Luciene Chaves Fernandes

Catarata infantil: importância do diagnóstico e tratamento precoces

ABSTRACT Purpose: To establish the frequency of infantile cataract inthe Low Vision Service of Sao Geraldo Hospital (HSG-HCUFMG) and to analyze basis of history, ophthalmologicexamination and optical prescription in these patients. Me-thods: Retrospective study of infantile cataract recorded inthe Low Vision Service from January/1992 to December/2002.Age, sex, race, age at the first evidence of leukocoria and whonoticed it, ages at diagnosis and phacectomy, family historyof cataract, intraocular lens implantation, visual acuity (VA)and optic prescription were evaluated. Results: There were 44patients. The age ranged from 0-15 years: 19 (43.0%) 0-3, 14(32.0%) 4-10 and 11 (25.0%) from 11-15 years. Twenty-eight(63.6%) were female and 19 (43.2%) leukodermic. The firstevidence of leukocoria was observed by the mother in 17patients (38.6%). Leukocoria was observed in the first 2months of life in 45.5% of the patients; phacectomy was per-formed in 43.2% of the patients with more than 1 year of age.Optic prescription was performed in 61.4% of the cases with9.1% of the patients below 1 year of age. Intraocular lens wasimplanted in 13.6% and 4 patients (9.1%) had a family historyof congenital cataract. In 20.4% VA was lower than 20/400 andsecondary glaucoma was observed in 18.2% of the cases. Lowvision aids included two glasses and one telescope. Conclu-sion: More information about congenital cataract should beprovided for families and pediatricians, and early surgicaltreatment, optic correction and treatment of amblyopia shouldbe performed promptly.Keywords: Cataract/congenital; Cataract/diagnosis; Cataract/epidemiology; Vision low

Charles Bonnet syndrome: characteristics of its visual hallucinations and differential diagnosis

OBJECTIVE To present an eight-case serie of patients with Charles Bonnet syndrome (CBS). METHOD All patients were initially evaluated by an ophthalmologist and then submitted to a neurologic evaluation with exclusion of alternative psychiatric and neurologic diagnoses. RESULTS Five patients were male (62.5%) and the mean age was 52.3+16.0 years. Two patients suffered from severe myopia and glaucoma, three had retinitis pigmentosa, one had anterior ischemic optic neuropathy, one had age-related macular degeneration and one had toxoplasmic retinochoroiditis. Mean visual acuity in the right eye was 1,12 logMAR and in the left eye 0.57 logMAR. A mean delay of 41.7 months occurred until diagnosis. All hallucinations were complexes and mostly ocurred on a weekly-basis (62.5%) and lasted for seconds (87.5%). CONCLUSIONS Physicians who care for low vision patients should be aware of CBS and appropriately diagnose its hallucinations after exclusion of psychiatric and neurologic diseases.

Distrofias retinianas da infância: análise retrospectiva

PURPOSE: To describe the clinical features and the results of diagnostic methods in all patients with diagnosis of one of the following retinal dystrophies: Leber congenital amaurosis (LCA), achromatopsia, cone distrophy or cone-rod distrophy, examined at the Low Vision Department of the Federal University of Minas Gerais, in the period of 1992 to 2003. METHODS: Retrospective analysis of charts of 40 patients. Ten had LCA, 17 had achromatopsia, 6 had cone distrophy and 7 had cone-rod distrophy. RESULTS: Visual acuity was extremely low in patients with LCA, ranging from 20/710 to light perception. The mean value for achromatopsia was 20/200, 20/280 for cone distrophy and 20/260 for cone-rod distrophy. High hyperopia was the most common refractional error in LCA patients. Hyperopia was more frequent in cases of achromatopsia and cone distrophy, while in cone-rod distrophy myopia predominated. Fundoscopy was altered in most cases of LCA, cone distrophy and rod-cone distrophy, and normal in most cases of achromatopsia. Oculodigital sign and enophtalmus were found only in LCA patients while photofobia and color vision defects prevailed in other groups. Nistagmus and strabismus were frequent findings in all groups. There was a high incidence of delayed neuro-psycho-motor development in LCA patients. Two of them had also associated genetic syndromes. Patients presented symptoms very early in life in LCA and achromatopsia, while in cone and cone-rod distrophies symptoms appeared later, but never after the age of 10. Consanguinity and positive familial history were strongly associated in all groups. The ERG was extinct in LCA, showed reduced photopic response in achromatopsia and diffuse reduction in cone-rod distrophy. Color vision tests were altered mainly in achromatopsia and in cone distrophy. CONCLUSIONS: Retinal distrophies in childhood are a heterogeneous group of diseases with unspecific symptoms. A careful analysis of clinical features and diagnostic tests, specially color vision tests, ERG and visual field may be useful in their diagnosis.

Eficiência dos testes cromáticos de comparação na discromatopsia hereditária: relato de casos

The authors describe two cases of hereditary dyschromatopsia and discuss the efficiency of the color vision tests. The patients were disapproved in different federal public examinations because Ishiharas test diagnosed hereditary dyschromatopsia. Ophthalmological evaluation was normal. No symptoms related to dyschromatopsia were presented. Panels D15 and Roth D 28 were normal. Desaturated D 15 showed deuteranomaly in case one. In the second case the comparative color vision tests showed nonspecific disorder. The diagnosis of dyschromatopsia is complex. The authors recommend comparative color vision tests to complement the Ishihara test for a better understanding of the color deficiency.

Coloboma ocular: alterações oculares e sistêmicas associadas

PURPOSE: To verify and compare with the literature the profile of patients with ocular coloboma, and also to verify visual acuity, ocular and systemic abnormalities. METHODS: Retrospective analysis of 18 patients with a definite diagnosis of ocular coloboma at the Low Vision Department of the Sao Geraldo Eye Hospital of the Federal University of Minas Gerais. Patients underwent a complete ophthalmologic evaluation: sex, age, race, family history, prenatal and birth history, complete or incomplete coloboma, location, microphthalmos or anophthalmos, other ocular and systemic abnormalities, and visual acuity. RESULTS: 10 (55.6%) patients were women. The age was from 4 to 57, and the mean was 9.5 years. Only three (16.7%) patients had a family history of coloboma. All patients had negative prenatal and birth history. The coloboma was bilateral in 100% of the patients, and associated with microphthalmos in 6 (33.3%) cases. The coloboma was considered typical in 14 (77.8%) patients, with retinochoroidal coloboma being the most frequent, 16 (88.9%) patients. 50% of the patients had coloboma as an isolated ocular anomaly, while the other 50% presented association with systemic anomalies. In 14 (77.8%) patients other ocular abnormalities were found. CONCLUSION: The complete ophthalmologic examination is extremely important for both the diagnosis and prognosis of the patients with coloboma, since the coloboma may be associated with important low visual and also systemic anomalies and syndromes.

Nova proposta de treinamento e avaliação do uso de auxílios ópticos em portadores de visão subnormal

Purpose: The design and use of new near-vision charts for training and evaluation of the use of optical aids in low vision patients. Methods: Construction of new charts obeying a linguistic complexity, starting with words, followed by expressions and sentences and ending with texts. The new material was used in thirty-two patients with retinitis pigmentosa, with a corrected visual acuity from 0.5 to 1.3 LogMAR. Reading speeds were recorded with and without optical aids. Results: Word-reading, expression-reading, sentence-reading and text-reading charts in different sizes, with black print on a white background and white print on a black background. The data regarding age, sex, visual acuity, optical aids, print size, reading speeds with and without aids and educational training are shown. Conclusion: Text reading is the best instrument in qualitative and quantitative evaluation of the use of optical aids. The proposed charts have an increasing linguistic complexity trying to minimize the nonvisual factors. This is an important material for low vision, but reading performance depends on features of each patient.

Estudo comparativo de três métodos de localização de escotomas centrais

ABSTRACT Objective: The aim of this study was to compare the sensitivi-ty of three methods of central scotoma localization. Methods: Twenty-nine patients (range 10–78 years) were referred to theService of Subnormal Vision of the Sao Geraldo Hospital (Mi-nas Gerais Federal University, School of Medicine) withprevious diagnosis of diseases with central scotoma. TheAsmler grid, face observation and near acuity test observa-tion methods were used. Results: Among these methods, theone which presented the highest percentile of patients thatreported scotoma presence was the Asmler grid (63.6%), follo-wed by face observation (47.3%) and near acuity test observa-tion (30.9%) (p<0.05). The three methods presented low sen -sitivity, possibly explained by the plasticity of the visual systemtrying to compensate the scotoma area. Conclusion: The pre-sent result demonstrates that new techniques should be de-veloped to improve the sensitivity of scotoma localization me -thods. Keywords: Scotoma; Vision, low; Observation/methods;Vision tests/methods

Espectrofotometria de lentes oftálmicas filtrantes coloridas sob radiação ultravioleta a e luz visível

PURPOSE: Determination of transmittance curves through spetrophotometric measurementes of color filtering lenses submitted to UVA and light visible radiation, and comparison of the results in the band between 320 and 800 nanometres (nm). METHODS: The filtering color of Danny yellow 1, orange, green and grey and Rio de Janeiro yellow 2 lenses have been analyzed using JEM Way model 6.400 spectrophotometer. RESULTS: All lenses showed distinct and variable transmittance in the spectrum of UVA and light visible radiation. In the bands between 320 and 400 nm all lenses showed less than 4% of transmittance. The yellow 1 showed the greatest average (3.7%) while the grey lens showed the smallest average (0.45%). Nevertheless no statistical differences were observed between those lenses. We analyzed the transmittance curve in three different lens positions and no statistically significant differences were found. CONCLUSION: Spectrophotometric properties need to be determined in order to indicate color-filtering lenses with safety. The capacity of filtering light radiation is more important than the fact of being colored or not.

Espectrofotometria de lentes oftálmicas orgânicas de visão simples submetidas à radiação ultravioleta A, ultravioleta B e luz visível

PURPOSE: To verify, by spectrophotometric study, the filtration power of A and B ultraviolet radiation and transmittance of visible light in colorless lenses of simple vision. METHODS: Spectrophotometric analysis (Model Humphrey Lens Analyzer LA 360 spectrophotometer) of 14 types of colorless ophthalmic lenses, made of organic material of different characteristics. Each lens type was represented by 20 copies, totaling a sample of 280 studied lenses. Later, the analysis of the transmittance curve in the spectrum range of 290 to 700 nm was performed. RESULTS: In relation to UVB radiation, all of the studied lenses presented transmittance from 0 to 1%. The ones that had a better performance (0% transmittance) were: Trivex, Rugged Fashion Wear, AO Lite, Hard Resin, Sola Light 1.56, MAR 1.56, MAR CR39, Stylis Crizal, Crizal, Air Wear, Orma 15. As for UVA rays, the transmittance oscillated from 1 to 18%. The ones that had a better performance (1% transmittance) were: Miolight Anti Reflex 1.56, Trivex, Miolight Excellence, Rugged Fashion Wear, Sola Light, MAR 1.56, Stylis Crizal e Air Wear. None of studied lenses completely filtered UVA radiation. All of the studied lenses presented transmittance over 95% in relation to the visible spectrum, with a variation from 95 to 100%. CONCLUSIONS: The studied colorless lenses present a real capacity of filtration of UV radiation, especially regarding the UVB spectrum, which is favorable since this is the main portion of the spectrum related to ocular damages. All of the studied lenses presented UVB filtration power from 99 to 100%, UVA from 82 to 99% and 95 to 100% of transmittance of visible light. The presence of such filters in colorless lenses increases the possibilities of prescription of this resource of ocular protection.

Lentes de contato filtrantes coloridas nas discromatopsias: relato de casos

The authors propose the use of absorptive and colored contact lenses as an aid to color defects in making color judgments and reduce glare sensitivity in dichromatic subjects, when the use of filter in glasses is not possible. Absorptive and colored contact lenses were adapted in two dichromatic subjects, one deutanope and the other with achromatopsia. In the former, a hard absorptive, red-colored, polymethacrylate lens was adapted monocularly, in the non-dominant eye to help color judgments. In the latter, a soft absorptive, dark brown-colored lens with amber pupil was worn in both eyes to reduce glare sensitivity. Subject # 1 remained with the same visual acuity and contrast sensitivity and demonstrated a better color perception on the PV-16 test. Subject # 2 showed an subjective reduced glare, in external and internal environment. Visual acuity and color vision remained the same. The findings suggest the use of absorptive colored contact lenses to increase color judgement and reduce glare sensitivity in dichromatic subjects.