Improvement in Near Vision Following Silodosin Treatment in Patients With Lower Urinary Tract Symptoms / 대한배뇨장애요실금학회지

Purpose@#The objective of this study was to investigate the change in near visual function after the administration of oral silodosin to patients with lower urinary tract symptoms (LUTS). @*Methods@#This prospective study included treatment-naive patients who were scheduled to start treatment with silodosin for LUTS. A comprehensive ophthalmological evaluation including the near vision and the automated pupillometry was performed at baseline and after 3 months of silodosin treatment. For subjective assessment of near visual ability and satisfaction, a Near Activity Visual Questionnaire-10 (NAVQ-10) was also used at the same time (higher scores indicating worse quality). @*Results@#Of 23 patients enrolled in this study, 15 continued with silodosin (8 mg once daily) treatment for 3 months and completed a follow-up evaluation. The mean age of participants was 60.4±8.4 years. Distant visual acuity and spherical error were unchanged after silodosin treatment. However, near vision acuity (logMAR) was improved after treatment (right, 0.47±0.36 vs. 0.38±0.39, P=0.018; left, 0.41±0.37 vs. 0.31±0.34, P=0.068; both, 0.27±0.26 vs. 0.21±0.27, P=0.043). Pupil size under room light decreased significantly in both eyes (right, 3.77±0.60 vs. 3.16±0.58, P=0.001; left, 3.72±0.80 vs. 3.21±0.75, P=0.002). The Rasch scale at NAVQ-10 improved from 54.7±9.9 to 48.5±11.2 (P=0.004). @*Conclusions@#This preliminary study demonstrated that highly selective alpha-1A adrenergic receptor antagonists such as silodosin improve near visual acuity and quality in patients with LUTS/benign prostatic hyperplasia. Decrease in pupil size caused by inhibition of adrenergic alpha 1 mediated contraction of iris dilator muscle is a possible mechanism underlying improved near vision.

Improvement in Near Vision Following Silodosin Treatment in Patients With Lower Urinary Tract Symptoms / 대한배뇨장애요실금학회지

Purpose@#The objective of this study was to investigate the change in near visual function after the administration of oral silodosin to patients with lower urinary tract symptoms (LUTS). @*Methods@#This prospective study included treatment-naive patients who were scheduled to start treatment with silodosin for LUTS. A comprehensive ophthalmological evaluation including the near vision and the automated pupillometry was performed at baseline and after 3 months of silodosin treatment. For subjective assessment of near visual ability and satisfaction, a Near Activity Visual Questionnaire-10 (NAVQ-10) was also used at the same time (higher scores indicating worse quality). @*Results@#Of 23 patients enrolled in this study, 15 continued with silodosin (8 mg once daily) treatment for 3 months and completed a follow-up evaluation. The mean age of participants was 60.4±8.4 years. Distant visual acuity and spherical error were unchanged after silodosin treatment. However, near vision acuity (logMAR) was improved after treatment (right, 0.47±0.36 vs. 0.38±0.39, P=0.018; left, 0.41±0.37 vs. 0.31±0.34, P=0.068; both, 0.27±0.26 vs. 0.21±0.27, P=0.043). Pupil size under room light decreased significantly in both eyes (right, 3.77±0.60 vs. 3.16±0.58, P=0.001; left, 3.72±0.80 vs. 3.21±0.75, P=0.002). The Rasch scale at NAVQ-10 improved from 54.7±9.9 to 48.5±11.2 (P=0.004). @*Conclusions@#This preliminary study demonstrated that highly selective alpha-1A adrenergic receptor antagonists such as silodosin improve near visual acuity and quality in patients with LUTS/benign prostatic hyperplasia. Decrease in pupil size caused by inhibition of adrenergic alpha 1 mediated contraction of iris dilator muscle is a possible mechanism underlying improved near vision.

Idiopathic intracranial hypertension in the Middle East: a growing concern

Idiopathic Intracranial Hypertension [IIH] is a disorder of increased intracranial pressure without any identifiable etiology. It is defined by elevated intracranial pressure [ICP] with normal neuroimaging and normal cerebrospinal fluid [CSF] contents. IIH typically affects young obese women and produces symptoms and signs related to high ICP. Headache and blurred vision are the most common symptoms, and papilledema is the major clinical sign. In this review we examine the epidemiology and demographic features of IIH in Middle Eastern countries and compare and contrast them with the published IIH literature from Western countries. The incidence of IIH in several Middle East countries has been estimated at 2.02-2.2/100,000 in the general population, which is higher than the Western rate. Obesity is a major risk factor globally and it is associated with an increased risk of severe vision loss due to IIH. There has been an increase in obesity prevalence in the Middle East countries mainly affecting the Gulf Council Countries [GCC], which parallels increased industrial development. This rise may be contributing to the increasing incidence of IIH in these countries. Other risk factors may also be contributing to IIH in Middle East countries and the differences and similarities to Western IIH merit further study

Structured curricula and curriculum development in ophthalmology residency

There has been a shift in graduate medical education [GME] from the traditional "apprenticeship" model to a more curriculum-based and competency driven model. Reflecting a global trend towards residency education reform, the International Council of Ophthalmology [ICO] introduced a resident and specialist curriculum and several live educational programs to promote standardization and more effective GME and continuing professional training. Implementation of these educational innovations will require efforts by local educator champions; modification and customization of teaching and assessing tools to the local learning environment; alignment of the implementation blueprint with available resources; and creation of accountability and sustainability mechanisms to insure long-term viability of the educational reforms. An ultimate goal of the ICO curriculum is to allow real world testing and modification so that the ideas generated in one part of the world might be applicable and generalizable in other areas. We aim to describe the Accreditation Council of Graduate Medical Education [ACGME] competencies in the United States [US] and ICO curriculum, as well as to provide a step-by-step plan for implementation of an ophthalmology residency curriculum

Visual hallucinations [Charles Bonnet syndrome] associated with neurosarcoidosis

The Charles Bonnet syndrome [CBS] refers to lucid and complex visual hallucinations in cognitively normal patients with acquired vision loss. It can be associated with any type of vision loss including that related to macular degeneration, corneal disease, diabetic retinopathy, and occipital infarct. Neurosarcoidosis, a multi-systemic inflammatory granulomatous disease affecting both the central and peripheral nervous systems, is rarely associated with CBS. We report a patient with biopsy-confirmed neurosarcoidosis who experienced visual hallucinations following the development of a right seventh-nerve palsy, right facial paresthesia, and bilateral progressive visual loss. This case highlights the importance of recognizing that the CBS can occur in visual loss of any etiology

Neuroimaging in ophthalmology

In the past three decades, there have been countless advances in imaging modalities that have revolutionized evaluation, management, and treatment of neuro-ophthalmic disorders. Non-invasive approaches for early detection and monitoring of treatments have decreased morbidity and mortality. Understanding of basic methods of imaging techniques and choice of imaging modalities in cases encountered in neuro-ophthalmology clinic is critical for proper evaluation of patients. Two main imaging modalities that are often used are computed tomography [CT and magnetic resonance imaging [MRI]. However, variations of these modalities and appropriate location of imaging must be considered in each clinical scenario. In this article, we review and summarize the best neuroimaging studies for specific neuro-ophthalmic indications and the diagnostic radiographic findings for important clinical entities

evaluation for isolated unexplained optic atrophy: implications for Saudi Arabia

To describe the evaluation of isolated optic atrophy based upon the individual clinical presentation, history and exam of the patient and a directed work up for disorders which are endemic to the patient population of interest. Review of literature and expert opinion. The evaluation of optic atrophy can be difficult and can lead to many expensive or unnecessary tests. The majority of patients with optic atrophy have historical or examination findings that allow the clinician to make an etiologic diagnosis or provide specific guidance for a focused laboratory or radiographic evaluation. Neuro-imaging, preferably cranial magnetic resonance imaging [MRI] with and without contrast and including orbital fat suppression is generally considered the first line evaluation for all patients with unexplained optic atrophy. Directed laboratory or other radiographic testing should be individualized based upon the prevalence of specific disorders in the patient population of interest