Preschool Vision Screening in Korea: Results in 2003

PURPOSE: To report the results of preschool vision screening in South Korea in 2003. METHODS: Nation wide, population-based vision screening tests were conducted in preschool children over the age of 3 years from March to September 2003. The first step involved home-screening using picture cards. The children who did not pass the first test were sent to public health care centers, where their visual acuity was re-tested. After the re-tests, some children were referred to ophthalmologists. The referral criteria for visual acuity were: age 3, less than 0.5 visual acuity; age 4 or older, less than 0.63 visual acuity in at least one eye. RESULTS: Among 56,836 subjects who had been enrolled, 2,637 (4.6%) children were referred to ophthalmologists. Refractive error was found in 1,746 (66.2%) children. Amblyopia was discovered in 480 (18.2%) children. Anterior segment abnormalities were detected in 269 (10.2%) children, manifest strabismus was detected in 169 (6.4%) children, and fundus abnormalities were found in 17 (0.6%) children. Myopic astigmatism (31.0%) was the most common type of refractive error. Refractive error (87.9%) was the most common cause of amblyopia and exodeviation (63.9%) was the most common type of strabismus. CONCLUSIONS: From the results of the 2003 Preschool Vision Screening, we collected data about the ophthalmic abnormalities that can affect visual development in children. This information will foster improvement in the overall quality and design of preschool vision screening systems.

Higher-order Aberrations in Pseudophakia with Different Intraocular Lenses

PURPOSE: To compare high-order aberrations in the pseudophakia with different types of intraocular lenses (IOLs), as well as with normal phakic eyes. METHODS: This single-center prospective study comprised 80 cataract patients who underwent cataract surgery and 20 phakic eyes. Twenty eyes received an AF-1(R) VA-60BB; 20 eyes, a Corneal(R) ACR6D SE; 20 eyes, a Sensar(R) AR40e; and 20 eyes, a ClariFlex(R). One month after cataract surgery, the eye aberration was measured using a Hartmann-Shack type aberrometer. The same test was performed for 20 normal phakic eyes. The individual Zernike polynomials, the root mean square (RMS) values of the third and fourth order aberration, and the total RMS among the groups were compared. RESULTS: The individual Zernike coefficient (Z3(-1), Z3(3), Z4(-4), Z4(0), Z4(4)) showed a significant difference in the IOL-implanted groups compared with the normal phakic eyes. There were statistically significant differences in the RMS values of the third and fourth order aberration, and total among each group. CONCLUSIONS: There was a statistically significant increase in aberration in patients with high refractive index IOL and a statistically significant decrease in patients with silicone IOL, compared to the normal phakic eyes.

Short Term Clinical Results of Laser Epithelial Keratomileusis and Epi-Laser in Situ Keratomileusis for Moderate and High Myopia

PURPOSE: To compare the results of laser epithelial keratomileusis (LASEK) and epi-laser in situ keratomileusis (Epi-LASIK) for the treatment of moderate to high myopia. METHODS: In this study, 50 patients with a manifest refraction of moderate to high myopia were assigned to two groups: 50 eyes of 25 patients treated with LASEK and 50 eyes of 25 patients treated with epi-LASIK. Uncorrected visual acuity (UCVA), manifest refraction, corneal haze, and postoperative pain were reviewed in LASEK and epi-LASIK treated eyes at 3 months after the operation. RESULTS: At one week after surgery, UCVA was recovered more rapidly after epi-LASIK than LASEK (LASEK: 0.61+/-0.23, Epi-LASIK: 0.79+/-0.11, p<0.05), but UCVA at both 1 and 3 months showed no significant difference between the LASEK and epi-LASIK groups. However, epi-LASIK-treated eyes had lower postoperative pain scores and lower corneal haze scores (1 month; p=0.01) than those of LASEK-treated eyes. CONCLUSIONS: Epi-LASIK showed a more rapid visual recovery than LASEK at 1 week after surgery for the correction of myopia. Epi-LASIK-treated eyes also had less postoperative pain and an earlier reduction of postoperative corneal haze. These results suggest epi-LASIK could be a viable alternative procedure for the correction of moderate to high myopia.

A Comparison of Corrective Effect on Astigmatism after LASIK and LASEK

PURPOSE: We studied the effect of LASIK and LASEK for correction of myopic astigmatism and the clinical results in relation to preoperative astigmatism and operative methods. METHODS: We retrospectively analyzed the results of 176 eyes of 97 patients in the LASIK group and of 56 eyes of 29 patients in the LASEK group. All patients had undergone LASIK or LASEK for correction of myopic astigmatism with MEL-70TM (Aesculap-Meditec, Jena, Germany). Patients were divided into groups I (or=3.00D) according to preoperative astigmatism, and into groups A (LASIK) and B (LASEK) according to operative method. Each patient was followed up for over 6 months with measurements of uncorrected visual acuity, manifested refraction, and spherical equivalent at 1, 3, and 6 months after operation. RESULTS: In groups IA, IB, IIA, IIB, IIIA, IIIB, IVA, and IVB, preoperative cylindrical errors were 0.56 +/- 0.17D, 0.61 +/- 0.13D, 1.27 +/- 0.28D, 1.24 +/- 0.21D, 2.18 +/- 0.25D, 2.10 +/- 0.25D, 3.39 +/- 0.66D, and 3.50 +/- 0.61D, and postoperative 6-month astigmatism measurements were 0.33 +/- 0.49D, 0.34 +/- 0.36D, 0.28 +/- 0.30D, 0.63 +/- 0.44D, 0.48 +/- 0.42D, 0.44 +/- 0.57D, 0.86 +/- 0.42D, and 1.00 +/- 0.78D, respectively. CONCLUSIONS: The correction of myopic astigmatism in LASEK was less effective than in LASIK at early postoperative periods, but they showed similar effect on the correction of astigmatism at 6 months after surgery, especially in the group with medium to low grade of astigmatism.

Preschool Vision Screening for 3 to 6-Year Old Children in Korea

PURPOSE: To inform the necessity of mass screening, we performed a mass screening for the detection of ocular disorders of preschool children. METHODS: Ocular examination was performed on 60, 827 children in Korea (3-6 years of age) during the period from March to October, 2000. The total of 3, 254 children were shown to have either visual acuity of less than 0.5 or anisometropia of over 2 lines. Detailed eye examination was conducted on those 3, 254 children. RESULTS: The numbers of first mass screening were 60, 826. Diagnosis consisted of refractive errors in 2, 216, amblyopia in 664, and strabismus in 235. Among the types of refractive errors, myopic astigmatism was the most common type (34.0%). Astigmatism was combined with all other types in 1, 659 children. Refractive error was the most common cause of amblyopia (88.0%) CONCLUSIONS: To prevent and treat amblyopia or strabismus, early detection and adequate care at preschool age seemed to be very effective. Participation rate for this mass-screening of eye disease during preschool age will be more increased by efforts of constiutional support and parental cooperation.

Comparison of the Clinical Effect of the 1% Rimexolone with That of 0.1% Fluorometholone Following LASIK

PURPOSE: We compared therapeutic efficacy and steroid-induced IOP elevation of 1% rimexolone with that of 0.1% fluorometholone. METHODS: Of all LASIK treated eyes from March of 2001 to December of 2002 in Sungae General Hospital, 46 eyes were treated with 1% rimexolone and 46 eyes were treated with 0.1% fluorometholone. And we measured the degree of myopic regression (1 day, 1 month, 3 month) and intraocular pressure (1 month). RESULTS: Statistically signicant difference in therapeutic efficacy of myopic regression, and no statistically signicant difference in IOP were found. The therapeutic efficacy of 1% rimexolone was higher. CONCLUSIONS: We concluded that application of 1% rimexolone was more useful in myopic regression following LASIK rather than that of 0.1% fluorometholone.

A Case of Nonspecific Normal Retinal Vessels in Foveal Avascular Zone

PURPOSE: To report a case of a young man with nonspecific normal retinal vessels found in foveal avascular zone. METHODS: We experienced a 20-year-old man with decreased visual acuity of left eye. In anterior segment there was no abnormality, but there were unusual vessels in foveal avascular zone that appeared to be normal vessels. RESULTS: In fluorescein angiography, dye was exhibited on the vessel of foveal avascular zone in 14-15 sec after injection, and there were no leaking or abnormal findings. CONCLUSIONS: Normal retinal vasculature in foveal avascular zone is known to be an extremely unusual case in normal adult, and it is to report a case with review of available papers.

Four Cases of Strabismus presenting after Cataract Surgery

PURPOSE: We report four cases of strabismus presenting after cataract surgery and review the previous reports. METHODS: We examined four cases with diplopia for three months or more following cataract surgery between March 2001 and February 2002 in our hospital. We reviewed our records to inquire the preoperative systemic and ophthalmologic exam included past and present medical history. Also, we performed the strabismus test such as prism and cover test, forced duction test, force generation test included CT scan, if necessary. RESULTS: Case 1, 2, 3 were performed by retrobulbar anesthesia. Case 1 showed left superior rectus muscle overaction, case 2 showed left inferior rectus muscle palsy, case 3 showed left inferior rectus muscle palsy and superior rectus muscle overaction. Case 4 showed irregular pattern of strabismus. In case 1, 2, 3, diplopia in primary position was improved after strabismus surgery. We have observed case 4 until the pattern of strabismus would be stable. CONCLUSIONS: After uneventful cataract surgery, persistent strabismus may be occurred. So the operator must explain the occurrence of strabismus to patient before surgery, and carefully perform pre and post operative strabismus test and retrobulbar anesthesia.

The Effect of Dopamine therapy on the Development of Retinopathy of Prematurity

PURPOSE: Since a recent study that the use of dopamine therapy for the hypotension of premature infants was a risk factor on the development of retinopathy of prematurity was reported, this study was intended to access whether treatment of premature infants with dopamine acts as a risk factor for development of retinopathy of prematurity. METHODS: We retrospectively reviewed the medical records of 123 premature infants who had been admitted in our Neonate Intensive Care Unit, and were alive and born under 36 weeks of gestational age, between January 1995 and December 1999. In comparing dopamine treated group (91) and non-treated group (31), we performed univariate and multivariate statiscal analysis for the comparisons of two groups. RESULTS: Although in the incidence of retinopathy of prematurity, dopamine treated group (51 of 91,55.4%) was higher than non-treated group (15 of 31,48.4%), statistically, it was not significantly different(P< 0.05). CONCLUSIONS: The use of dopamine therapy was not risk factor for the development of retinopathy of prematurity.

Treatment of Acute Retinopathy of Prematurity with Argon Indirect Laser Ophthalmoscope 2nd Report

PURPOSE: It is to report the efficacy and safety of an argon laser photocoagulation which was the treatment modality for retinopathy of prematurity. METHODS: From March 1996 to December 1999, on 69 prethreshold retinopathy of prematurity, they were series of observations following periods of two to five days, one week, two weeks, four weeks, three months and one year time respectively. RESULTS: We noticed the regressions in 84 prethreshold retinopathy of prematurity cases as well. CONCLUSIONS: The report emphasized the advantages of the argon laser photocoagulation which reduce the risk from a general anesthesia by applying a topical anesthesia, and the safety of using laser technique of convenience to apply and minimize the tissue damages of the lesions. It also described the preferable consequent results following the early treatment with divided applications on the prethreshold cases.

Comparision between Manifest vs. Cycloplegic Photore fraction with MTI Photoscreener in Prematurity

Amblyopia and strabismus are common in eyes of prematurity and the need for early detection of amblyopia and amblyogenic factors is widely recognized. So, we performed refraction in premature infants at the 6 months of age to evaluate the incidence and degree of myopia and the changes of refractive errors according to the development, disease course and photocoagulation therapy of retinopathy of prematurity[ROP]. It is the purpose of this study to evaluate the effectiveness of MTI[medical Technology, Inc]photoscreener by comparing the sensitivity and specificity between refractive errors determined by manifest photorefraction and cycloplegic photorefraction in 6-month-old premature infants in Sung-Ae General Hospital. Pass or fail screening data from photograph of 32 non-dilated and dilated premature infant were calculated by two masked observers, compared with the results of cycloplegic retinoscopy, and the statical analysis was carried out. In the cases of cycloplegic photorefraction, Ten eyes of myopia, 4 eyes of emetropia, and 50 eyes of hyperopia were found, and 21 eyes of astigmatism above 1.5D were also detected. Overall statistical analysis of sensitivity and specificity rate were 71.7% and 69.5%in manifest photorefraction, 87.5% and of 75%in cycloplegic photorefraction, respectively. In non-cycloplegic photorefraction, sensitivity of myopia and hyperopia were 92.8%, 65%, but in cycloplegic photorefraction, sensitivity of myopia and hyperopia were 75%, 100%, respectively. The outcomes of our study suggest that MTI photoscreener in cycloplegic photorefraction was more reliable than non-cycloplegic photorefraction. Myopia under 1D turned to hyperopia in cycloplegic photorefraction, so the sensitivity of that was not to be reliable, but the sensitivity of hyperopia was high. Thus, the authors can readily recommand this cycloplegic photorefraction in uncooperable infants to evalute the refractive error conveniently.

A Case of Intraorbital Ectopic Lacrimal Gland with Lacrimal Duct

Ectopic lacrimal gland denotes a lacrimal gland which is located anywhere other than its normal site, lacrimal fossa, and it can occur in places like conjunctiva, cornea, lid, nasal mucosa, and orbit. It is a rare congenital anomaly and needs to be differentiated form other tumors. The literature contains few reports of ectopic lacrimal gland. We experienced a case of a 28-year-old Korean man who presented with an ectopic lacrimal gland with duct at temporal aspect of bulbar conjunctiva. The glandular tissue was excised and was histopathologically confirmed as such. We report it with reviews of the literature concerned.

The Epidemiological Study on the Ocular Disorders of the Rural Aged Population

OBJECT: It is to evaluate the priority area for effective eye care service to the aged population of rural comniunity at present and in future. METHOD: Number of aged group surveyed on 60 and over 60 years age that, counted 531 among the total 580 patients. Visual acuity was tested and refractive error was measured by Retinornax (Nikon, Japan) . Ocular examination was performed to determine the causes of visual impairment. This survey was conducted under the auspices of the Korean Foundation for Prevention of Blindness with assistance of the Seoul National University Postgraduate School of Public Health from 1994 to 1996 at the Public Health Center of Chun-Cheon, Kang-Won Do(Province). RESULTS: Age distribution showed the sixties (60-69) 49,3%, the seventies (70-79) 33.9%, and the eighties (80) 16.8%. Proportion of visual acuity of 0.7 or upper in the better eyes constituted 32.2% and of 0.2 or worse 19.4%. Causes of visual impairnnente consisted of refractive errors 35. 9%, cataract 35. 9%, macular degeneration 7, 4%, and corneal opacity 3.9% in order. Contributed modes of care were spectacles 27.9%, surgeries 23.9% (cataract, operation, pterygium removal etc.), and medical treatment 23.9%. DISCUSSION: Surgery of the aged population in rural comrnunity of Chun-Cheon revealed the most. prevalent. causes of visual impairment as the refractive errors and cataract. It is suggested that. the most effective eye care would be provided systemically based 0 the result of the epidemiological study on the various ocular disorders.

A Case of Ossification in the Phthisis Bulbi

Phthisis bulbi, resulting from repeated ocular inflammation and infection or ocular trauma, causes various degeneration of ocular tissue as well as changes in ocular external shape. It shows the impression of scleral thickening with calcification of ocular tissue and an unusual ossification as well. Having observed 31-year-old patients of phthisis bulbi and band keratopathy caused by repeated operation after ocular trauma years ago, we extracted the tan brown colored shell-like firm tissue in posterior segment and report sclerotic impression of some of ocular tissue and histopathologic finding of the typical ossificationof ocular tissue during the course evisceration.

Effect of the Illumination and the Types of the Lenses on Near Visual Acuity in Low Vison Patients

To obtain adequate information of illumination and lens types for visual acuity test of low vision patient, the relation between various illumination and vision was evaluated. Visual acuity for near and effective lens types were examined. Among the 28 patients (of 36 eyes), intensities of illumination were set at 200, 500, 1000 and 2000lux and the lenses of biconvex, aspheric and aplanatic were tested. The best visible range of illumination for the low vision patients was 500-1000lux, with lower power diopter for the same visual acuity and with aspherin and aplantic lenses. Results attained by our study may be applied for appropriate condition of illumiation and type of lens in the low vision care.

Clinical Evaluation of Ophthalmic Injury Associated with Head Injury

Secondary eyeball injury can be caused by head injury as well as direct injury of the eyeball or the orbit. Authors of this report have researched on 117 patients who were applied for ophthalmic examination which in care of the neurosurgical department and have researched frequency of secondary eyeball injury, association between the eyeball injury and the head injury, and favourable frequency of the eyeball injury which were developed without direct injury of the eyeball. There were 21 eyes(9.0%) with external ocular abnormality in 18 patients which included lagophthalmos, ptosis, paralytic strabismus, and there were 14 eyes(6.0 %) with posterior segment abnormality which were vitreoretinal hemorrhage, option. injury and papilledema in 11 patients. In association between the head injury and the eyeball injury, there were many external paralytic injury in basal skull injury and many posterior segment injury in cerebral parenchymal injury. After their injury, follow-up was executed in 3 month interval for 12 month. 15 eyes with external ocular abnormality and 8 eyes with posterior segment abnormality showed favourable progression. Posterior segment abnormality improved statistically significant at 3 month after injury(p<0.05). Secondary ophthalmic injury can be caused by various head injuries. Based on periodic observation, external ocular abnormality improved frequently at more than 9 months after injury. In cases of posterior segment abnormality, there was statistically significant improvement at 3 month after injury(p<0.05). Thus careful observation and treatment should be made in its early stage.

A Case of Extraconal Neurilemmoma

The orbital neurilemmoma originates exclusively from Schwann cells of the cranial nerve, any myelinated peripheral nerve, and sympathetic nerve. The incidence of this benign neoplasia is reported as rare and arises usually in the intraconal. A 28-year-old female complained of lid swelling and palpable mass on the right upper lid for a period of 8 months. The mass wsa excised totally and histopathologic examination revealed a typical neurilemmoma(Schwannoma). In this case, there was no proptosis because the mass was located extraconally. It is to report a rate case of extraconal neurilemmoma of the orbit.

Refractive Errors in Relation to Acute ROP State

It was reported that the refractive power in the premature infants was more frequently myopic than in the normal, but there was little known about the onset and pathogenesis. The 106 premature infants, less than 37 weeks's gestational age, were comparatively examined at the age of 4 weeks to determine that there was myopic shift before cicatrical ROP state and the correlation of corneal diameter, axial length with refractive errors. The No-ROP group was 70 infants(140 eyes), and ROP group was 36 infants(72 eyes), and it was possible to analysis statistically only within the 33-36 post-conceptional age because the two groups were not normally distributed. The mean spherical equivalents at the 33-34 weeks were +1.91 Diopter, +1.48 Diopter in the No-ROP group and -0.21 Diopter, 0.00 Diopter in the ROP group, and this was statistically different(p0.05). This study revealed that the refractive errors in the ROP group were more myopic shift than in the No-ROP group in regard to early active state of ROP.

Delayed Tear Clearance Induced by Botulinum Toxin Injection in Essential Blepharospasm and Hemifacial Spasm

Assuming that botulinum toxin injection can release the involuntary contraction as well as reduce the tear drainage function, mediated by paralysis of orbicularis oculi muscles, then give rise to effect on tear clearance, Authors have examined 18 blepharospasm and 32 hemifacial spasm patients to evaluate the pre- and post- botulinum toxin injectional values of BUT, Schirmer test, and fluolescein clearance test 1, 2, which evaluate possibilities of delayed tear clearanee induced by botulinum toxin injection. Following treatment with botulinum toxin, results of BUT were increased significantly (p<0.0001), values of Schirmer test tended to increase without statistical significance. In fluorescein clearance test 1, length and concentration values were increased significantly(p<0.05), but in fluorescein clearance test 2, only length measurements were increased significantly(p<0.05). And also in blepharospasm cases of BUT values less than 4 second, both Schirmer test and fluorescein clearance test results were increased with statistical significance(p<0.05). We concluded that delayed tear clearance induced by botulinum toxin injection could be effective treatment for facial dystonias, especially combined cases with dry eye.

Clinical Experience on the Visual Rehabilitation of Low Vision Patients

We evaluated the efficacy of the optical and non-optical low vision aids on the basis of our 31 low vision patients, whose visual acuities were not corrected with the conventional glasses nor operations. Out results were following that the improved visual acuities by the low vision aids were stastically significant(p<0.01, paired t-test), and meet their needs. We think the optical and non-optical low vision aids are required to rehabilitate the visually impaired patients.