Retinitis pigmentosa and the new genetics
17/12/99
A previous article by the authors described the recent advances that have been made in understanding the molecular genetics of retinoblastoma, the most common intraocular tumour of childhood. These advances led to the discovery of a gene responsible for retinoblastoma and how defects or mutations in this gene could result in the development of a tumour.
Richard A. Armstrong, BSc, DPhil and S.N. Smith, PhD
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Clinical case history Q&A - case number four
03/12/99
xpand your clinical knowledge with our series of cases from the files of consultant ophthalmic surgeon, Chris Heaven.
Chris Heaven FRCOphth, FCOptom
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The physiological causes of contact lens complications
03/12/99
It is important to remember that a contact lens effectively occludes the cornea from its surrounding environment of oxygen, tears and ocular secretions. The effect depends on lens thickness, size, method of fitting and material. As has been outlined in previous articles in this series, the physiological effects caused can be said to fall under the following headings: corneal metabolism; corneal tissue fragility; corneal temperature; corneal sensitivity; corneal topography; and refractive error. This article looks at the background detail and the reason why problems are caused.
Judith Morris MSc, FCOptom
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The not-so-benign intracranial hypertension
03/12/99
Although it is believed that many cases of benign intracranial hypertension, also known as pseudotumor cerebri or idiopathic intracranial hypertension, resolve spontaneously without causing any visual damage, severe vision loss and even blindness can occur.
Leonid Skorin Jr, OD, DO
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Clinical optometry and sport. A two-way application
19/11/99
Five articles have been published recently about seemingly disparate phenomena met in clinical practice which can help optometrists suitably advise patients engaged in or about to engage in sport. In addition, it has been found that sports people, by relating their practical experiences, can help optometrists in their clinical skills. This paper, based on a poster presented by the author at the 1st International Sports Vision Conference last September, discusses these five topics.
Brain Ariel
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Unusual retinal vessels and vessel formations
19/11/99
As optometrists, we constantly scrutinise the retinal vasculature and so we are well aware of its normal characteristics. Retinal arterioles and veins steadily ramify to nourish and drain each quadrant of the fundus. They branch as curving rather than acute bifurcations and arterioles usually cross veins. There is an arteriolar-to-vein size relationship of 2:3 and a spontaneous venous pulse is present at most optic discs. Retinal vessels rarely ?invade? the macula. These are all routine observations. Occasionally, however, we see vessels or vessel formations that are unusual and may impact significantly on the patient?s vision. This paper will seek to clarify some of these situations.
Peter G. Swann, BSc (Hons), MappSc, FCOptom, FAAO
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Macular hole
19/11/99
The macula, also known as the posterior pole, area of centralis or central retina, provides the central 15-20?? of the visual field. It is used for central vision and reading and is approximately 5. 5mm in diameter and 3-4mm in the vertical. It extends from the temporal edge of the optic disc, lying within the vascular arcades.
M. Elton & J. Giralt
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Clinical case history Q&A - case number three
19/11/99
Expand your clinical knowledge with this third case from the files of consultant ophthalmic surgeon, Chris Heaven.
Chris Heaven FRCOphth, FCOptom
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Advantages of contact lenses for young athletes
05/11/99
In the early 1980s, Dr Lewis Coopersmith of Health Products Research (HPR) projected only a 7% growth rate from 1981 to 1982 in the number of children, 17 years of age and younger, who needed visual correction and wore contact lenses. His statistics climbed to 21% for 1984 and 1985.
Dr David Hansen
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Clinical case history Q&A - case number two
05/11/99
Expand your clinical knowledge with this second case from the files of consultant ophthalmic surgeon, Chris Heaven.
Chris Heaven FRCOphth, FCOptom
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Allergy and sensitivity as a result of contact lens wear
05/11/99
Allergy is an altered response that develops in some individuals following their second contact with an allergen. This definition has now generally come to mean an immediate (IgE-mediated) hypersensitivity response. For example, a first exposure to an allergen such as pollen causes no clinical response, but some individuals become sensitised. Following a second exposure to the pollen, there is then an immediate hypersensitivity response in these sensitised individuals with mast cell degranulation and the release of inflammatory mediators, including histamine, into the tissue. Atopic individuals demonstrate the clinical manifestations of immediate hypersensitivity such as eczema, asthma, allergic rhinitis and allergic eye disease.
Stephen Tuft MChir, MD, FRACO, FRCOphth
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Diagnosis and management of eyelid and lacrimal abnormalities
05/11/99
Patients may visit their optometrist with symptoms of eyelid or lacrimal disease, or an abnormality may be noticed incidentally. Although many conditions are not serious, some may be sight or life-threatening. This article aims to help practitioners make an accurate diagnosis and formulate an appropriate management plan. It is not meant to be an exhaustive text of diseases in this area and so it concentrates on the more common conditions seen in clinical practice.
M.J. Wearne & J. Pitts
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Automated perimetry. How to obtain the best possible results
22/10/99
Visual field testing in the optometric practice has become the standard of care when investigating a variety of ocular conditions, ranging from glaucoma to neurological problems and unexplained vision loss.
Dr Paul Ajamian
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Clinical case history Q&A - case number one
22/10/99
Expand your clinical knowledge with our new Q&A series from the case files of consultant ophthalmologist, Chris Heaven.
Chris Heaven FRCOphth, FCOptom
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Dietary prevention of age-related macular degeneration
22/10/99
Age-related macular degeneration (ARMD) is the leading cause of blindness in people over 65 years old, and its prevalence is expected to increase as the population ages. Although the incidence of ARMD increases sharply with age, recent studies indicate that prevention measures and dietary changes implemented early in life can reduce an individual?s risk of ARMD.
S. Pratt
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Some examples of fundus pigmentation and their significance
22/10/99
Pigmentation in or of the fundus is a common finding in routine eye examinations, especially if the pupil is dilated and binocular indirect ophthalmoscopy is undertaken. This article reviews and gives examples of some of these conditions.
Peter G. Swann, BSc (Hons), MappSc, FCOptom, FAAO
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The compromised eye: tear film abnormalities and atopic disease
08/10/99
The ocular surface is normally coated by a thin tear film layer. A normal tear film is required for ocular comfort, to provide a smooth optical surface for refraction, and for the health of corneal and conjunctival epithelial cells. The tear film is also involved in the defence of ocular tissue against infection and injury.
Melanie Hingorani FRCOphth
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The role of therapeutic contact lenses in corneal wound healing
08/10/99
The use of therapeutic contact lenses (TCLs) is a well established technique in modern ophthalmological practice. They have proved to be an extremely effective tool in the management of a wide variety of ophthalmic disorders. Such lenses may be used to return abnormal tissues (usually the cornea) to a more anatomical and functional state. TCLs are most commonly used to relieve pain, promote healing and provide mechanical protection and support during healing. Sometimes they can also be used as a means of drug delivery. Very often the aims of TCL wear are a combination of the above.
C. Steele
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Conjunctival concretion removal
24/09/99
A concretion is a degeneration of the conjunctiva and consists of a yellowish-white inclusion cyst found in the fornices or palpebral conjunctiva and is filled with keratin and epithelial debris. Concretions are usually associated with advancing years and only give trouble if they harden and erode the overlying conjunctiva and cause a foreign body sensation.
David P. Austen, MSc, BSc (Hons), FCOptom, FAAO
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Optic disc pits can cause vision loss
24/09/99
Optic disc anomalies are numerous and varied. The congenital optic disc pit is one such anomaly which can lead to vision loss.
Leonid Skorin Jr, OD, DO
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Corneal wound healing: a review
24/09/99
In comparison to cutaneous wound healing, corneal wound healing is more complex as a result of the greater differentiation and organisation of the corneal sub-structures. Our understanding of corneal wound healing continues to improve as the importance of the various physiological processes involving cellular and sub-cellular events, occurring under the influence of extra-cellular matrix proteins and growth factors, is developed.
C. Steele
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Red eyes. The good, the bad and the ugly
10/09/99
In the final part of our OEL series on Essential clinical skills for tomorrows patients?, renowned US practitioner, Diane Adamczyk, discusses a variety of aetiologies of red eyes - some good, some bad and some ugly.
Diane T. Adamczyk, OD, FAAO
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The Argyll Robertson pupil
10/09/99
Pupillary testing is a critical part of any ocular examination. The visual pathway begins at the retina and terminates in the occipital cortex. Pupillary dysfunction can be indicative of neurological disease and can provide insight on the homeostasis of intracranial contents. In 1869, Douglas Argyll Robertson was the first to describe several patients whose pupils reacted poorly to light with a normal near response. It wasn?t until 30 years later that physicians realised the aetiology of this pupillary anomaly was a manifestation of tertiary syphilis.
C. Dente. A. Gurwood
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Differential diagnosis of infections relating to contact lens wear
10/09/99
It is important to know whether an inflamed eye of a contact lens (CL) wearer with epithelial or sub-epithelial infiltrates is due to a reaction to the lens or to an infectious agent (microbial keratitis). This can be difficult, and requires multiple cultures before infection is finally excluded. Appropriate therapy should be targeted towards an offending organism, if present, or towards an inflammatory cause such as the tight fit lens syndrome if absent. Clinical judgment is all-important, together with a history of frequency of wear (daily or extended wear) and lens hygiene (use or non-use of disinfectants with or without tap water).
David V. Seal MD, FRCOphth, FRCPath
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A study of 530 patients referred for RGP scleral contact lens assessment
20/08/99
The purpose of this study was to analyse the current application of scleral contact lenses (sclerals). The case notes of 530 patients assessed for fitting or refitting with rigid gas permeable (RGP) sclerals were retrospectively analysed to determine the indication for contact lenses and the outcome. Sclerals were offered as a conservative management option in suitable cases for a variety of visual and medical indications. Various types of primary corneal ectasia (PCE) including keratoconus, keratoglobus and pellucid marginal degeneration formed 53% of the total referred for assessment. The other principal indications for contact lenses were corneal transplant (15.8%), aphakia (10.3%), high myopia (8.9%) and various ocular surface disorders (8.2%). Sixty percent continued use of sclerals, 42.9% RGP and 17.1% PMMA. Twenty-two percent discontinued scleral lens wear or failed a trial of sclerals with 9.3% in progress at the time of assessment and 8.7% lost to follow-up.
K.W. Pullum
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Acanthamoeba keratitis in compliant users of a one-step hydrogen peroxide contact lens disinfection system
20/08/99
Following intense media attention to a case-control study showing irregular and/or chlorine-based disinfection as risk factors for contact lens (CL) related acanthamoeba keratitis (AK), there was widespread concern among CL users regarding the optimum disinfection system for avoiding the disease. The manufacturers and the optical profession welcomed the attention to the importance of CL hygiene compliance, but largely dismissed the issue of varying efficacy of different disinfection systems against Acanthamoeba.
C. Radford
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Radiation effects on the eye. Part 3b - Ocular effects of ultraviolet radiation
30/07/99
The electromagnetic spectrum is measured and expressed in radiometric units, since photometric units can only be used for visible radiation. In biological research, the power of a radiation source is called its irradiance, and is measured in watts per square centimetre (W/cm2). The exposure is some duration of time, in seconds, and hence the biological system receives a radiant exposure measured in joules per square centimetre (J/cm2).
Dr Janet Voke
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Improving patient success with RGPs
30/07/99
Rigid gas permeable contact lenses (RGPs) have numerous benefits. The quality of vision, oxygen transmission, durability and surface wettability are well recognised. In addition, it is apparent that RGP lens wear reduces the progression of myopia in young people, as much as two-thirds when compared to spectacle wearers.
E.S. Bennett
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Contact lens surface properties and interactions
30/07/99
The tear film is a complex fluid composed mainly of water, lipids, proteins, sugars, mucin and carbohydrates. It serves several functions and amongst the most important are a source of nutrition for the cornea and conjunctiva, and removal of waste products from these tissues. Once a contact lens is placed on the eye, there is a synthetic material in a natural environment. This situation arises in other parts of the body where there has been some synthetic implant and one of the remaining challenges of biomedical science is to achieve proper biocompatibility.
Michael J. A. Port, MSc, FCOptom, DCLP, FAAO
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Radiation effects on the eye. Part 3a - Ocular effects of ultraviolet radiation
16/07/99
Today people are spending more leisure time out of doors. This poses great risks to their eyes from ultraviolet (UV) radiation. In many cultures, 50% of the lifetime exposure to UV occurs by the age of 18. It is not only when outdoors that people are exposed to high dose UV radiation. The use of sun lamps has also increased in the past decade and many people are careless about protecting their eyes.
Dr Janet Voke
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Tonic pupils
02/07/99
A tonic pupil, sometimes referred to as internal ophthalmoplegia, is the result of damage to the parasympathetic innervation to the eye, resulting in decreased function of the iris sphincter as well as the ciliary body.
Andrew S. Gurwood, OD, FAAO
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Neurological aspects of toxoplasmosis
02/07/99
Toxoplasmosis is caused by the protozoan, Toxoplasma gondii, which infects both humans and animals. The common routes of transmission to humans are ingestion of contaminated food or undercooked meat, inhalation of the oocysts of the parasite shed in cat stool, and intrauterine infection to the foetus of an infected mother.
Leonid Skorin Jr, OD, DO
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The effects of contact lens wear on the ocular environment
02/07/99
The repeated or continuous application of a manufactured appliance to some of the most delicate and unusual tissues of the body is not an action to be undertaken lightly. Yet often contact lens prescribers take little heed of the major changes to the environment of the anterior eye produced by contact lens wear and the consequences of these changes.
Professor Geoffrey Woodward, PhD, FCOptom, DCLP
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Am I seeing things?
18/06/99
Visual disturbances may be a manifestation of a variety of aetiologies. These include disturbances produced by the eyes? own structures, loss of vision, positive visual disturbances and, of particular interest, are visual hallucinations and their implications. This article discusses the various causes that may leave a patient asking themselves, Am I seeing things?
Andrew S. Gurwood, OD, FAAO
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Radiation effects on the eye. Viewing the solar eclipse PART 2
18/06/99
Without doubt the total eclipse of the sun which will occur on the morning of August 11 in parts of Devon and Cornwall, the Scilly Isles and the Channel Islands will be a once-in-a-lifetime event. It is the first total eclipse visible from mainland Britain for 72 years, and for most of us the only opportunity we will even have to witness such an event.
Dr Janet Voke
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Contact lens complications
04/06/99
Contact lenses continue to become more flexible in their applications, and therefore more attractive to potential wearers (around 70 million lenses were sold in the last 12 months). As demand increases, and as expectations of the performance of the devices grow, the importance of adequately explaining the potential complications to prospective users, and dealing effectively with those complications, becomes ever more important.
C. Steven Bailey, MB, BS, BSc, FRCS, FRCOphth, DO, Moorfields Eye Hospital
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Is my sight good enough to fly?
04/06/99
There may be some confusion amongst the profession on what the visual limits are for pilot applicants. The aim of this article is to provide some clarification.
Adrian Chorley, BSc, MCOptom. Dr Raymond Johnston, MB, ChB, FRCP, FFOM, DAvMed
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Horner's syndrome
04/06/99
In the first of a three-part series on pupils, Dr Andrew Gurwood looks at Horner?s syndrome.
Andrew S. Gurwood, OD, FAAO
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Examination of the paediatric patient
21/05/99
Paediatric examinations are an important part of optometry. They can be interesting, worthwhile and financially viable, although sometimes challenging. Minimal additional equipment is required, and patience and speed are important virtues. A modified history and symptoms is required to elicit parental concerns and any educational difficulties for those of school age. A range of visual acuity charts are needed in order to use the most complex format that the child can cope with. Accurate binocular vision evaluation with emphasis on the cover test and stereopsis is paramount, as is a detailed fundal examination to rule out organic disease. Proper paediatric examination can result in early detection of refractive, binocular vision and ocular anomalies and treatment is more likely to have a successful outcome.
Frank Eperjesi, BSc, MCOptom, FAAO
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Radiation effects on the eye. Part 1 - Infrared radiation effects on ocular tissue
21/05/99
August brings the rare occurrence of a total eclipse of the sun, which can be viewed in Cornwall. This article, the first in a series of three, discusses how the heating effect of the sun through infrared rays can be hazardous to ocular tissue, and describes the mechanisms of cataractogenesis resulting from occupational exposure.
Dr Janet Voke
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Clinical decision making in paediatric ophthalmology
07/05/99
Children?s eyecare is a vast subject that extends from the challenge of the first routine eye examination of a healthy child through to rehabilitation of the infant who is blind at birth. This article explains possible approaches to children?s eyecare and presents some examples of conditions that may be encountered.
Dr John Ross Ainsworth, BMBS, BMedSc, FRCOphth, FRCS
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Mobile phones and human exposure
23/04/99
There is growing concern that mobile phone usage may be a hazard to the brain and eyes. In response to this, the Department of Health has instructed the National Radiological Protection Board to set up an independent, expert working group to assess the current state of research into mobile phones. In this article, Anne C. Silk looks at the issues.
Anne C. Silk FRSM, FFDO, FADO (Hons), FRSA
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Everyday immunology for the optometrist
23/04/99
If optometry is to move forward and become involved in the management of anterior segment conditions, it is vital that we have a full understanding of the disease process.
Jonathan Walker BSc, FCOptom, DCLP
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Ocular side-effects of systemic drugs: CNS drugs - Part 2
09/04/99
The drugs to be discussed in this article include the anti-Parkinsonian drugs, anti-convulsants, anaesthetics, anti-emetics and centrally-acting analgesics. These drugs are used to treat neurological or other physical illnesses, as each group name suggests, and will be discussed in succession, together with an introduction to the disease being treated in each case.
Mukesh Patel, BSc(Hons) Pharmacol, BSc(Hons) Optom
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Clinical decision making in ocular emergencies
09/04/99
The optometrist is the first professional contacted by many people suffering acute ophthalmological conditions. It is, therefore, important that these are recognised and managed effectively, especially those conditions in which prompt treatment has the potential to significantly improve the outcome.
Adrian Parnaby-Price, MA, MB, BChir, (Cantab), FRCSEd
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Testing for myasthenia gravis
09/04/99
Myasthenia gravis is an autoimmune disease which affects the neuromuscular junction. It is characterised by fatiguability, abnormal rapid exhaustion and loss of strength in muscles under voluntary control-particularly the ocular and facial muscles. Symptoms increase over the course of the day and after exertion. Ptosis and extraocular muscle motility disturbances with diplopia are frequently the first indicators of myasthenia. In 20-30% of patients, the condition remains confined to the region of the eyes, whereas 90% of patients with generalised myasthenia also have ocular involvement.
Leonid Skorin Jr, OD, DO
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The clinical application of sports vision appliances
26/03/99
An awareness of the importance of the eye examination has grown over the years and has led to the need for optometrists to be able to recognise and diagnose pathology. What seems to have been sidelined, however, is the importance of the optometric routine, including refraction, as a powerful diagnostic tool and a means of clinically justifying an optical appliance.
Geraint Griffiths, MSc, MCOptom
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Low vision care: an overview
26/03/99
Low vision patients are the most under-treated, under-referred and generally overlooked patients in many eyecare practices. With the current growth in the elderly population, this may be a perfect time to re-evaluate your approach to this ever-expanding group of patients.
Thomas I. Porter, OD, FAAO
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Ocular complications from amiodarone
26/03/99
Amiodarone is a drug used to treat life-threatening arrhythmias which have proved to be refractory to other medications. It is known as a Class III antiarrhythmic agent, and has the ability to prolong the cardiac action potential, thus suppressing ventricular and supra-ventricular arrhythmias. Amiodarone can accumulate extensively in the body by becoming bound in tissues, and has a very long plasma half-life. Therefore, the beneficial effects of the drug can take a long time to develop, and any toxic effects may take weeks or months to resolve.
eter G. Swann, BSc(Hons), MAppSc, FCOptom, FAAO and Ken McLaren, BAppSc(Optom)
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Is this headache serious?
26/03/99
Headaches are a common complaint of patients seen by the eyecare practitioner. Although eye-related headaches are common, a headache?s underlying aetiology is often non ocular. For most patients, the history and clinical assessment are adequate to reach a diagnosis. However, in some patients, further work-up, including imaging studies, may be necessary. This article presents an overview of the various types of headaches, their diagnosis and management. ?Is this headache serious?? is a question the eyecare practitioner must answer for every patient who presents with a headache.
Diane T. Adamczyk, OD, FAAO
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Multipurpose solutions. Testing their efficacy against acanthamoeba - a perspective
12/03/99
Since multipurpose solutions (MPSs) were launched in the UK in late 1994, there is no doubt that they have brought tremendous benefits to the patient. These include ease of use, ongoing antimicrobial efficacy and safety. As more alternative MPSs have been introduced to the market over the last four years, each of the manufacturers have spent time and effort on product development and marketing to try to differentiate their products. This battle for differentiation and superiority has, in the main, centred on three areas-namely antimicrobial efficacy, cleaning efficacy and comfort.
Howard Griffiths, BSc (Hons), MRPharmS Technical Director, Sauflon Pharmaceutica
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Clinical management of retinal disorders
12/03/99
Retinal disorders are increasingly recognised by practitioners as they improve techniques of retinal visualisation, for example using slit lamp indirect biomicroscopy. However, it is not only important to diagnose these disorders, but to know the most appropriate stage to refer and the degree of urgency. Doctors in medical school are taught that 70% of diagnoses are made on the history alone, and this aspect is often ignored in such a visual subject as retinal disease. Many of us rush to examine the retina before we take a careful history, which may actually allow us to establish if and when a patient needs to be referred.
Christopher Hammond, MRCP, FRCOphth
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Retinoblastoma and the new genetics
12/03/99
Wardop first described retinoblastoma in 1809. It is the most common intraocular tumour of childhood and the most common tumour of the retina. It was originally thought to be a glioma arising from glial cells of the retina. However, in 1926 it was recognised as a tumour of undifferentiated photoreceptor cells and given the name retinoblastoma by the American Ophthalmological Society.
Richard A. Armstrong, BSc, DPhil and S.N.
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Lacrimal dilation and syringing
26/02/99
Typically, lacrimal dilation and irrigation are performed in hospital. However, with a little practice and care, it is a relatively simple procedure for any optometrist or GP to carry out. The equipment required is inexpensive and easily obtained (see Appendices I and II). This paper will review the relevant anatomy and physiology, discuss the aetiology and evaluation of epiphora (watery eye), and then explain dilation, syringing and the various dye tests associated with investigating the lacrimal drainage system.
David P. Austen, MSc, BSc (Hons), FCOptom, FAAO
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Binocular vision evaluation in practice
26/02/99
Some form of binocular vision (BV) evaluation should be undertaken on every patient. The equipment required is easily obtainable, easy to use and, relative to other optometric instrumentation, of low cost. General BV assessments can be conducted with a cover stick, near and distance targets, an RAF rule, prism bars, pen torch, Mallett Unit and tape measure (Figure 1).
Lyndon Jones, BSc, PhD, FCOptom, DCLP, DOrth, Frank Eperjesi, BSc, MCOptom and B
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Clinical decision making in diabetes
12/02/99
Diabetic retinopathy is the most common cause of blindness in the working population of the Western world. Despite this, it appears that a major objective of the 1989 St Vincent Declaration - to reduce new diabetic blindness by one third in five years - is rarely accomplished. In addition, evidence exists to suggest that blindness frequently occurs prior to ophthalmic referral. It is, therefore, imperative that as diabetes becomes more common, steps should be taken to enhance recognition of sight-threatening retinopathy in the community. In addition, links with the secondary care sector should be strengthened to ensure appropriate management is instituted promptly. One method of achieving this is through refinement of clinical decision making processes.
Jonathan Dowler, FRCS, FRCOphth
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Molecular genetics. New clues to the pathogenesis of retinal diseases
12/02/99
The last decade was notable in vision science for the improvement it brought in our understanding of the cause of retinitis pigmentosa (RP). Whilst the retinal pigment epithelium (RPE) was known to be severely affected by RP, the genetic mutations which cause the disease were found to occur in the genes for rhodopsin and a number of other photoreceptor-specific proteins. These discoveries shifted the attention of scientists from the RPE itself, to the photoreceptors and the interactions that occur between the photoreceptors and the RPE. As a result, a number of new treatment options are being explored for this previously untreatable retinal disease. At present, however, these are still in the experimental stage.
Jeremy A. Guggenheim, PhD
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Contemporary case histories
29/01/99
This series aims to demonstrate the scope of modern optometric practice in the UK today. Each case illustrates a particular facet of contemporary practice, be it contact lenses, pathology, binocular vision or low vision.
Dr Trusit Dave, PhD, MCOptom, FAAO David Ruston, BSc(Hons), FCOptom, DCLP, FAAO
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Heterochromia Signs & symptoms
29/01/99
Heterochromia literally means a situation where one iris is a different colour from the other iris, or where part of one iris is a different colour from the remainder. Although uncommon overall, optometrists do see patients with heterochromia from time to time. Some of the causes of this condition can be very significant with potential vision or even life threatening sequelae.
Peter G. Swann, BSc (Hons), MappSc, FCOptom, FAAO
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