David M. Krumholz

Tear Glucose Dynamics in Diabetes Mellitus

This study compares tear glucose dynamic differences between 121 diabetic and nondiabetic subjects after the administration of a carbohydrate load. A quantitative chromatographic analysis of tear glucose was used and the values correlated to blood glucose values. Diabetic and nondiabetic tear glucose mean values were 0.35 ± 0.04 mmol/L and 0.16 ± 0.03 mmol/L, respectively. Significant differences were observed among the subject groups in both the tear and capillary blood glucose values. A correlation between tear glucose and capillary blood glucose was observed. The concentration of glucose in the tear fluid changes proportionately with respect to capillary blood glucose after a carbohydrate challenge. Although it is possible to determine the diabetic status of a subject using tear glucose values alone, in the clinical setting this may not prove to be practical due to technical limitations.

Gentamicin Retinal Toxicity After Cataract Surgery in an Eye That Underwent Vitrectomy

A cataract developed in a 23-year-old man 4 months after a vitrectomy to repair a traumatic retinal detachment. An uneventful phacoemulsification was performed, using antibiotic-fortified infusion solution. Afterward, a large area of atrophic retina, consistent with gentamicin toxicity, was observed in the macula. The patient remains stable with 20/200 best-corrected acuity. The authors suggest that because the vitreous had been removed, gentamicin was able to settle over the macula during the entire cataract procedure. Therefore, gentamicin should be used intracamerally with caution, especially in eyes in which vitrectomy has been performed.

The practice of optometry: National Board of Examiners in Optometry survey of optometric patients.

Purpose. A study commissioned by the National Board of Examiners in Optometry was designed to obtain information about patients seen in general practice. Methods. Providers completed an encounter form for patients seen during a 2-day sample. Data were obtained from 11,012 patients in rural, urban, and suburban environments from a diverse population of 480 optometrists representative of profession-wide practitioners in terms of geographic distribution and practice settings. Although practitioners were randomly selected, the response rate among those who were invited to participate was only 17.7%. Optometrists who specialized and did not classify themselves as general practitioners were excluded from the study. Results. The study provides insights into the most common diagnostic and therapeutic procedures performed, medications prescribed, and referrals made in general practices. Seventy-one percent of all examinations were categorized as comprehensive eye examinations, approximately 13% the result of disease, and 11% was for contact lens care. Almost 17% of all patients received a formal visual field test (Goldmann or automated). Refractive error was the most prevalent diagnosis reflective of the ocular problems found in the general population and systemic conditions were the second largest category. Although 12% of all patients were referred to an ophthalmologist for further care, other types of referrals were infrequent. Referrals to a primary care physician, laboratory, and imaging or for refractive surgery accounted for only 8% of all referrals. Conclusion. Ocular disease treatment was found to be an integral part of the optometrist’s practice. Prescribing topical medications, both legend and “over the counter,” was a primary treatment option. The most common medications prescribed were for glaucoma, with antibiotics, antiinflammatory, and antiallergy drops making up the remainder in descending order.

Glaucoma among patients enrolled in a national vision care plan.

BACKGROUND Glaucoma is one of the leading causes of impaired vision and blindness in the United States. An understanding of the disease process and its risk factors by patients is essential if its consequences are to be mitigated. Among the known risk factors, family history is one that can help promote awareness for early recognition and treatment among potential patients. This study reports on the responses to a questionnaire by glaucoma patients on their use of vision care, their understanding of their disease, and whether they shared their medical history with other family members. METHODS A survey was mailed to members of a national vision care benefits plan who received an eye examination with a diagnosis of glaucoma. Patients were identified by diagnosis through the managed care organizations management information system. A survey instrument was designed to determine family history, use of vision care, medications used, and basic knowledge of glaucoma. RESULTS One hundred forty-eight surveys were returned; two thirds were from glaucoma patients and one third from glaucoma suspects. The frequency of eye examinations and the reason for their most recent examination differed between the 2 groups. Most glaucoma patients informed relatives of their condition. As expected, glaucoma patients were better educated than the glaucoma suspect group; however, knowledge of the disease process and its consequences was lacking even among those who were taking glaucoma medication. CONCLUSIONS Some glaucoma patients appear to be unaware as to how glaucoma affects their vision. Understanding ones disease can enhance patient compliance and ensure that the patient returns for continued treatment and management. Patients with poor health literacy (especially with a disease with an asymptomatic beginning stage) are at a higher risk for noncompliance.

Idiopathic juvenile macular sub-retinal neovascularization: to treat or not to treat

Abstract Juvenile macular sub-retinal neovascularization is an exceedingly rare condition. It occurs in patients under the age of 20. Subretinal neovascularization is so rare in patients less than twenty years of age, that the macular photocoagulation study presents data only for patients 18 years of age or older. This poster describes a 17-year-old female with a foveal hemorrhage secondary to idiopathic juvenile macular sub-retinal neovascularization in one eye. Although the patient was given the treatment option of laser, she refused, and opted for close observation instead. In this case the hemorrhage resolved spontaneously and left the patient with 20/80 vision. The rationale for and against laser treatment is discussed. The significance of the Macular Photocoagulation Study is reviewed with respect to this case.

Decreased vision from asteroid hyalosis

Abstract Purpose: We present an unusual case of decreased vision from asteroid hyalosis, an entity not normally associated with decreased vision. Patients and methods: This 74-year-old male had vision gradually decreasing to 20 400 in the right eye. The left eye was 20 70 , consistent with his lens changes, which were symmetrical. A dense clump of asteroid hyalosis was noted just posterior to the lens in the right eye, obscuring the fundus view. B-scan ultrasonography, pupil testing, and flash visually evoked potential testing were all normal, suggesting the potential for equal function between the eyes. A vitrectomy was performed on the right eye to remove the asteroid, which was confined to the anterior vitreous due to a posterior vitreous detachment. Results: Post operative vision was 20 60 , now consistent with the lens changes. Conclusions: Since the only change between the pre and post operative state was the removal of the asteroid hyalosis, we conclude that the asteroid hyalosis was causing the decreased vision in the right eye. A posterior vitreous detachment allowed the asteroid to coalesce into a dense clump just posterior to the crystalline lens, which explains the unexpected, profound effect on the patients vision.

An unusual presentation of central serous choroidopathy

Abstract A 68 year old female patient was diagnosed with central serous choroidopathy. The diagnosis was confirmed by fluorescein angiography and the patient was successfully treated with laser photocoagulation. Central serous choroidopathy is uncommonly diagnosed in the elderly population. Differential diagnosis and management of the case are discussed.