The Leboyer method of delivery. An assessment of risk.

The safety of a modified Leboyer method of delivery was assessed by comparing 87 Leboyer deliveries with 232 conventional ones. No significant increase in risks to mother or newborn was identified. The subjective advantages of the method are a quiet delivery room, immediate newborn-maternal contact and the father's participation in the birth.

Optical penalization can improve vision after occlusion treatment.

BACKGROUND: Optical penalization (OP) has previously been shown to successfully maintain vision in amblyopic eyes of older children when patching compliance is poor and when vision decreases once patching is discontinued. This study shows that the final vision in optically penalized eyes is often better than the vision obtained after patching alone. SUBJECTS AND METHODS: During the 5-year period from January 1992 to February 1997, 28 children aged between 3.7 and 8.2 years (average age, 6.5+/-1.1 years) were optically penalized for an average of 1.5+/-0.75 years. The maximum length of penalization was 3.3 years, whereas the minimum time was 6 months. There were 21 children with strabismic amblyopia and 7 children with anisometropic amblyopia. All 28 children had worn a patch to achieve their best visual levels and then had shown a loss of best vision when occlusion was stopped. Patching was usually resumed and continued until the previous best vision was obtained; at this point OP was started to "maintain" vision. Eighteen of the 28 children have discontinued penalization and have been followed up an average of 1(1/2) years. RESULTS: Twenty-six (93%) of the 28 patients showed an increase in best vision from that found at the conclusion of patching, and 2 patients maintained their vision at the initial level. The average visual acuity at the start of penalization was 20/50 (0.42+/-0.11 logarithm of the minimum angle of resolution [log MAR]). Final average visual acuity was 20/27 (0.15+/-0.12 log MAR). The average increase in vision was nearly 3 lines or 0.27+/-0.12 log MAR. CONCLUSION: OP alone (without the use of pharmacologic agents such as atropine) not only maintains vision after patching therapy, but also appears to improve the final visual outcome.

Low-contrast visual acuity cards in pediatric ophthalmology.

The usual high-contrast visual acuity chart is well known as the best indicator of central visual function. It has the limitation of only testing the high frequency, high-contrast sensitive cells in the visual system. Some conditions demonstrate a normal response on the standard visual acuity test, but abnormal results when testing visual fields or contrast-sensitivity function (CSF). A variety of diseases fall into this category (multiple sclerosis, diabetes mellitis, glaucoma, CNS tumors in the visual system, etc). The testing of CSF permits us not only to vary the size of the target (spatial frequency), but also to determine the contrast of the target first visible to the patient. Due to the time necessary to conduct the test and the important challenge of obtaining consistent subjective responses, contrast-sensitivity testing in children has been difficult. Recently, Regan has developed low-contrast visual acuity cards similar in format to those used in the Sheridan Gardiner test. Although they do not require literacy, correct responses can be immediately verified and the test can be carried out within a short period of time. These cards allow testing well within the child's limited attention span. In the future it may be possible to use this method of testing to detect CSF defects in amblyopia similar to those previously reported by Hess and others and to see how these defects are affected by standard treatment.