Long-Term Binocularity in Accommodative Esotropia

PURPOSE: To find clinical factors related to the long-term outcome of binocularity in accommodative esotropia. METHODS: Forty-nine patients with accommodative esotropia who were followed over 5 years after successful optical alignment within 8 prism diopters of orthophoria at near and distance with glasses including bifocals were included. The patients who had stereo acuity better than 50 seconds/arc and central fusion without suppression scotoma at the final visit were divided into the bifoveal fusion group and the others were divided into the peripheral fusion group. Clinical factors were analyzed between the two groups (Chi-square test, student t-test). RESULTS: Of the 49 patients, 15 patients were included in the bifoveal fusion group and 34 patients were included in peripheral fusion group. Mean follow-up was 88.9 +/- 25.4 months. Clinical factors that were significantly related to the bifoveal fusion group were older age of onset, shorter duration of misalignment, intermittent esotropia at the initial visit and after initial optical correction, smaller residual deviations at distance after initial optical correction and at the final visit, and lesser amblyopia. CONCLUSIONS: To obtain better levels of long-term binocularity, optical correction should be done as early as possible, before the presence of constant eye misalignment or amblyopia, and the residual esodeviations after optical correction should be kept as small as possible.

The Effect of Various Factors on Variability of Retinal Nerve Fiber Layer Thickness Measurements Using Optical Coherence Tomography

PURPOSE: To evaluate the effects of various factors on the variability of retinal nerve fiber layer (RNFL) thickness measurements using the Stratus optical coherence tomography (OCT) in normal and glaucomatous eyes. METHODS: Four hundred seventy-four subjects (103 normal eyes and 371 glaucomatous eyes) were scanned to determine the RNFL thickness measurements using the Stratus OCT. Measurements were obtained twice during the same day. The standard deviation (SD) was used to compare the variability in RNFL thickness measurements of the normal subjects to that of the glaucomatous patients. Multivariate regression analysis was used to evaluate which covariates were independent predictors of SD in overall mean RNFL thickness. RESULTS: The mean SD of all RNFL thickness measurements was larger in the glaucoma group except in one sector. In the multivariate regression analysis, the average signal strength (SS) and the relative SS change (difference in SS between initial and repeat scans, divided by initial SS) were independent predictors of the SD in the RNFL thickness measurements (partial R2 = 0.018, 0.013; p = 0.016, 0.040, respectively). CONCLUSIONS: Glaucomatous eyes tend to be more variable than normal eyes in RNFL thickness measurement using the Straus OCT. The average SS and the relative SS changes appear to correlate with the variability in RNFL thickness measurement. Therefore, the results of the RNFL analysis should not be interpreted independently of these factors.

Conventional Epi-LASIK and Lamellar Epithelial Debridement in Myopic Patients with Dermatologic Keloids

We report the outcome of conventional epipolis laser in situ keratomileusis (Epi-LASIK, flap-on) and lamellar epithelial debridement (LED; Epi-LASIK, flap-off) in myopic patients with dermatologic keloids. Three patients, who were all noted to be susceptible to keloid scarring, received conventional Epi-LASIK in their right eyes and LED in their left eyes. The patients were followed-up for 6 to 21 months after their surgeries, and the outcomes were then evaluated. In case 1, the preoperative spherical equivalent (SE) was -6.5 diopters (D) in the right eye (OD) and -6.25 D in the left eye (OS). At 21 months postoperatively, the uncorrected visual acuity (UCVA) was 20 / 12.5 in both eyes. In case 2, the preoperative SE was -5.25 (OD) / -6.00 (OS). After six months, the postoperative UCVA was 20 / 12.5 in both eyes. In case 3, the preoperative SE was -4.5 (OD) / -2.0 (OS). The UCVA at the six-month follow-up was 20 / 12.5 in both eyes. No adverse events, including corneal haze, occurred in any of the patients. All three of our patients reported excellent visual outcomes following both conventional Epi-LASIK and LED, despite their histories of keloid formation. The present cases suggest that both Epi-LASIK and LED may be safe and effective techniques for myopic patients with dermatologic keloids.

The Prevalence of Vitreoretinal Diseases in a Screened Korean Population 50 Years and Older

PURPOSE: To describe the prevalence of vitreoretinal diseases in the Korean population 50 years or older at a health screening center. METHODS: The participants of this study included 11,180 adults 50 years of age and older who visited the Health Promotion Center of Kangbuk Samsung Hospital from January to December 2006. Digital images of non-mydriatic fundus photographs were examined. We calculated the sex- and age-adjusted prevalence of vitreoretinal diseases using the direct standardized method based on the number of resident registrations. RESULTS: The age- and sex-adjusted prevalence of vitreoretinal diseases in Korean adults 50 years of age and older was 9.9%. The prevalence of vitreoretinal diseases significantly increased with age (P=0.000). There was no significant gender difference in the prevalence of vitreoretinal diseases (p=0.553). Age-related macular degeneration was the most common vitreoretinal disease, with an age- and sex-adjusted prevalence of 5.2%. Epiretinal membrane, retinal vein occlusion, and diabetic retinopathy were common vitreoretinal diseases in that order, and the age- and sex-adjusted prevalences were 1.5%, 1.1%, and 0.9%, respectively. CONCLUSIONS: The prevalence of vitreoretinal diseases in a screened Korean population 50 years and older was 9.9%. Vitreoretinal diseases are a major ophthalmic problem in Korea. As the Korean population continues to age and the prevalence of diabetes increases, further investigations about the epidemiology and prevention of vitreoretinal diseases are needed.