Dacryoscintigraphic Findings in the Children with Tearing

PURPOSE: To investigate the diagnostic effectiveness of dacryoscintigraphy in children with tearing; to evaluate tear clearance rate as a diagnostic factor of dacryoscintigraphy in children with tearing; and to analyze the results of treatment according to dacryoscintigraphic findings in children with tearing. METHODS: Between January 2010 and April 2014, 176 eyes of 88 children with tearing (49 boys and 39 girls; mean age, 23.81 ±14.67 months; range, 12 to 72 months) were studied retrospectively. Of these, 37 of 88 children with tearing were bilateral cases, and 51 were unilateral cases. None of the patients had a history of craniofacial disorder or trauma. The chief complaint of tearing with or without eye discharge and delivery mode, past history of neonatal conjunctivitis, syringing, or probing were collected from parents, grandparents, or previous hospital data. The drainage pattern of the nasolacrimal duct was analyzed, and the clearance rate of 50 microCi 99m technetium pertechnetate was measured by dacryoscintigraphy. RESULTS: According to the dacryoscintigraphy results, 98 of 125 eyes (78.4%) with tearing showed nasolacrimal obstruction and 29 of 51 eyes (56.9%) without tearing showed patency. There was a significant difference between tearing eyes and normal eyes (p = 0.001). The clearance rate difference after 3 and 30 minutes was 16.41 ± 15.37% in tearing eyes and 23.57 ±14.15% in normal eyes. There was a significant difference between epiphoric eyes and normal eyes (p = 0.05). Based on the dacryoscintigraphic findings, nasolacrimal-duct obstruction was treated with probing or silicone-tube intubation. The majority of patients showed symptom improvement (75.2%) during the two months of follow-up. CONCLUSIONS: Dacryoscintigraphy is a non-invasive method of qualitatively and quantitatively diagnosing nasolacrimal duct obstruction in children with tearing.

Pharmacologic Effects of Atropine Penalization in Amblyopic Eyes

PURPOSE: To analyze the pharmacologic effect of atropine penalization in amblyopic eyes. METHODS: Distant and near visual acuity, near point of accommodation (NPA), and pupil size were measured in the sound eye of 40 children with amblyopia before and after receiving atropine sulfate 1% solution. Amblyopic children were divided into 2 groups according to the time of follow-up visit: 4-days and 7-days after injection; the same tests were performed on all the scheduled follow-up visits. This study included a control group of 20 normal children who received the same test on the initial visit and the scheduled follow-up visits. RESULTS: Visual acuity of the sound eye at distance showed greater decreases in children with 4-day follow-up visits compared with 7-day visits in the amblyopic group (p = 0.24). There was no significant difference in near visual acuity between the amblyopic group and the normal control group by follow-up interval (p = 0.98, p = 0.75). Near point of accommodation significantly increased in the 4-day visit group in both the amblyopic and the normal control groups (p = 0.04 and p = 0.03, respectively), Pupil size was significantly maintained in the 4-day visit, amblyopic group (p = 0.01). CONCLUSIONS: Atropine effectively decreased the vision of the sound eye in amblyopic children. However, to maintain the pharmacologic effect, two separate atropine instillations per week (on a weekday and the weekend) should be considered as a treatment for amblyopia.

A Study of Driving Behaviors among Patients with Chronic Ophthalmological Disorders

PURPOSE: This study examines driving behaviors among patients treated for chronic ophthalmologic disorders and the effects of visual acuity and visual field on driving performance. METHODS: A 15-item survey was given to 153 patients treated for chronic ophthalmologic disorders including diabetic retinopathy, glaucoma, retinal vessel occlusions, and senile macular degeneration. Six items questioned the patient's discomfort based on a five-point scale according to different driving conditions and one item involved a self-assessment of driving problems. Results were compared with the best corrected visual acuity (BCVA) and visual fields of the patients. RESULTS: In total, 16.2% of first-class drivers and 24.1% of second-class drivers rated below the evaluation standards of the driving license aptitude test. Overall, 82.6% of the patients continued to drive, while 7.8% renounced driving due to decreased visual acuity. Patient discomfort was significantly correlated with visual acuity (r = -0.503, p < or = 0.01). Among the patients scoring below the evaluation standards, 74.2% responded that their visual acuity had become a problem while driving. CONCLUSIONS: These results call for appropriate driving programs and measures to educate people about responsive driving considering the visual function of patients treated for chronic ophthalmologic disorders.