Leo Semes

The relationship among race, iris color, central corneal thickness, and intraocular pressure.

Purpose. Central corneal thickness (CCT) influences applanation intraocular pressure (IOP) measurement. The present study sought to determine whether iris color might represent a qualitative surrogate for CCT or race, and therefore differential risk for elevated IOP and, consequently, developing glaucoma. Methods. Eligible patients included those with best-corrected visual acuity (BCVA) better than 20/40 and who had not worn contact lenses within 24 hours. Exclusion criteria were prior ophthalmic surgery, topical ocular or systemic medication that would influence IOP, previous ocular inflammatory conditions, or current treatment for ophthalmic treatment. Data collection included demographic (name, date of birth, race), BCVA, and iris color. Iris color was judged according to a purpose-developed chart (white: blue, green, brown or black: brown) and patients were assigned to one of four groups. Goldmann applanation tonometry and pachymetry measurements were performed consecutively. To attain a power of 90% to find a difference of 40 &mgr;m with alpha <0.05, we examined at least 14 subjects (28 eyes) for each group. Results. Comparing pachymetry measurements among iris colors revealed no statistically significant difference among the three groups of whites: blue (552 &mgr;m), green (552 &mgr;m), and brown (562 &mgr;m). The same held true when comparing IOP and CCT-adjusted IOP with iris color: blue—15.2, 15.1, green—15.4, 15.2, and brown—14.7, 14.0. When comparing CCT between whites and blacks, CCT was significantly thinner in blacks (533 &mgr;m), whether evaluating all whites (555 &mgr;m, p = 0.03) or comparing only the brown-iris white group with the black group (562 &mgr;m vs. 533 &mgr;m, p = 0.03). Mean CCT-adjusted IOP was barely significantly different between whites (14.8) and blacks (16.7) (p = 0.04). Conclusion. These results suggest that iris color is not associated with CCT and apparently iris color does not influence measured IOP. We were able to establish a relationship between race and IOP when adjusting IOP for CCT. Our data show a significantly higher CCT-adjusted IOP for blacks than whites demonstrating a racial difference in CCT-corrected IOP.

Intraocular pressure response to scleral indentation

Purpose. Intraocular pressure (IOP) is influenced by many factors. Our purpose was to determine the immediate response of the IOP to scleral indentation (SI). Methods. Twenty-five subjects had IOP measured using Goldmann applanation tonometry before and after SI. The total indentation time was 40 s. IOP was remeasured in a masked fashion. Results. Average IOP for the control eyes was 15.32 mm Hg (range: 10 to 22 mm Hg) before SI and 14.80 mm Hg (range: 9 to 24 mm Hg) after SI. The average IOP for the subject eyes was 15.08 mm Hg (range: 8 to 22 mm Hg) before SI and 13.14 mm Hg (range: 6 to 22 mm Hg) after SI. Conclusions. These results indicate an average decrease of 1.94 mm Hg for the subject eyes vs. 0.52 mm Hg for the control eyes in response to SI. This represents a statistically significant drop in IOP among the subject eyes in response to SI (p<0.001)

Hemorrhagic Detachment of the Peripheral Retinal Pigment Epithelium

ABSTRACT Peripheral hemorrhagic detachments of the retinal pigment epithelium after choroidal neovascularization in age‐related macular degeneration in the fellow eye have been reported only rarely. We report a case of a 75‐year‐old male with such involvement who presented with the acute onset of a shower of floaters in the right eye 9 months after argon laser photocoagulation of juxtafoveal choroidal neovascularization in his left eye. The peripheral hemorrhagic detachment resolved within one month.

Unveiling idiopathic macular telangiectasia: clinical applications of optical coherence tomography angiography

Purpose Idiopathic macular telangiectasia type 2 (IMT2) is a bilateral acquired maculopathy, with a spectrum of clinical presentations associated with inner retinal telangiectatic vascular anomalies. Cases often are underdiagnosed or misdiagnosed. Current diagnostic modalities such as spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) are valuable to the understanding of the clinicopathology. More recently, optical coherence tomography angiography (OCTA), as an emerging noninvasive technology, has been shown to be particularly useful in the assessment and management of IMT2. Methods Three clinical cases of IMT2 are discussed. Clinical presentation, fundus photography, FA, SD-OCT, and OCTA are presented. Each case illustrates variable presentation, staging, and associated findings related to IMT2. Results Optical coherence tomography angiography provides additional value when paired with traditional multimodal imaging in the assessment and management of IMT2. Conclusions These cases present an opportunity to demonstrate the features of the OCTA in the evaluation of vascular diseases such as IMT2. Additionally, these examples emphasize the critical importance of OCTA in the clinical diagnosis and management of IMT2.

The OSHA bloodborne pathogens standard. Implications for optometric practice

The Occupational Safety and Health Act empowers the Occupational Safety and Health Administration (OSHA) to establish a standard when it determines that a significant risk to employees exists. Leading to the OSHA bloodborne pathogen Standard were the following events: recognition of Hepatitis B virus as an occupational hazard where blood and body fluids are handled. Similarly, the human immunodeficiency virus (HIV) had been shown to infect those exposed to blood and body fluids, and OSHA was petitioned by two unions to require employers to require Hepatitis B vaccine free of charge and to mandate general infection control practices as recommended by the Centers for Disease Control (CDC) as early as 1983. OSHA determined that the risk of contracting Hepatitis B virus and HIV was significant and that the final bloodborne pathogens Standard would substantially reduce that risk.

Idiopathic Cysts of the Anterior Uvea

Idiopathic cysts of the anterior uveal tract most frequently involve the epithelial layers of the ciliary body and iris. Idiopathic cysts occur less frequently in the iris stroma. Characteristically asymptomatic, most of the cases reported in the literature have been discovered during routine eye examination by slitlamp biomicroscopy as an iris elevation. Cysts of the epithelial layers rarely enlarge to cause ocular complications. Stromal cysts, although extremely rare, appear to have a greater propensity to enlarge. The visual prognosis for patients with idiopathic anterior uveal cysts is quite good. A review of the literature and examples of these disorders are presented to emphasize the clinical characteristics and management of patients with a diagnosis of idiopathic anterior uveal cyst.

The validity of labeled parameters of aphakia-correcting soft contact lenses.

This study examines the validity of labeled parameters of aphakia-correcting soft contact lenses. The Nikon Projection Lensometer (NPL) and the Hydro-Vue Soft Lens Analyzer (HSLA) were used by two independent inspectors to measure 51 aphakia-correcting lenses. The contact lens power, diameter, and base curve were measured by each of the inspectors and compared to the labeled parameters. All parameter relations that were analyzed revealed that measurements made by the inspectors were not statistically different (p greater than 0.05) from each other and that their combined measurements were not statistically different (p greater than 0.05) from the labeled values.