Hans C. Fledelius

Changes in refraction and corneal curvature during growth and adult life. A cross-sectional study.

Abstract A cross‐sectional analysis was performed regarding refractive value (spherical equivalent) and keratometry in a sample comprising 454 subjects aged 5–80 years. The refractive range was +5.5 to ‐6.75D. According to the requirements of a parallel study of eye position and age, eyes with excessive ametropia had been excluded, but otherwise the sample was considered refractively unselected. Concerning refractive distribution, the present data supplement previous investigations of adults by the first author. Myopia increased from 6% in the age group 5–10 years to a peak level about 35% in adults aged 20–40, with a subsequent decrease towards old age, where hypermetropia showed a significantly increasing share. Concerning corneal curvature radius, male and female mean values (7.93 and 7.75 mm) showed no variation through the age span under study, however with a tendency of decreasing at old age (significantly in males only). The possible association with refractive change by age is discussed. Corneal astigmatism showed the established shift from predominantly with‐rule in the very young to more against‐rule and oblique astigmatism cases in older subjects.

IS MYOPIA GETTING MORE FREQUENT? A CROSS-SECTIONAL STUDY OF 1416 DANES AGED 16 YEARS +

A hospital material considered refractively unselected is made up by adult patients referred for general eye examination from other (non‐ophthalmic) departments (n = 1416; 2832 eyes). Thirty per cent of all eyes had negative refractive value. The highest myopia prevalence, about 40%, was seen in the age group 26–45 years. Glass‐demanding myopia (of at least ‐0.75 D) occurred in 14% of the elderly (66 years +) against 27–28% in younger adults. Up to the age of 45, more females were myopic than males. The present prevalences are considerably higher than expected from previous Danish studies. It is discussed to what extent this increase is real. The diabetics of the sample (representing 762 eyes) show a shift towards negative refractive values (37.9% with myopia) as compared to non‐diabetics (27.5%). The diabetic surplus is due to low degree myopia cases. The association between myopia and (well‐controlled) diabetes seems to be a new observation.

Ophthalmic changes from age of 10 to 18 years. A longitudinal study of sequels to low birth weight. IV. Ultrasound oculometry of vitreous and axial length.

The present report on vitreous and axial length completes an analysis of changes in eye size during adolescence. The sample is divided into 70 with low birth weight (< 2000 g) and 67 full‐term controls (FT). 1) Contrary to classical statements regarding early arrest of eye growth, a basic ‘pubertal’ axial growth of about 0.4– 0.5 mm is found in refractively static eyes. Eyes with progressive myopia elongate even more, due mainly to vitreous elongation. 2) The previously reported 10‐year LBW ocular size deficit remains an adult feature, even in seemingly normal eyes. There is a parallel permanent lack of catching‐up also regarding height, head circumference, and some other anthropometric parameters. 3) Two classical rules of thumb are discussed: a) 1 mm axial length change coincides with 3 D refractive change, and b) that of 24 mm as the emmetropic eye length. Although tenacious, bot statements have to be modified – according to biological variation and the weak correlation between most refractive parameters.

Favourable effect of TNF-α inhibitor (infliximab) on Blau syndrome in monozygotic twins with a de novoCARD15 mutation†

Blau syndrome is a hereditary granulomatous disease caused by mutations in the CARD15 gene that is diagnosed in children of young age with exanthema/erythema, arthritis/periarthritis and/or uveitis. We report two cases of Blau syndrome in Danish Caucasian monozygotic male twins, exhibiting a heterozygous de novo R334W mutation in codon 334 of CARD15. The patients were initially diagnosed as having sarcoidosis. In both twins, symptoms (exanthema, arthritis/periarthritis) started at 1 year of age, and were followed by uveitis at 7–10 years of age. There was no involvement of the lungs or other organs. An initial course of standard antituberculous treatment had no effect on the symptoms. Hydroxychloroquine and cyclosporine A were also ineffective, and the latter caused impaired renal function. Partial symptomatic relief was obtained with prednisolone and increased benefit was observed in combination with methotrexate. Subsequent introduction of the TNF‐α inhibitor eternacept did not discernibly benefit the clinical condition, but was associated with recurrent infections. In contrast, a trial of infliximab therapy demonstrated clinical efficacy and eliminated all symptoms, restoring a high quality of life. At follow up at 20 years of age (after 2–5 years of infliximab treatment) the twins had an almost normal physical appearance and a normal psychomotoric development, indicating a favourable short‐term prognosis of the disease. Blau syndrome has pathologic, clinical and therapeutic features in common with sarcoidosis, but rarely involves the lungs or other parenchymatous organs. In children, discrimination between early onset sarcoidosis and Blau syndrome should include a CARD15 mutation analysis.

Ophthalmic changes from age of 10 to 18 years. A longitudinal study of sequels to low birth weight. II. Visual acuity.

A report is given on refractive change (Δ R) from age of 10 to 18 years. The 1979 follow‐up comprises 137 persons who had earlier (around 1970) participated in a larger investigation into ophthalmic sequels to a low birth weight (n = 539).

CHANGES IN EYE POSITION DURING GROWTH AND ADULT LIFE

Abstract The association between eye position and age is analysed in a material comprising 267 subjects aged 5–20 years and 187 aged 21–80. The study was prompted by a previous longitudinal finding of a 3 mm increase in exophthalmometry value from age of 10 to 18 years, and by a literature almost devoid of similar investigations in young age groups. The increase in Hertel value during growth could be confirmed. An adult mean value of 16.0 mm in females and 16.6 mm in males was achieved in late teen‐age years, the level being stable after that. The adult range was 11–23 mm. After a similar marked increase in the young, interpupillary distance and orbital width also showed some slight trends in adults. A suggested decrease in orbital width towards old age was consistent with a secular trend, while a concomitant increase in interpupillary distance was unexpected, the combined result being a more divergent (relative) eye position with age (P < 0.01). There was no significant correlation between exophthalmometry and refractive value. Fixed upper Hertel value limits of normal are hard to give; clinically it is the changes that matter. Modelling of facial bony structures and soft tissue contours is discussed.

Ultrasound in ophthalmology

The first ocular echogram was published in 1956. Since then, ophthalmic ultrasound has developed into a multifaceted diagnostic discipline, the basic methods being A-scan and B-scan, Doppler techniques and recently also three-dimensional approaches. Unique for ophthalmology is the newly invented, highly resolving equipment utilising ultrasound frequencies of 50 MHz and higher, so-called ultrasound biomicroscopy. During this development, the special ophthalmic items often kept colleagues from other fields at some distance. With a view to a fair balance between specific and more general information, the primary aim of the present overview is to provide insight for other medical branches employing diagnostic ultrasound. Regarding intraocular morphology, ultrasonic evaluation in experienced hands is superior to other imaging methods. As for orbital pathology, imaging by CT and MR appears more complete. Ultrasound is valuable, however, in particular as part of the initial clinical work-up, and for the follow-up of orbital disease. Furthermore, tissue differentiation by way of ultrasound is of great value with regard to certain entities.

Pre-term delivery and subsequent ocular development. A 7-10 year follow-up of children screened 1982-84 for ROP. 4) Oculometric - and other metric considerations.

Eighty-eight children of pre-term delivery 1982-84 (mean birthweight 1467 g, mean gestational age 31 weeks) with regular early control for retinopathy of prematurity (ROP) had ophthalmic follow-up at the age of 7-10 years. Bilateral blindness appeared in four out of the 28 in the regional survey who had ROP. In the remaining 60 there had been no ROP. In this article focus is on various size parameters, general (height, weight, head circumference, interpupillary distance) and ophthalmic (corneal transversal diameter and curvature radius, axial eye measurements by ultrasound). Comparing with available standards the group average for height was 2-3 cm below the norm for age. With regard to +/- ROP, growth parameters had lower values in the subgroup with ROP. Oculometrically, there was a more curved cornea and a shorter axial length than expected from refractive value. The average values for emmetropia (n = 23) and for myopia of prematurity (6 eyes) were: refraction + 0.54 D and -7.8 D, Crad 7.58 and 7.47 mm, and axial length 22.93 and 25.3 mm, respectively.

Treatment for Retinopathy of Prematurity in Denmark in a Ten-Year Period (1996–2005): Is the Incidence Increasing?

OBJECTIVE. The objective of this study was to analyze the population incidence of retinopathy of prematurity treatment in Denmark in the 10-year period from 1996 to 2005. METHODS. Patient charts of infants treated for retinopathy of prematurity and the national birth registry provide information about neonatal parameters. These parameters, along with birth in the latter half of the period (2001–2005), were analyzed as risk factors for retinopathy of prematurity. The national registry for blind and visually impaired children was accessed to obtain information about visual impairment attributable to retinopathy of prematurity in both treated and untreated infants. RESULTS. The study population consisted of 5467 Danish preterm infants born in 1996 to 2005, with a gestational age of <32 weeks, who survived for ≥5 postnatal weeks; 2616 were born in 1996 to 2000, and 2851 were born in 2001 to 2005. The incidence of treated retinopathy of prematurity cases increased significantly from 1.3% in 1996 to 2000 to 3.5% in 2001 to 2005. Significant risk factors for retinopathy of prematurity treatment were low gestational age, small for gestational age, male gender, and multiple birth. Other, yet unknown factors contributed to the increased incidence in the latter half of the period. Of the study population, 0.6% were registered as visually impaired because of retinopathy of prematurity within 2 years after birth (early-detected visual impairment). The incidences were not significantly different between 1996 to 2000 and 2001 to 2005. Of all of the early-detected, visually impaired children, 16% had not been treated for retinopathy of prematurity and were considered screening failures. CONCLUSIONS. The incidence of retinopathy of prematurity treatment in Denmark has more than doubled during the past half-decade. This increase could not be fully explained by increased survival rates for the infants or by changes in the investigated neonatal risk factors.

OPHTHALMIC CHANGES FROM AGE OF 10 TO 18 YEARS: A Longitudinal study of sequels to low birth weight.: III. Ultrasound oculometry and keratometry of anterior eye segment

Anterior eye segment features were investigated longitudinally by ultrasound and keratometry in 70 low‐birth‐weight subjects (LBW < 2000 g) and 67 full‐term controls, at the ages of 10 and 18 years. Concerning the changes during adolescence, a slight significant deepening of anterior chamber and lens position is found (about 0.1 mm), while lens thickness, corneal curvature radius and corneal astigmatism have remained stable. Differences between BW‐groups indicate a permanent influence of LBW on ocular development, as evident from a presumed early environmental (LBW) arrest of corneal growth, given by a significantly lower value of corneal curvature radius, just as zonular slackness due to a smaller suspension ring may explain a thicker lens. Further a LBW disturbance of correlation between refraction and anterior eye segment parameters is suggested. Besides the documented occasional posterior eye segment damage of LBW (retinopathy of prematurity), the present study indicates a more general restraining influence also on anterior eye segment development.