Weaning children with accommodative esotropia out of spectacles: a pilot study.

BACKGROUND/AIM: Many children with accommodative esotropia must continue spectacle use throughout life. This study was undertaken to determine which factors are predictive of successfully weaning children with accommodative esotropia out of spectacles. METHODS: A retrospective review of 10 children with accommodative esotropia, who were gradually weaned from their hyperopic correction, and three age matched controls was performed. The main outcome measure was resolution or non-resolution of esotropia following weaning and eventual discontinuation of spectacles. Secondary outcome measures were final refractive error and the final esotropic or esophoric angle without correction. RESULTS: Six patients were successfully weaned from spectacles. At the completion of the weaning period one child was orthophoric and the other five children had well controlled esophorias. The other four patients remained spectacle dependent because of persistent esotropia or decreased vision without spectacles. The baseline and final refractive errors were significantly lower in the children successfully weaned from spectacles (p = 0.014). While the children who were successfully weaned from spectacles were older when initially diagnosed with accommodative esotropia (4.6 v 2.5 years), this difference was not statistically significant (p = 0.09). CONCLUSION: Some children with accommodative esotropia may be weaned out of spectacles during the grade school years with resolution of their esotropia. It is likely that gradual reduction of the hyperopic correction increases divergence amplitudes, but it is unclear whether this facilitates emmetropisation.

Evaluating a visual field screening test for glaucoma: how the choice of the gold standard affects the validity of the test.

OBJECTIVE: To examine the effects of the gold standard on sensitivity, specificity, and area under the ROC curve when determining the validity of a screening test. METHODS: Fifty-eight people were recruited from a Veterans' Administration eye clinic. Screening included testing with the 26-point oculokinetic perimeter (OKP). We used different gold standards to categorize patients as positive or negative for glaucoma. The glaucoma hemifield test (GHT) and corrected pattern standard deviation (CPSD) from the Humphrey visual field analyzer (HVF) were used as objective gold standards. Ophthalmologist review of the HVF, using two different methods for classifying visual field defects, was also used as a gold standard. RESULTS: Using the review of the HVF that included mild, moderate, or severe defects, the area under the ROC curve was not significantly different from 50%. However, for all the other gold standards, the area under the ROC curve was significantly different from 50%. CONCLUSIONS: In determining the ability of the OKP to differentiate between glaucoma and normal subjects, the choice of a gold standard led to different conclusions about its usefulness as a screening test for glaucoma. Furthermore, sensitivity and specificity varied widely depending on which gold standard was used, and what cutoff point was used for the OKP. Although clinician review of the HVF may be used when specific criteria are given to define visual field defects, using objective measures from the HVF is easier and will allow for better comparisons between studies.

A survey of ocular complaints in postmenopausal women.

Aging patients often complain about chronic ocular irritation, which is commonly related to dryness of the eyes. To determine the effect of hormone replacement therapy (HRT) on ocular complaints and tear production, we compared these parameters in postmenopausal women who were taking or not taking HRT. A questionnaire was administered to determine the number of ophthalmic complaints of 79 women who were postmenopausal at least 1 year (mean, 22 +/- 13.5 years) and were not using any ophthalmic drops or medication known to contribute to dry eyes. A Schirmer test with anesthesia was performed on each subject to quantify tear production. We found that the number of ophthalmic complaints of women taking HRT was statistically fewer (P = 0.015) than women not taking HRT. Women taking HRT for 5 years or longer had statistically fewer complaints and greater tear production, as measured by the Schirmer test, than women taking HRT for 5 years or less. The study concluded that women taking HRT have significantly fewer ocular complaints than women not taking HRT. HRT may help alleviate symptoms related to ocular dryness in postmenopausal women.

Comparison of frequency doubling perimetry with humphrey visual field analysis in a glaucoma practice.

PURPOSE: To determine the sensitivity and specificity of frequency doubling perimetry with Humphrey visual field testing used as the gold standard. METHODS: Frequency doubling perimetry and Humphrey visual field testing (24-2) were performed on 29 consecutive patients in a glaucoma practice. Data for the right eye were used to calculate sensitivity, specificity, and receiver operating characteristic curves. RESULTS: For the frequency doubling perimetry in screening mode, and with an abnormal glaucoma hemifield test used as the gold standard, the area under the receiver operating characteristic curve was 89.3%, 81.5%, or 75.0% for the presence of mild, moderate, or severe relative defects, respectively. Similar results were found with the use of mean deviation (P <.05) to define Humphrey visual field defects. For frequency doubling perimetry in threshold mode, the area under the receiver operating characteristic curve was 93.4% with the presence of any defect (P <.05) used as the criterion for an abnormal case, and an abnormal glaucoma hemifield test as the gold standard. In all cases, the threshold mode detected defects better than the screening mode.

Anterior hyaloid face opacification after pediatric Nd:YAG laser capsulotomy.

PURPOSE: The purpose of this study was to examine the clarity of the visual axis after Nd:YAG laser capsulotomy following cataract extraction and primary intraocular lens implantation in a pediatric population. METHODS: A retrospective review was performed of all cases of cataract extraction and primary intraocular lens implantation over a period of 5 years. A group of children who had been treated by primary surgical posterior capsulotomy and anterior vitrectomy (Group 1) was used as the "gold standard," with whom the children treated with Nd:YAG laser capsulotomy (Group 2) were compared. The groups were studied for the incidence of opacification of the visual axis after the primary procedure. RESULTS: Data on 78 eyes were reviewed, and 56 eyes met inclusion criteria. Of these, 33 eyes were treated with primary posterior capsulotomy and anterior vitrectomy (Group 1) and 23 eyes were treated with Nd:YAG laser capsulotomy (Group 2). One eye (3%) of Group 1 experienced postoperative visual axis reopacification. Thirteen (57%) of 23 eyes in Group 2 experienced reopacification, requiring retreatment. Four eyes (17%) treated with Nd:YAG laser required a third treatment. CONCLUSIONS: In our series, 57% of patients treated with Nd:YAG laser capsulotomy experienced reopacification across the anterior hyaloid face. With the removal of the anterior vitreous at the time of cataract extraction, the scaffolding for cell migration is removed and reopacification of the visual axis is rarely seen. For patients in whom slit-lamp capsulotomy is not possible, especially if there is no Nd:YAG laser available for use in the operating room or when loss to follow-up may be an issue, primary posterior capsulotomy and anterior vitrectomy should be strongly considered.

Reliability of partner reports of sexual history in a heterosexual population at a sexually transmitted diseases clinic.

BACKGROUND: In epidemiologic research, information about sexual frequency and condom use is by necessity based on self-reports. This study investigated the reliability of self-reported sexual behavior in 162 heterosexual partnerships. METHODS: Subjects were part of a larger study of condom use and sexually transmitted diseases (STD) conducted in two Baltimore STD clinics from 1990 to 1992. Partners were enrolled on the same day and were interviewed separately. Information about sexual activity and condom use was collected using a retrospective calendar for the 30 days before enrollment. RESULTS: Participants were predominantly young, unmarried African-Americans. Based on Spearman's correlation coefficients and kappa statistics, the authors found only fair agreement (K = 0.43; r = 0.51) between partner reports of overall condom use for the 30-day period before the interview. Correlation coefficients ranged from 0.43 for frequency of any sexual activity to 0.56 for number of days on which vaginal intercourse occurred. CONCLUSIONS: Partner agreement for condom use and frequency of sexual activity decreased as the recall period increased. Higher partner agreement was observed for questions with definite answers compared to the more open-ended sexual behavior questions. These findings indicate potential reporting bias in self-reports of sexual behavior in a population at high risk for STDs.

A prospective study of early pregnancy loss.

The New York State Early Pregnancy Detection Study was a prospective study of early pregnancy loss, between implantation and menses, in 217 women attempting to become pregnant during 1989-1992. Women collected urine samples on three consecutive mornings during the late luteal phase of their menstrual cycle, for up to 12 cycles, contributing samples for 1253 menstrual cycles. Urinary human chorionic gonadotrophin (HCG), measured using an immunoradiometric assay, was the biomarker for pregnancy. We observed a range of early pregnancy loss (EPL) rates, from a low estimate of 11.0% to a high estimate of 26.9%, depending on the definition used and the subgroup analysed. Based on a definition of 3 days of HCG concentration > or = 4.00 pmol/l, 2 days > or = 5.33 pmol/l or the last day of HCG > or = 6.67 pmol/l, we identified 115 positive cycles; 95 cycles were clinically confirmed pregnancies and 20 cycles were EPL, giving an EPL rate of 17.4% [95% confidence interval (CI) 11.0-25.6]. In addition, we observed an EPL rate of 19.5% (95% CI 11.3-30.1) for samples collected within a 15 day window around menses, and a rate of 20.3% (95% CI 11.3-32.2) for samples limited to the first three menstrual cycles. Because studies use urine collection schemes other than daily sampling, the definition of pregnancy will be crucial in defining EPL.

Pilot study to detect early pregnancy and early fetal loss.

A 6-month pilot study was conducted to investigate the feasibility of detecting early pregnancy and early fetal loss in a population of healthy women. To ascertain early pregnancy, monthly 3-day morning urine specimens were collected during each woman's late luteal phase. A specific human chorionic gonadotropin (hCG)-radioimmunoassay, using antibodies against the unique carboxy-terminal portion of beta-hCG, was used to determine pregnancy as early as 9 days fetal developmental age. Eight pregnancies have been reported on a clinical basis, one of which ended in a spontaneous abortion. This pilot study demonstrated the feasibility of detecting early pregnancy and early fetal loss, and an epidemiological study is now being planned to estimate the rate of fetal loss in a large population to establish a baseline for early pregnancy loss.