Burden and Depression in Caregivers of Blind Patients in New York State.

PURPOSE: To describe the degree of burden of care and the proportion at risk of depression among individuals caring for legally blind patients. METHODS: We performed a cross-sectional study of 486 individuals providing care to their family members who were legally blind. Best-corrected visual acuity of the better-seeing eye in patients determined group placement: Group 1, 20/200-10/200; group 2, 10/200 to light perception (LP); group 3, no light perception (NLP); group VF, visual field loss to <20 central degrees. Burden was evaluated using the Burden Index of Caregivers (BIC-11) and the prevalence at risk of depression was determined by the Center for Epidemiologic Studies Depression (CES-D) scale. RESULTS: Total mean BIC-11 scores ranged from 8.78 ± 4.82 (group 1) to 12.03 ± 5.22 (group 3; p = 0.04). Daily hours spent on close supervision, intensity of caregiving and presence of multiple chronic illnesses in caregivers were the significant covariates affecting BIC-11 scores (p < 0.05). The prevalence of caregivers at risk of depression increased with vision loss from 6.9% (group 1) to 17.9% (group 3; p < 0.05). Female caregivers had an odds ratio (OR) of 2.89 for depression (95% confidence interval, CI, 1.07-3.97; p = 0.04). Caregivers with ≥2 comorbidities had OR 4.24 (95% CI 2.41-6.11) for risk of depression (p < 0.01). CONCLUSION: Burden of care was highest among caregivers who provided greater hours of supervision. Patients with more limitations in their activities of daily living had caregivers who reported higher burden. Female caregivers and caregivers with multiple chronic illnesses were at higher risk of depression.

Central corneal thickness and glaucoma in aphakic and pseudophakic children.

BACKGROUND: The risk of glaucoma among aphakic children is as high as 32%, based primarily on intraocular pressure (IOP) measurements. Although IOP may be falsely elevated by increased central corneal thickness, central corneal thickness (CCT) values have not been reported in this population. METHODS: Patients from the practices of 2 pediatric ophthalmologists and 2 glaucoma specialists had measurements of CCT, IOP, and optic nerve cupping, with visual field analysis when possible. Normal fellow eyes of unilateral aphakes and pseudophakes were included as controls. RESULTS: In 36 aphakic and 6 pseudophakic eyes CCT averaged 660 microns compared with 576 microns for phakic fellow eyes (P < 0.0001). Glaucoma, defined by IOP at least 35 mm Hg or by IOP at least 22 mm Hg associated with optic nerve changes, occurred in 21% of 28 aphakic patients but in no pseudophakic patient. CONCLUSIONS: CCT in aphakic/pseudophakic children is substantially increased compared with control patients. These values may be important in interpreting IOP measurements in these children.

Optic nerve morphology in normal children.

PURPOSE: To expand the normative database of pediatric eyes analyzed with the Optovue optical coherence tomography (OCT). METHODS: In a community-based, cross-sectional analysis, 77 healthy 5-year-old children were recruited from pediatric practices. No subject had any known ocular disorder. Their optic nerves were assessed using Optovue optical coherence tomography (OCT). Data were compared to the normative database obtained by Optovue for adults, ages 18-25, 40-45, and 55-60. Comparisons included thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), and optic nerve head disk area, vertical (VCD) and horizontal (HCD) cup:disk ratios, and cup area. RESULTS: In comparison to all adult age groups, the children's optic nerve heads were statistically less cupped (cup area, VCD, HCD), all with P values of <0.0003. No statistical difference was identified between the children and adults aged 18-25 and 40-45 with respect to RNFL or GCC. Both RNFL and GCC were thicker in the children compared to adults aged 55-60 (P < 0.003). Children's disk area's were marginally smaller than those of adults, the difference not reaching statistical significance. CONCLUSIONS: Our OCT results demonstrate that young children's optic nerves are statistically less cupped than those of all normal adults. The children's RNFL and GCC are statistically thicker than those of adults aged 55-60.

Heterochromia iridis and pertinent clinical findings in patients with glaucoma associated with Sturge-Weber syndrome.

PURPOSE: To examine the clinical and gonioscopic findings in patients with glaucoma associated with Sturge-Weber syndrome. METHODS: Retrospective review of clinical findings of all patients with Sturge-Weber syndrome who presented between January 1978 and December 2003. Koeppe gonioscopy was performed under general anesthesia and findings were photographed when feasible. Iris color was documented by color sketch or photograph at initial presentation. Fisher exact test was used to determine whether the presence of heterochromia was statistically higher in the glaucomatous group. RESULTS: Fifty-five patients who met inclusion criteria were identified, of whom 44 (80%) had glaucoma. Unilateral glaucoma was diagnosed in 30 eyes and bilateral glaucoma in 14 eyes, yielding 58 eyes with glaucoma and 52 eyes without. Gonioscopic examination revealed distinct anatomic abnormalities in the anterior chamber angle in 32 (55%) of the glaucomatous eyes in contrast to the normal fellow eyes in patients with unilateral glaucoma and to the patients without glaucoma. Heterochromia iridis with darker iris on the glaucomatous side was present in 11 of the 30 patients with unilateral glaucoma (37%, P < .001) but in none of the patients without glaucoma. CONCLUSION: The characteristics observed in the anterior chamber angle in this large, uniquely examined series are the first reported to the authors' knowledge and may support a role for neural crest derived anomalies in the pathogenesis of glaucoma in these infant eyes. Careful examination for heterochromia iridis may be judicious in these patients.