Keila Miriam Monteiro de Carvalho

O aluno portador de visão subnormal na escola regular: desafio para o professor?

Purpose:1) To check self-knowledge and needs for orientation among regular class teachers working with low vision students; 2) To gather information to assist the training on visual deficiency of regular class teachers. Methods: A survey was conducted for the academic year of 1999 among those teachers working in public schools, Campinas/SP/Brazil, of which 11 were municipal and 9 state schools, respectively 79.0% and 90.0% of these schools. A self-administered questionnaire was used as data collection instrument. Results: The sample was composed of 50 teachers with a regular class experience averaging 20 years. Most of them, 94.0%, said that they had no specific preparation in the area of low vision. Only 18 teachers declared to have received some kind of information/orientation in order to work with their low vision students and of those only 15 teachers mentioned the kind of orientation received. The whole group of 50 declared interest in receiving information. From the information/orientation requested 66.0% mentioned extended working class materials, 50.0% visual performance and eye disease of their students and 46.0% visual acuity/visual field. Conclusion: It was detected that teachers of regular classes received none or little information about their low vision students but demonstrated interest in its obtention. It was also shown that those teachers are not prepared to work with visually impaired children.

Visual control in children with developmental dyslexia

PURPOSE To assess binocular control in children with dyslexia. METHODS Cross-sectional study with 26 children who were submitted to a set of ophthalmologic and visual tests. RESULTS In the dyslexic children less eye movement control in voluntary convergence and unstable binocular fixation was observed. CONCLUSION The results support the hypothesis that developmental dyslexia might present deficits which involve the magnocellular pathway and a part of the posterior cortical attentional network.

Surgery with intraoperative botulinum toxin-A injection for the treatment of large-angle horizontal strabismus: a pilot study

Some patients with large-angle strabismus may refuse or may not meet the criteria for binocular surgical correction. A second option for these patients involves a monocular procedure, which can be performed under peribulbar anesthesia and offers certain advantages (1). Improved surgical outcomes for conventional procedures may enhance the effectiveness of monocular surgery. In theory, this enhancement could be achieved by the coadjuvant use of intraoperative botulinum toxin A (BT) (2). To date, few reports have described the intraoperative injection of BT (3-5). Owens et al. (3) performed supramaximal monocular recession-resection surgeries and successfully used intraoperative BT in three large-angle exotropia patients. Khan (4) successfully performed two-muscle horizontal rectus surgery with simultaneous BT injection in patients with severe large-angle esotropia. Additionally, seven patients underwent bilateral medial rectus recession and bilateral BT injection, and one patient underwent a unilateral recess/resection surgery with medial rectus BT injection. These results indicated that bilateral medial rectus recession with simultaneous BT injection is a safe and effective surgical procedure for patients with severe large-angle esotropia, although more extensive studies are required to confirm these findings. Oskan et al. (5) reported the results of 10 patients with large-angle horizontal deviations (eso- or exotropia) who received BT injections into one recessed muscle and concluded that such treatment may provide greater surgical success compared to conventional horizontal rectus muscle surgeries. The results of these uncontrolled studies have reinforced the hypothesis that long-term realignment of the eyes can be achieved with surgery plus BT administration. However, the effectiveness of the addition of intraoperative BT compared to surgery alone is unclear. In this pilot study, we used a prospective, controlled, and randomized double-blind methodology to examine the effectiveness of BT injection in combination with surgical treatment compared to surgical treatment alone for the correction of large-angle horizontal deviations under local anesthesia.

E-learning as a complement to presential teaching of blindness prevention: a randomized clinical trial

OBJECTIVE: To investigate if E-learning material improves the basal student knowledge level before attending the presential class of blindness prevention (BP) and if helps to fix this information one-month after the class. METHODS: Fourth-year medical students were randomly assigned to have a presential class of BP (Traditional group = TG) or to have a presential class of BP plus an additional E-learning material (E-learning group = ELG). This material was e-mailed one week before the presential class. The students were submitted to a multiple-choice test (with three options each) with seven questions immediately before the presential class, immediately after the class, and one-month later. The three tests had the same questions; however, the answers options were distributed in different sequences. The primary outcome was immediate pretest score. The secondary outcomes were immediate posttest score and one-month posttest score. RESULTS: Among the 120 fourth-year medical students, a random sample of 34 students was assigned to the TG and 34 students was assigned to the ELG. The two groups showed similar immediate posttest score (TG=6.8 and ELG=6.9; P<.754), but the differences at the immediate pretest score (TG=3.6 and ELG=4.7; P<.001), and at the one-month posttest score, were significant (TG=6.1 and ELG=6.8; P<.001). CONCLUSIONS: The pretest and the one-month posttest results suggested that the E-learning material acts as an effective complementary tool of the presential class of blindness prevention.

Terapia oclusiva em ambliopia: fatores prognósticos

Objetivos: Ambliopia e o defeito visual mais comum em criancas e por mais de 250 anos a terapia oclusiva vem sendo o melhor tratamento. Sendo assim, propusemo-nos a determinar os fatores que influenciam no sucesso do tratamento da ambliopia por terapia oclusiva em nosso meio. Metodos: Foi realizado um estudo retrospectivo com 169 criancas ambliopes atendidas no Ambulatorio de Ambliopia do Hospital de Clinicas da UNICAMP, Campinas (SP), entre janeiro de 1996 e maio de 1998. A populacao atendida foi classificada quanto ao sexo, idade de inicio do tratamento por faixa etaria (3 grupos), olho afetado, tipo de ambliopia (estrabismica, anisometropica, por deprivacao, associacao de dois tipos), tempo de seguimento, gravidade da ambliopia (leve, moderada, grave), adesao ao tratamento (regular, irregular) e resposta obtida (cura, melhora, sem cura). Resultados: A adesao ao tratamento nao diferiu entre as faixas etarias (p=0,68) e nao foi influenciada pela gravidade da ambliopia (p=0,82). Dos pacientes estudados 52,67% curaram-se, 19,52% melhoraram e 27,81% nao obtiveram cura. Os pacientes com adesao regular tiveram indice de cura significativamente maior do que os pacientes com adesao irregular (p=0,0009). O resultado do tratamento nao dependeu da idade de inicio do mesmo (p=0,39) e da gravidade da ambliopia (p=0,30). Conclusao: Concluimos, assim, que, no nosso grupo de estudo, a adesao e o principal fator prognostico no sucesso da terapia oclusiva.

Avaliação da autonomia em atividades de leitura e escrita de idosos com baixa visão em intervenção fonoaudiológica: resultados preliminares

INTRODUCAO: A autonomia e a independencia, gerando melhora na qualidade de vida, vem sendo objeto de estudos nos ultimos anos, com a crescente taxa de envelhecimento da populacao, despertando tambem o interesse da area oftalmologica, fonoaudiologica e de reabilitacao. OBJETIVO: Conhecer as caracteristicas desta populacao e avaliar os resultados dos aspectos visuais e de leitura e escrita em idosos com baixa visao, pre e pos-intervencao fonoaudiologica. METODO: Realizou-se estudo descritivo e transversal, avaliando-se 23 sujeitos com baixa visao adquirida, atendidos no ambulatorio de Visao Subnormal do Hospital de Clinicas da Universidade Estadual de Campinas (VSN-HC-UNICAMP). O questionario foi aplicado antes e apos a intervencao fonoaudiologica, com duracao de tres encontros. RESULTADOS: A principal doenca ocular encontrada foi o glaucoma (47,8%). Quinze pacientes (65,2%) relataram usar algum tipo de auxilio optico, dentre eles oculos, lupa, telelupa e regua lupa. Antes de participar dos encontros, 34,8% dos sujeitos (n=8) relataram nao usar a leitura nem a escrita apos a perda visual. Depois de participarem dos encontros, 50,0% (n=4) dos que relataram nao mais usar a leitura e a escrita voltaram a utiliza-las. CONCLUSAO: Apos a intervencao fonoaudiologica, verificaram-se melhora e frequencia de realizacao das atividades de leitura e escrita. A importância das acoes de reabilitacao esta relacionada a promocao da independencia e autonomia para os idosos deficientes visuais.

Teller test with functional vision evaluation in children with low vision

Objective: To know the effectiveness of Teller card test along with the functional vision evaluation in low vision preschool children presenting normal or delayed development. Methods: Transversal study comprising patients from the children visual stimulation Ambulatory Service of the Faculty of Medical Sciences, University of Campinas Teaching Hospital, Campinas (SP)(FCM/HC/ Unicamp). The best corrected visual acuity was obtained using Teller cards and functional vision evaluation, independent from the child development. Results: From a total of 143 evaluated children, 65% did not respond to the Teller card test, only to, the functional vision evaluation. Among 143 children, 99 (70%) presented development delay and 44 (30%), normal development. Conclusion: The Teller card test was not enough to evaluate the children visual acuity with development delays, since more than half of them were not responsive to it, making it necessary that they were submitted to a complementary functional visual evaluation.

Life quality of low-vision elderly people: before and after hearing and speech intervention

Aim: To evaluate life quality of elderly people with acquired low vision before and after hearing and speech intervention. Methods: This was a descriptive cross-sectional study. The study was made with 52 elderly people with acquired low vision. Two questionnaires that measures life quality were used in this study. The first was ‘Low Quality of Life Vision (LVQOL)’ and the second the ‘National Eye Institute Visual Function Questionnaire (NEIVFQ-25)’. The study included people with more than 60 years with acquired low vision and who accepted to participate signing the consent form. The hearing and speech therapy were made into three months, one meeting a week. The questionnaires were applied in the first and last day of the intervention. Results: The age ranged between 60 and 91 years. The macular disorder (38%), such as age-related macular degeneration, macular hole and high myopia were the main causes of visual loss. Although the tests show superior performance after the intervention, there was no statistically significant difference. On the question about difficulties seeing in general, 17 participants answered that they had much more difficulty before the intervention and only 5 participants have reported having much difficulty after the intervention. Conclusion: The intervention trended to positive results, and after the meetings, participants showed improvements in aspects of the two questionnaires used in the study, decreasing the degree of difficulty in performing activities.

Influência da aplicação intraoperatória de mitomicina C tópica episcleral na proliferação e diferenciação de células epiteliais córneo-conjuntivais de coelhos

Objective: To evaluate the influence of a three-minute application of 0.02% mitomycin C (MMC) on proliferation and differentiation of rabbit corneal epithelial cells. Methods: Topical MMC or 0.9% saline solution was applied to the episclera of the temporal limbal area of both eyes, maintaining intact epithelial tissue in one eye, and after partial corneal deepithelialization in the contralateral eye. The animals were arranged in groups A (20 eyes), B (16 eyes) and C (14 eyes) and sacrificed respectively on the 4th, 15th and 45th postoperative days. In order to stimulate cell proliferation, group C was submitted to central corneal deepithelialization three days before sacrifice. Cell differentiation markers (AE1, AE3 and AE5) were used for differentiation analysis and 5-bromo-2-deoxyuridine (BrdU) for detection of corneal epithelial cells proliferation. Results: There was no statistical difference in differentiation cells when drugs or surgical techniques were analyzed. Cell proliferation when using MMC or SF was statis-tically significant at central and temporal areas when applied after partial corneal deepithelialization in all groups. Conclusion: These results suggest that the three-minute episcleral application of 0.02% MMC does not affect epithelial cell differentiation; however, when MMC application occurs after corneal deepithelialization, it may affect cell proliferation.

Optical and nonoptical aids for reading and writing in individuals with acquired low vision.

PURPOSE To evaluate the use of optical and nonoptical aids during reading and writing activities in individuals with acquired low vision. METHODS This study was performed using descriptive and cross-sectional surveys. The data collection instrument was created with structured questions that were developed from an exploratory study and a previous test based on interviews, and it evaluated the following variables: personal characteristics, use of optical and nonoptical aids, and activities that required the use of optical and nonoptical aids. RESULTS The study population included 30 subjects with acquired low vision and visual acuities of 20/200-20/400. Most subjects reported the use of some optical aids (60.0%). Of these 60.0%, the majority (83.3%) cited spectacles as the most widely used optical aid. The majority (63.3%) of subjects also reported the use of nonoptical aids, the most frequent ones being letter magnification (68.4%), followed by bringing the objects closer to the eyes (57.8%). Subjects often used more than one nonoptical aid. CONCLUSIONS The majority of participants reported the use of optical and nonoptical aids during reading activities, highlighting the use of spectacles, magnifying glasses, and letter magnification; however, even after the use of these aids, we found that the subjects often needed to read the text more than once to understand it. During writing activities, all subjects reported the use of optical aids, while most stated that they did not use nonoptical aids for such activities.