Distant cancer effects on standardised testing of peripheral vision.

BACKGROUND: Profound central-retinal visual losses have been a major presenting factor reported in cancer and melanoma associated retinopathies (CAR, MAR). However, it is well established that standardised tests of peripheral retinal function are often the most sensitive detectors of early eye disease. This is a preliminary investigation of the responsiveness of the peripheral retina to "distant" (non-eye or CNS) cancers using easily obtained standardised tests. METHODS: The design is a single blind study where test results are compared with published norms and a small age matched control group. Of 120 ambulatory cancer outpatients who were interviewed at routine follow up examinations, 111 volunteered and admitted a range of mild visual changes. 25 cancer patients completed all tests of peripheral vision function and a clinical screening. There were seven control subjects of the same age range. RESULTS: 98% (49 of 50) of eyes from the patient cohort were judged clinically normal following examinations which emphasised the central retina, fundus appearance, and static fields. On testing which emphasised the visual periphery, 46 (92%) eyes showed one or more quantitative abnormalities >2 SD from the age adjusted norm means. These abnormalities clustered mainly about dark adaptation (rod cell) sensitivity (31, 62% of measured sites), the blue sensitive retinal cells (17, 34% of measured eyes), and the oscillatory component (OP) of the electroretinogram (23, 46% of measured eyes). One control eye (7%) showed a significant dark adaptation abnormality and ERG reduction. There was no identifiable interaction between chemotherapy mode and the cancer associated retinal deficits (CARD). Antiretinal antibodies were found in sera from most patients and controls. CONCLUSION: CARD is common in the retinal periphery of many cancer patients, and is distinct from rare CAR, MAR central-retinal responses. CARD has numerous potential clinical uses which justify expanded research with more defined large samples.

The efficacy of octreotide in the therapy of severe nonproliferative and early proliferative diabetic retinopathy: a randomized controlled study.

OBJECTIVE: The pilot study examined the ability of octreotide to retard progression of diabetic retinopathy (DR) and delay the need for panretinal photocoagulation (PRP) in patients with advanced stages of retinal disease. RESEARCH DESIGN AND METHODS: Patients with severe nonproliferative DR (NPDR) or early non-high-risk proliferative DR (PDR) were randomly assigned to conventional diabetes management (control group, 12 patients) or to treatment with maximally tolerated doses of octreotide (200-5,000 microg/day subcutaneously; 11 patients). Ocular changes in each eye were assessed at a minimum of every 3 months for 15 months or until disease progressed to high-risk PDR requiring laser surgery. Endocrine assessments occurred at 3-month intervals during the study RESULTS: Only 1 of 22 eyes from patients treated with octreotide reached high-risk PDR requiring PRP, compared with control patients, in whom 9 of 24 eyes required PRP. The decreased incidence of progression requiring laser surgery was statistically significant if events were considered independently (P < 0.006). The incidence of ocular disease progression was only 27% in patients treated with octreotide compared with 42% in patients with conventional diabetes management. This treatment effect on whether the retina worsened approached statistical significance using repeated measures analysis (P = 0.0605). Endocrine management was similar between treatment groups. Thyroxine replacement therapy was administered to maintain a euthyroid state for all octreotide-treated patients and 7 of 12 control patients. CONCLUSIONS: Our results suggest that octreotide treatment in euthyroid patients may retard progression of advanced DR and may delay the time to laser surgery.

Human photopic response to circulating glucose.

Circulating glucose was manipulated in young human volunteers with clinically normal vision. Fasting achieved a concentration range of 45-91 mg/dl. And sugar loading produced a range of 79-108 mg/dl. Glucose increased in all subjects. A nonparametric ANOVA provided a p=0.0005 for the significance of the concentration differences between group glucose concentrations under the two conditions in the sample. Each volunteer participated in each condition of the repeated-measures design. Clinical tests were completed before electroretinograms were recorded under photopic and scotopic adaptation conditions. Measures were made from 12 eyes. Only photopic adaptation conditions with maximal stimuli produced significant results. Inter-individual differences were robust and constrained to reduced implicit times for b-wave peaks and 30 Hz flicker implicit times. Under the elevated glucose conditions. Other variables showed very strong trends. These results confirm and extend other human indications of photopic retinal sensitivity to variations within the normal range of circulating glucose concentrations.

Occurrence of pigment precipitates after small incision cataract surgery.

PURPOSE: To assess the incidence of pigment precipitates and potential association with glaucoma, diabetes, and/or intraocular lens (IOL) optic center thickness in patients having small incision cataract surgery and foldable IOL implantation. SETTING: Eye Care Physicians of Michigan, Jackson, Michigan, USA. METHODS: A retrospective data analysis was conducted of patients with a preoperative diagnosis of glaucoma or diabetes or in whom pigment precipitates had been reported after cataract surgery. Group 1 consisted of 23 patients in whom pigment precipitates had been reported and Group 2, 92 patients in whom no precipitates were reported. Two statistical models were used to analyze preoperative, demographic, surgical, and postoperative variables and determine potential correlations. An overall incidence of the occurrence of pigment precipitates was calculated based on the total number of patients with foldable IOLs. RESULTS: The incidence of pigment precipitates was 0.35% (n = 23/6519). Mean time to occurrence was 5.5 months. No between-group differences were found in pathologies or other demographics or postoperative variables. Intraocular lens size and implantation correlated with the occurrence of pigment precipitates. CONCLUSION: The development of pigment precipitates after foldable IOL implantation did not appear to be affected by the presence of glaucoma or diabetes. Newer, slimmer IOL styles and refined insertion techniques were associated with a lower occurrence of precipitates.

Leber's congenital amaurosis with Duchenne's muscular dystrophy.

We studied a family with Leber's congenital amaurosis and Duchenne's muscular dystrophy. One son, the proband, was noted to be blind from shortly after birth and had absent pupillary reflexes, attenuation of retinal blood vessels and pigmentary changes of the retina. He manifested Duchenne's muscular dystrophy at 6 years of age and died of its complication--severe respiratory failure--at 21 years of age. His older brother also was blind since birth, with absent pupillary light reflexes and an extinguished electroretinogram in both eyes. The proband's younger brother with Duchenne's muscular dystrophy died following respiratory failure. Their oldest brother was apparently unaffected. Their mother and sister were proven carriers of Duchenne's muscular dystrophy and a maternal uncle and great-uncle also died from this condition. The parents were consanguineous, third generation cousins.

Public attitudes toward donation of body parts, particularly the eye.

A survey of 595 metropolitan Toronto residents aged 16 years or older was done during 1986-87 to assess their interest in organ and tissue donation in general and their willingness to donate eyes in particular. Subjects were selected at random from the telephone directory and were interviewed on the telephone with a prepared questionnaire. Most of the respondents were aware of the value and types of organ and tissue transplantation. Although 63% expressed a willingness to donate body parts, only 37% had signed the organ donation portion of their driver's licence or an organ donor card. The respondents who were unwilling to donate body parts expressed certain deep-rooted anxieties and fears. More public education is needed to allay the fears and misunderstandings that remain in the minds of many potential donors.

Comparison of 2% hydroxypropyl methylcellulose and 1% sodium hyaluronate in implant surgery.

We conducted a prospective randomized clinical trial of 2% hydroxypropyl methylcellulose and 1% sodium hyaluronate (Healon) in routine extracapsular cataract surgery with implantation of a posterior chamber intraocular lens. Of the 84 patients 40 received methylcellulose and 44 received sodium hyaluronate. There was no statistically significant difference in endothelial-cell loss or induced cellular polymegathism between the two groups. The intraocular pressure before and after surgery was similar in the two groups, as was the visual acuity 8 weeks after surgery. The results suggest that 2% hydroxypropyl methylcellulose is a safe and effective alternative to 1% sodium hyaluronate in routine implant surgery.