Macular degeneration. A devastating but treatable disease.

To provide optimum care for patients who have age-related macular degeneration, primary care physicians need to be aware of symptoms such as acute loss of vision and distorted vision. Immediate referral to an ophthalmologist is necessary so that diagnosis can be confirmed and laser treatment can begin if indicated. Patients are at risk for recurrence and should use an Amsler grid daily to detect further visual changes. Current studies are investigating the role of dietary supplements in preventing macular degeneration.

Diabetic retinopathy in a rural diabetic population. Prevalence and risk.

As part of the West Virginia Diabetes Eye Care Project of 1986, 178 patients in a rural diabetic population were screened for diabetic retinopathy using psychophysical testing and stereo fundus photography. The effects of sex, age, mode of therapy, and duration of diabetes mellitus on the prevalence of retinopathy were investigated. The prevalence of retinopathy was 34 per cent among insulin-treated patients, 18 per cent for those receiving oral hypoglycemics, and seven per cent for the diet-controlled group. Diabetic retinopathy was most prevalent among insulin-dependent patients with prolonged duration of disease. Age did not affect the prevalence of retinopathy after adjustment for sex and duration of diabetes.

Increased retinal vascular tortuosity in gestational diabetes mellitus.

The authors report the first study which demonstrates that women with gestational diabetes mellitus (GDM) have increased tortuosity of their retinal vessels. Women with GDM underwent fundus photography and were compared with a normal control group (NC) and a pregnant nondiabetic control group (PC). Five ophthalmologists evaluated the unlabeled photographs, resulting in a combined mean prevalence of tortuosity of 21.6% NC, 24.7% PC, and 60.3% GDM. Statistical analysis showed that the GDM group was significantly different from both the NC and PC groups. Tortuosity was unrelated to acute elevation in blood glucose and was still present at 5 months postpartum.

Increased mortality rates after cataract surgery. A statistical analysis.

One hundred ninety-three patients 50 to 89 years of age had cataract surgery between January 1, 1979, and December 31, 1980, at West Virginia University Medical Center, Morgantown. In comparison with 182 patients who elected one of three other surgical procedures, cataract surgery patients had a significantly higher mortality rate (P = 0.0005) than control group patients, according to life-table analysis estimates adjusted for age and sex. Patients with adult onset diabetes mellitus had slight increased survival and did not alter relative mortality. The authors' results support the hypothesis that senile cataracts may reflect systemic factors in addition to localized ocular disease.

Perfluorocarbon gases in vitreous surgery.

Fifty-six patients with complicated retinal detachments were managed with vitreous surgery and one of two perfluorocarbon gases. These gases are capable of greater expansion and greater longevity compared to sulfur hexafluoride. Forty-five patients received perfluoropropane (C3F8), eleven received perfluoroethane (C2F6). The retinas of 31 patients (55.4%) were attached at six months after the disappearance of the gas. In many instances, operations performed with air-sulfur hexafluoride mixtures had failed and the retina was subsequently reattached with the use of the perfluorocarbon gases. The major complications were increased intraocular pressure, which was usually transient, and gas-induced lens opacities.

Nursing homes and the Roemer-Feldstein hypothesis.

The theory of certification-of-need is based in large part on the Roemer-Feldstein hypothesis, which holds that demand for services is proportional to bed supply. Athough developed solely from hospital data, this hypothesis is commonly assumed to hold for nursing homes as well. In fact, a high correlation between nursing home bed supply and bed utilization does exist. However, the rate of utilization should not be judged without reference to the appropriateness of use. Analysis of nursing home placement data revealed that overplacement of patients in skilled nursing facilities decreased as bed supply increased. These results suggest that the Roemer-Feldstein hypothesis may provide an inadequate rationale for regulation of nursing home bed supply. Further developments should be based on more sophisticated notions of bed supply, should make reference to the appropriateness of services, and should be subjected to empirical verification.