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Volume 3, Number 6
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Monday, February 10, 2003
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Contact Lenses for Pediatric Cataract Patients | ||
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Treatment for Keratoconus Progression | ||
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Family History and Disease Severity in Younger Glaucoma Patients | ||
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Briefly | ||
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| Contact Lenses
for Pediatric Cataract Patients Contact lenses are well tolerated by children who have undergone cataract surgery, and the lenses are preferred by caregivers as an effective visual rehabilitation option over intraocular lenses (IOLs) and glasses, according to a study by clinicians at the Hospital for Sick Children in Toronto, Canada. IOLs are increasingly used to treat pediatric cataract patients older than 2 years, and are presently being considered to treat children younger than 2, including infants. Researchers in this study present the additional risks that IOL implantation may introduce in pediatric cataract patients, including possible repeat surgery to remove, replace or reposition IOLs; increased use of medications to treat iris inflammation induced by IOLs; lazy eye from planned correction of hyperopia in young children; and unpredictable refractive outcomes. They also note that the trend may pose unknown long-term risks. The study followed 123 caregivers of cataract patients aged eight or younger who had the surgery in one or both eyes at the Toronto hospital. The caregivers were surveyed for stress levels for contact lens use, and they were given the choice of contact lenses, IOLs or glasses for visual rehabilitation for the children. Researchers explained that vision outcomes are equal among the three treatment options; they were also informed that higher complications were possible with IOLs and that the cataract patient most likely would require eyeglasses after insertion of an IOL. Almost 82 percent of the caregivers chose contact lenses for their cataract patients. Initial resistance to contact lenses was high but decreased with time. The authors of the study suggest that contact lenses be seriously considered as a viable treatment option for young cataract patients, especially those younger than 2 years. |
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SOURCE: Ma JJK, Morad Y, Mau E, Brent HP, et al. Contact lenses for the treatment of pediatric cataracts. Ophthalmol 2003;110(2). |
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| Treatment for
Keratoconus Progression Collagen cross-linking may be a useful conservative treatment to stop the progression of keratoconus and significantly reduce the need for keratoplasty, according to a study conducted at the Universitäts-Augenklinik in Dresden, Germany and Zurich, Switzerland. Following a study in which combined riboflavin/UVA-induced collagen cross-linking was used in rabbit and porcine eyes, with results showing a significant increase in corneal stiffness, researchers treated 16 eyes of 15 patients with progressive keratoconus and mostly moderate keratectasia (48 to 56 dpt). After they removed the epithelium of each eye, they applied riboflavin solution on the corneas, which was irradiated with UVA (370 nm, 3 mW/cm2) at a distance of 1 cm for 30 minutes. Post-operative follow-up controls were conducted every 3 months in the first year and then every 6 months up to 3 years, always including visual acuity testing, corneal topography and measurements of endothelial cell density. Progression of keratectasia was stopped in all patients. Best corrected visual acuity and the maximal keratometry values improved slightly in about 50 percent of cases. In all patients, corneal transparency, the degree of keratectasia registered by corneal topography and the density of endothelial cells remained unchanged within the follow-up time. Researchers observed no negative side-effects. The study authors suggest that given the simplicity of the technique and minimal costs, the treatment might also be well suited for use in developing countries. They advise further studies to exclude long-term side effects and to evaluate the long term durability of the mechanical stiffness effect. |
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SOURCE: Wollensak G, Spörl E, Seiler T. Treatment of keratoconus by collagen cross linking. Der Ophthalmologe 2003;100(1):44-49. |
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| Family History
and Disease Severity in Younger Glaucoma Patients A family history of glaucoma is associated with a better visual field at diagnosis in patients younger than 50 years, according to clinicians at Australia’s Eye Associates and Save Sight Institute, Sydney University, New South Wales. Patients who are aware of glaucomatous signs and who suspect that they may have the disease may present earlier. A patient being diagnosed with glaucoma may alert his or her family members to seek assessment and they may thereby be diagnosed earlier themselves. In this study, researchers recorded family history of glaucoma, age at diagnosis, and visual field mean defect within 2 years after diagnosis in 292 patients with primary open-angle glaucoma. At diagnosis, patients with a family history of glaucoma were younger than those without such a history (mean ± SD, 58 +/- 12.7 years versus 63 +/- 10.8 years; t = 3.68). Patients who were younger than 50 years at the time of diagnosis and had a positive family history were significantly less likely to have a worse visual field than those with a negative family history (OR = 0.3; 95 percent CI, 0.1-0.6); those aged 50 years or older showed no such correlation (OR = 0.9; 95 percent CI, 0.7-1.3). |
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SOURCE: Landers J, Goldberg I, Graham S. Does a family history of glaucoma affect disease severity at the time of diagnosis? J Glauc 2003;12(1):31-35. |
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BRIEFLY
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MEDICARE
CARRIER TO LIMIT ANESTHESIA CARE IN CATARACT SURGERY.
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