The Finnish evidence-based guideline for open-angle glaucoma.

In most patients, chronic open-angle glaucoma is a slowly progressive disease. Eyes with very high intraocular pressure (IOP > 30 mmHg) represent an exception to this and should be treated and followed extremely intensively. As lowering IOP is, so far, the only means of treating glaucoma, the majority of research reports deal with the IOP-lowering effect of the treatment. The primary goal of treatment, however, is to prevent glaucomatous damage to the structures and function of the eye. The effectiveness of treatment is monitored with optic disc and retinal nerve fibre layer imaging and with visual field examinations. If the glaucomatous changes are progressing, more effective treatment should be given. In the course of follow-up, it should be noted that the changes in the optic nerve structure and function appear and progress at different time-points with delays of up to several years. The assessment of abnormalities is dependent on the examination method and requires a great deal of experience on the part of the examiner. The important risk factors in glaucoma are elevated IOP (even if IOP is within normal range in half of patients ), age, positive family history, exfoliation, race and myopia.

Tolerance to different kinds of contact lenses in young atopic and non-atopic wearers.

PURPOSE: To study tolerance to three types of soft and onetype of rigid gas permeable (RGP) contact lens in young atopic and non-atopic subjects starting to wear contact lenses. METHODS: A prospective study was conducted in 73 young subjects (mean age: 18.7 years, range: 11-37 years). Each subject was allotted at random to one of four groups. Each group of subjects used a different type of contact lens for a year. Tolerance was determined by means of self-assessment by the subjects, ophthalmologic methods, and cytology. The study was conducted on a blind basis. The investigators assessing tolerance did not know what kind of lens a patient had been wearing. RESULTS: Fifty-six percent of subjects who had used soft contact lenses, but only 14% of RGP lens users described their lenses as very comfortable to wear. Sixty-three percent of non-atopic subjects but only 47% of atopic subjects described their lenses as very comfortable to wear. No differences were found between the three types of soft contact lens. Four cases of giant papillary conjunctivitis (GPC) and two cases of macropapillary reaction were recorded. No connections with atopy, type of lens, or lens care solution were found. CONCLUSIONS: Higher percentages of users of soft contact lenses than users of RGP contact lenses described their lenses as very comfortable to wear. Wearing of all types of lenses was associated with follicular or papillary reactions in some subjects. Young people can wear contact lenses safely only if monitoring takes place at least twice a year.

Two-flash photorefraction in screening of amblyogenic refractive errors.

A selection of amblyopic (n = 14) and nonamblyopic (n = 18) children with different ametropias, anisometropias, and astigmatisms was photorefracted without cycloplegia by two-flash photorefraction (T-FP) in which refractions in both horizontal and vertical meridians of both eyes are measured simultaneously. The results were compared to conventional cycloplegic retinoscopy in a blind study. Significant amblyogenic conditions, such as hyperopic anisometropias of more than 1.0 diopter (D), high ametropias, or astigmatism and strabismus cases of 2 degrees to 3 degrees or more are detectable. The technique provides a simple and useful tool for mass screening of infants. The sensitivity of the method for detecting amblyopia seems to be at least as high as in visual checking. Media opacities are recordable, and a permanent document is obtained.

Risk factors and markers associated with proliferative retinopathy in patients with insulin-dependent diabetes.

To define risk factors and markers associated with proliferative retinopathy (PR), we compared 44 insulin-dependent diabetic patients with PR with 45 matched patients without advanced retinopathy (NR). Glycemic control assessed by HbA1 measurements from 5 yr preceding diagnosis of PR was significantly worse than in NR patients. The NR patients had more frequently been treated with multiple daily insulin injections than the PR patients. About half of the PR patients had Albustix-positive proteinuria, and these patients were further characterized by an abnormal lipid profile in plasma and increased frequency of cardiovascular disease. In contrast, PR patients without proteinuria did not differ from NR patients in these variables. Sensorimotor and autonomic neuropathy were twice as frequent in the PR than in the NR group. There was no correlation between anti-insulin antibody titer, immune complexes, and the presence of PR, but T-lymphocyte response to different stimuli was slightly reduced in the PR patients. The anti-insulin-antibody titer correlated with duration of diabetes in the NR but not the PR group. The frequency of HLA-DRw8 was slightly higher in the PR group than in the NR group (16 vs. 0%, NS), but we could not confirm the previously suggested association between HLA-DR4 and PR. Serum C4 levels were low in the diabetics but did not differ between PR patients without proteinuria and NR patients. In conclusion, poor glycemic control was clearly associated with PR in this study, and attempts to prevent this hazardous complication should include means to improve insulin therapy. We did not find support for the view that susceptibility to PR is associated with any known HLA antigen(s).(ABSTRACT TRUNCATED AT 250 WORDS)

Toxicologic effects on the eyes at work.

This review presents some examples of toxic effects on the eyes at work. The type of toxic action ranges from direct splash injuries to late effects of chronic toxic exposure of systemically absorbed substances. The site of toxic action can be on the cornea and conjunctiva, on the retina, on the optic nerve and the visual pathways and even at the visual cortex.

Impaired color discrimination among viscose rayon workers exposed to carbon disulfide.

A possible effect of chronic carbon disulfide exposure on the optic nerve was studied by giving the Farnsworth Munsell 100-Hue Test for color discrimination to 62 exposed and 40 nonexposed men. Carbon disulfide exposure did not relate to specific pattern defects in color discrimination, but impaired color discrimination occurred significantly more often in the exposed group than among the referents. The abnormal findings suggest an impairment in the receptiveness of the ganglion cells or demyelination of the optic nerve fibers.