Liza M. Cohen

Sun Protection Counseling by Pediatricians has Little Effect on Parent and Child Sun Protection Behavior

OBJECTIVE To compare counseling concerning sun protection and outdoor exercise with the parents report of the behavior of a child aged 9-16 years old. STUDY DESIGN Structured interviews of medical personnel in 3 Chicago area practices elicited information about counseling methods and recommendations. In each practice, a convenience sample of parents completed a self-reported survey of their and their childs behavior. RESULTS Sun protection counseling occurred more frequently than exercise counseling in all practices (P = .014). Sun protection counseling was associated with parental prompting (P = .004), performing a summer camp physical (P = .002), and the child having a sunburn (P = .003). After controlling for the childs age, sex, and skin tone, sun protection counseling was not associated with the childs use of sun protection. In multivariate analysis of the childs sun protection behavior, parental sunburns, indoor tanning in the last 12 months, perception of skin cancer risk, and sun protection self-efficacy were significant (P = .02). Children who pursued outdoor sports were twice as likely to use inadequate sun protection and sustain sunburns (CI 1.3-1.7). CONCLUSIONS The childs sun protection behavior was influenced by parental sun protection, parental perception of skin cancer risk, and parental sun protection self-efficacy; therefore, sun protection for children needs to be aimed at parents as well as children. Communication with parents in a way that incorporates the principles of motivational interviewing may be more effective in promoting behavioral change than admonitions to use sunscreen.

Acute, posterior multifocal placoid pigment epitheliopathy: a case of 11 recurrences over 15 years.

PURPOSE To report the case of a patient with recurrent, acute posterior multifocal placoid pigment epitheliopathy. To the best of our knowledge, this is the longest documented course with the greatest number of recurrences reported. METHODS Observational case report of one patient. A 27-year-old otherwise healthy male patient presented with recurrence of new scotomata over 15 years. Fundus photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and optical coherence tomography documented his clinical course. RESULTS Over the course of 15 years, the patient developed 11 symptomatic (5 imaging-documented) recurrences of acute, posterior multifocal placoid pigment epitheliopathy affecting both eyes. Each episode manifested with new subjective scotomata and new lesions noted on imaging. Symptoms mostly resolved after each episode, and visual outcome remained excellent (20/20 in the right eye and 20/25 left eye at the last follow-up). CONCLUSION Although typically monophasic, acute posterior multifocal placoid pigment epitheliopathy can rarely present with a recurrent course over a prolonged period of time and should be considered as a diagnosis in patients presenting with recurrent visual symptoms and new placoid lesions on imaging. In recurrent cases, visual recovery may still remain excellent.

Structure-function Relationships in Uveitic Cystoid Macular Edema: Using En Face Optical Coherence Tomography to Predict Vision

Abstract Purpose: To explore whether preserved retinal tissue on baseline en face optical coherence tomography (OCT) correlates with post-treatment visual acuity in patients with uveitis-associated cystoid macular edema (CME). Methods: A retrospective cohort study was conducted on 25 eyes (23 patients) with uveitis and CME, with resolution of CME at post-treatment follow-up. Baseline en face OCT images were analyzed to determine the proportion of pixels representing preserved retinal tissue. Macular thickness and volume data were also analyzed. Results: The proportion of preserved retinal tissue on baseline OCT strongly correlated with baseline visual acuity (r = 0.61, p = 0.0014), and correlated even better with vision after CME resolution (r = 0.73, p < 0.0001). Weak correlations were found between macular thickness and volume at baseline and post-treatment acuity (r = 0.38, p = 0.058 and r = 0.39, p = 0.055). Conclusions: Preserved retinal tissue at baseline strongly correlates with post-treatment visual acuity in patients with uveitis-associated CME, and is a better predictor of future vision than macular thickness or volume.

Potential correlation between menopausal status and the clinical course of orbital cavernous hemangiomas.

Purpose: To evaluate the clinical course of radiologically diagnosed orbital cavernous hemangiomas in the setting of presumed changes in estrogen/progesterone levels. Methods: An institutional review board–approved retrospective cohort chart review of patients from January 1, 1983, to January 1, 2013, was undertaken searching both outpatient ophthalmology diagnoses and radiologic diagnoses, identifying 32 orbital cavernous hemangiomas, which were subsequently divided into group 1, presumed to have stable levels of estrogen/progesterone, and group 2, presumed to have decreasing levels of estrogen/progesterone. Patients were then categorized as having short-term, mid-range, or long-term follow up. Serial imaging studies were evaluated and graded as having increased, decreased, or remained stable in size. Results: In group 1, no lesions decreased in size, 69% remained stable, and 31% increased in size. In group 2, no lesions increased in size, 45% remained stable, and 55% decreased in size. When evaluating only those patients with long-term follow up, many masses in group 1 increased in size, while the majority in group 2 decreased in size. Conclusions: In this study evaluating orbital cavernous hemangiomas over a span of 30 years, the authors found that in postmenopausal women with assumed decreasing levels of circulating estrogen/progesterone, the vast majority of lesions either remained stable or decreased in size, suggesting the effect of hormone levels on such vascular lesions and supporting the role for observation in asymptomatic individuals in this patient population.

A Novel Computerized Portable Pupillometer Detects and Quantifies Relative Afferent Pupillary Defects.

Abstract Purpose: A test of validation study was conducted to investigate the use of a novel computerized portable pupillometer to detect and quantify relative afferent pupillary defects (RAPDs). Materials and methods: Binocular pupillary response curves were recorded in patients with RAPDs clinically graded by an examiner (n = 32) and in normal subjects (n = 31) with RAPDs simulated using quantifiable dimmed light intensities. In 14 normal subjects, testing was repeated within two months. Pupillary constriction amplitude (CA), velocity (CV) and onset latency (COL) were used to calculate RAPDs. Results: RAPDs in normal subjects were 0.16 ± 0.12 log units (LU) (range = 0–0.38). In retested normals, inter-visit variability was 0.21 ± 0.12 LU (range = 0–0.42). Significant correlation was found between RAPD values and dimmed light intensity in normal subjects (Pearson’s r = 0.87, p < 0.0001) and between clinician and pupillometer grading of RAPDs in patients (r = 0.81, p < 0.0001). Using the upper limit of the one-sided 95% confidence interval (CI) of the ratio of percentage change in CA (LU) as determined from normals, 21/23 (91%) patients with RAPDs ≥ 0.5 LU were distinguished from normals. The area under the receiver operating characteristic curve for distinguishing RAPDs ≥ 0.5 LU was 0.98 (95% CI = 0.95–1.00). RAPDs calculated using CA and CV correlated more strongly with the clinician’s grading compared to COL (Steiger’s test p < 0.0001). Conclusions: This novel pupillometer correlated strongly with an expert examiner’s clinical grading of RAPDs and detected clinically significant RAPDs with high sensitivity and specificity, suggesting it may have a prominent role as an objective clinical tool in the screening of patients with vision loss.

A retrospective review of cases preoperatively diagnosed by radiologic imaging as cavernous venous malformations

ABSTRACT The purpose of this study is to examine orbital lesions identified on preoperative radiologic imaging as cavernous venous malformations (CVMs), identify their imaging characteristics, and determine if these may help differentiate CVMs from other intraorbital masses. An IRB–approved retrospective chart review over 30 years was undertaken identifying lesions “consistent with cavernous hemangioma” on radiologic studies, which were subsequently surgically resected with a tissue diagnosis. All radiologic images (CT and MRI) obtained preoperatively were re-reviewed by a single masked neuroradiologist. The pattern of contrast enhancement on sequential MRI views was used to determine whether the enhancing characteristics helped identify CVMs compared to other intraorbital masses. Fifty-seven orbital lesions consistent with a CVM were identified on imaging. Fourteen (25%) of them were resected, of which nine (64%) were found to be CVMs on pathologic examination. Five (36%) were found to be a different lesion, most commonly schwannoma (21%). On imaging, CVMs tended to display heterogeneous progressive enhancement, whereas other tumors, in particular schwannomas, enhanced at their maximum level immediately. Based on these characteristics, on re-review, the masked neuroradiologist was able to differentiate a CVM versus other tumors for all 14 imaging cases. This study suggests that examining the pattern of contrast enhancement may help to correctly differentiate a CVM from other isolated, encapsulated orbital lesions on CT/MR imaging.