.50 dioptres appears to be a risk factor for deterioration of visual acuity in the long term, following treatment of amblyopic eyes by occlusion of the fellow eye.

Space proton flux and the temporal distribution of cardiovascular deaths.

The influence of solar activity (SA) and geomagnetic activity (GMA) on human homeostasis has long been investigated. The aim of the present study was to analyse the relationship between monthly proton flux (> 90 MeV) and other SA and GMA parameters and between proton flux and temporal (monthly) distribution of total and cardiovascular-related deaths. The data from 180 months (1974-1989) of distribution in the Beilinson Campus of the Rabin Medical Centre, Israel, and of 108 months (1983-1991) from the Kaunas Medical Academy, were analysed and compared with SA, GMA and space proton flux (> 90 MeV). It was concluded: (1) monthly levels of SA, GMA and radiowave propagation (Fof2) are significantly and adversely correlated with monthly space proton flux (> 90 MeV); (2) medical-biological phenomena that increase during periods of low solar and/or geomagnetic activity may be stimulated by physical processes provoked by the concomitant increase in proton flux; (3) the monthly number of deaths related (positively or negatively) to SA are significantly and adversely related to the space proton flux (> 90 MeV).

Relationship between suicide and myocardial infarction with regard to changing physical environmental conditions.

In recent years, the possible association of changes in mortality from cardiovascular disease and myocardial infarction (MI) and deaths related to violence and the suicide rate has been repeatedly discussed. This study examined the relationship between cosmic physical changes (solar, geomagnetic and other space activity parameters) and changes in the total number of in-hospital and MI-related deaths and deaths from suicide to determine if a relationship exists between the distribution of total and MI-related deaths with suicide over time; some differences in the serotonergic mechanisms involved in the pathogenesis of MI and suicide were also taken into account. All suicides (n = 2359) registered in the State of Israel from 1981 to 1989 (108 months) were analysed and compared with the total number of deaths (n = 15601) and deaths from MI (n = 1573) in a large university hospital over 180 months (1974-1989). The following were the main features of the Results. (1) Monthly suicide rate was correlated with space proton flux (r = 0.42, P = 0.0001) and with geomagnetic activity (r = -0.22, P = 0.03). (2) Total hospital and MI-related deaths were correlated with solar activity parameters (r = 0.35, P < 0.001) and radiowave propagation (r = 0.52-0.44, P < 0.001), an with proton flux (r = -0.3 to -0.26, P < 0.01). (3) Monthly suicide distribution over 108 months was correlated with MI (r = -0.33, P = 0.0005) and total hospital mortality (r = -0.22, P = 0.024). (4) Gender differences were prominent.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors affecting long term results of successfully treated amblyopia: initial visual acuity and type of amblyopia.

AIMS: The study aimed to assess the effect of initial visual acuity and type of amblyopia on the long term results of successfully treated amblyopia. METHODS: The visual acuity of 94 patients, who had been successfully treated for unilateral amblyopia by occlusion of the good eye and followed up to the age of 9 years, was examined 6.4 years, on average, after cessation of treatment. Patients were divided into two groups according to the depth of amblyopia before occlusion therapy was started: those with visual acuity between 20/60 and 20/100 and those with visual acuity of 20/100 or worse. RESULTS: Deterioration of visual acuity was observed in 42% of patients in the first group and in 63% of patients in the second group. Their average deterioration, as measured by the Snellen chart, was 0.58 and 1.54 lines, respectively. The results were also assessed by the division of patients into three groups according to the type of amblyopia: strabismic, strabismic anisometropic, and anisometropic. Deterioration of visual acuity occurred in 46%, 79%, and 36% of patients in these three groups, with an average deterioration on the Snellen chart of 0.70, 2.04, and 0.64 lines, respectively. CONCLUSION: It is concluded that low initial visual acuity and strabismic anisometropic amblyopia are risk factors for deterioration of visual acuity in the long term, following the successful earlier treatment of eyes with amblyopia.

Intraocular pressure (IOP) in relation to four levels of daily geomagnetic and extreme yearly solar activity.

The link between geomagnetic field activity (GMA), solar activity and intraocular pressure (IOP) in healthy individuals was investigated. The IOP of 485 patients (970 eyes) was recorded over three nonconsecutive years (1979, 1986, 1989) which were characterized by maximal solar activity (1979, 1989) or minimal solar activity (1986). The measurements were also correlated with four categories of GMA activity: quiet (level I0), unsettled (II0), active (III0), and stormy (IV0). Participants were also differentiated by age and sex. We found that IOP was lowest on days of level IV0 (stromy) GMA. The drop in IOP concomitant with a decrease in GMA level was more significant during periods of low solar activity and in persons over 65 years of age. There was a trend towards higher IOP values on days of levels II0 and IV0 GMA in years of high solar activity. Differences between the sexes and among individuals younger than 65 years were not significant. Our results show an interesting aspect of environmental influence on the healthy population.

Factors affecting long-term results of successfully treated amblyopia: age at beginning of treatment and age at cessation of monitoring.

The visual acuity of 104 patients who had previously been successfully treated for unilateral amblyopia by occlusion of the good eye was examined 6.4 years, on average, after cessation of treatment. Three age groups were defined, according to the age at which treatment was started: younger (2 to 5.5 years), middle (5.5 to 8 years) and older (above 8 years). In 55% of the patients, the long-term follow-up examination revealed deterioration of the visual acuity. In patients in whom amblyopia had been monitored at least up to the age of 9 years, the age at which treatment was started did not significantly affect the mean amount of deterioration or the mean visual acuity noted at the long-term follow-up examination.

Geophysical variables and behavior: LXIX. Solar activity and admission of psychiatric patients.

Numbers of first admissions per month for a single psychiatric unit, from 1977 to 1987, were examined for 1829 psychiatric inpatients to assess whether this measure was correlated with 10 parameters of geophysical activity. Four statistically significant values were 0.197 with level of solar radioflux at 2800 MHZ in the corresponding month, -0.274 with sudden magnetic disturbances of the ionosphere, -0.216 with the index of geomagnetic activity, and -0.262 with the number of hours of positive ionization of the ionosphere in the corresponding month. Percentages of variance accounted for were very small.

Hospital cardiovascular deaths and total distribution of deaths in 180 consecutive months with different cosmic physical activity: a correlative study (1974-1988).

The dynamics of total hospital deaths from different kinds of cardiovascular diseases in one 1000-bed hospital were compared with 10 monthly cosmic/solar and geomagnetic physical activity parameters. Data used were of 180 consecutive months; 15,601 deaths including 5667 from cardiovascular diseases were included in this study. It was concluded that the number of monthly hospital deaths shows a highly significant correlation with monthly solar physical activity.

Solar activity and admissions of psychiatric inpatients, relations and possible implications on seasonality.

Admission data for a month, from a single psychiatric unit, were examined for over 1800 psychiatric inpatients during the period of 1977 to 1987, to assess their correlation with 10 parameters of geophysical activity. This pilot study indicates two statistically significant correlations between the numbers of first psychiatric admissions per month and the level of solar radioflux in the corresponding month (p less than 0.05) and sudden magnetic disturbances of the ionosphere (p less than 0.01). There is a statistically significant inverse correlation between the number of first psychiatric admissions per month, with the index of geomagnetic activity (GMA) (p less than 0.05) and with the number of hours of positive ionization of the ionosphere in the corresponding month (p less than 0.01).

Intraocular pressure fluctuations during regular hemodialysis and ultrafiltration.

The effect of hemodialysis and of ultrafiltration on intraocular pressure (IOP) was studied in 30 non glaucomatous patients (58 eyes) with chronic renal failure. IOP and serum osmolality were measured before and after dialysis and every hour during the procedure. IOP showed a slight but non-significant rise when measured after hemodialysis and a significant drop for ultrafiltration. Serum osmolality decreased significantly when measured after hemodialysis, but remained stable for ultrafiltration. The variations in IOP were found to be significantly correlated with changes in osmolality during hemodialysis.

Monthly cosmic activity and pregnancy induced hypertension.

Monthly distribution of PIH (Pregnancy Induced Hypertension) was investigated in relation to the number of deliveries and nine specific cosmic and geomagnetic activity parameters during the years 1979-1983. PIH was observed in 3.165% of 19,843 deliveries. Significant (p less than 0.01) inverse correlation between the PIH index and monthly geomagnetic activity level was shown. Moderately significant (p less than 0.05) correlation with monthly maximal (noon hours) gamma-radiowave propagation was evident as was inverse correlation with this parameter in hours of minimal (early morning) propagation.

Is localization of acute myocardial infarction time related?

A total of 1744 patients admitted to the ICCU with acute myocardial infarction (AMI) were studied in 1462 consecutive days (1982-1986). The aim of the study was to check whether the localization of the AMI was time related. Anterior (anterolateral) (AW) (n = 834) versus inferior-posterior (inferolateral) (IPW) (n = 823) AMI were compared: a third group with isolated lateral wall (LW) AMI (n = 87) was included in the study. Significant differences between monthly AMI localizations were registered, but no rhythmicity (monthly, seasonal) was found. A small absolute prevalence of AW localizations was found in all four seasons, but monthly differences made those differences not statistically significant. Some significant correlation (p less than 0.01) was found between AW AMI domination and daily geomagnetic activity (GMA level I-IV). Only on days with low (quiet) levels of GMA were there more IPW AMIs. Adverse relationship was seen with LW AMI, relatively benign in AMI, was adversely correlated with GMA level (p less than 0.01). Differences in AW/IPW and left/right coronary artery autonomic receptors distribution and flow regulation and/or changes in cardiovascular homeostasis/coagulation, aggregation, viscosity, microcirculation, and so on connected with AMI expansion may be involved in these differences of AMI localization.

Compliance and results of treatment for amblyopia in children more than 8 years old.

Our prospective study of 350 amblyopic children divided them into three age groups: 2 to 5 1/2 years, 5 1/2 to 8 years, and 8 years and older. Treatment consisted of occlusion of the good eye. Compliance with treatment was analyzed by age group for the whole study population, but visual acuity results were evaluated only in children who complied fully with treatment and who cooperated at the initial visual acuity test with a Snellen chart. Younger children were significantly more compliant than older ones. This was probably the primary reason for the high incidence of treatment failure in older children. Children older than 8 years who complied with treatment showed a marked improvement in visual acuity--one almost as good as that in the younger children. A better initial visual acuity can be taken as a good prognostic sign, especially for this age group. In each group, most of the improvement occurred during the first three months of treatment. Improvement after this period was marginal.