Usefulness of refractive measurement of wavefront autorefraction in patients with difficult retinoscopy.

PURPOSE: To assess the ability of the WaveScan WaveFront System (VISX Inc, Santa Clara, CA) to measure refractive errors in patients with difficult retinoscopy and to compare results to standard cycloplegic retinoscopy. METHODS: The medical records of patients with an ocular condition that could contribute to difficult or unreliable retinoscopy who underwent nondilated, noncycloplegic evaluation with the WaveScan WaveFront System were reviewed retrospectively. Results were compared to a standard cycloplegic retinoscopy. RESULTS: A total of 60 eyes of 31 patients were included. Wavefront sphere, cylinder, and spherical equivalent measurements were strongly correlated with retinoscopy results; however, the wavefront measured more myopia and more cylinder compared to standard retinoscopy. CONCLUSIONS: Wavefront can be used to augment and enhance cycloplegic streak retinoscopy.

Effect on intraocular pressure of extraocular muscle surgery for thyroid-associated ophthalmopathy.

PURPOSE: To study the effect of extraocular muscle surgery on intraocular pressure (IOP) in patients with thyroid-associated ophthalmopathy. DESIGN: Retrospective, observational case series. METHODS: The medical records of patients with restrictive myopathy secondary to thyroid-associated ophthalmopathy who underwent strabismus surgery from July 1, 1997 through July 31, 2003 were reviewed and analyzed retrospectively. Seventeen patients met the criteria and were included in this study. All patients were seen at the Thyroid Eye Center at the University of California, San Diego, a university-based tertiary referral center. The main outcome measure was IOP readings obtained before and after surgery in both primary gaze and upgaze. RESULTS: A statistically significant decrease in IOP in upgaze was noted after extraocular muscle recession. The mean IOP before surgery was 16.6 +/- 3.78 mm Hg in primary gaze and 23.2 +/- 7.27 mm Hg in upgaze. After strabismus surgery, the mean IOP after one month was 15.7 +/- 2.36 mm Hg (P = .215) in primary gaze and 18.9 +/- 2.96 mm Hg in upgaze (P = .001). CONCLUSIONS: Strabismus surgery resulted in a significant reduction in IOP in the early postoperative period in patients with restrictive myopathy secondary to thyroid-associated ophthalmopathy.

Change in proptosis following extraocular muscle surgery: effects of muscle recession in thyroid-associated orbitopathy.

PURPOSE: To evaluate the effect of strabismus surgery on proptosis in patients with thyroid-associated orbitopathy. METHODS: The medical records of 22 consecutive patients with thyroid-associated orbitopathy undergoing strabismus surgery were reviewed. Data pertaining to the number of muscles operated on, amount of muscle recession, prior orbital decompression, and exophthalmometry were evaluated. RESULTS: Thirty-eight eyes in 22 patients with thyroid-associated orbitopathy were studied before and after strabismus surgery. The mean change in exophthalmometry following strabismus surgery in all eyes was +0.6 mm (p < 0.01). Eyes with prior decompression averaged a 0.9 mm increase following strabismus surgery (p < 0.01); those without decompression averaged a 0.2 mm decrease (p = 0.658). In eyes that underwent two rectus muscle recessions the increase in Hertel measurements averaged 1.2 mm; when only one muscle was recessed, the average increase was 0.2 mm. In the eyes with muscle recession < or =5 mm, the mean exophthalmometric increase was 0.7 mm. When a muscle recession of more than 5 mm was performed, the exophthalmometry showed a mean increase of 0.5 mm. CONCLUSIONS: Strabismus surgery on patients with thyroid-associated orbitopathy can worsen proptosis, especially in those with prior decompression. When planning for orbital decompression, the surgeon should consider this effect. Moreover, patients should be made aware of the possible changes to their appearance.

The relationship between convergence insufficiency and ADHD.

BACKGROUND: Children being evaluated for attention deficit hyperactivity disorder (ADHD) often have an eye exam as part of their evaluation. The symptoms of convergence insufficiency (CI) can make it difficult for a student to concentrate on extended reading and overlap with those of ADHD. METHODS: A retrospective review of 266 patients with CI presenting to an academic pediatric ophthalmology practice was performed. All patients included were diagnosed with CI by one author (DBG) and evaluated for the diagnosis of ADHD. A computerized review was also performed looking at the converse incidence of CI in patients carrying the diagnosis of ADHD. RESULTS: We reviewed 266 charts of patients with CI. Twenty-six patients (9.8%) were diagnosed with ADHD at some time in their clinical course. Of the patients with ADHD and CI, 20 (76.9%) were on medication for ADHD at the time of diagnosis for CI while 6 (23.1%) were either not on medication or the medication was discontinued several months before the diagnosis of CI. The review of computer records showed a 15.9% incidence of CI in the ADHD population. CONCLUSION: We report an apparent three-fold greater incidence of ADHD among patients with CI when compared with the incidence of ADHD in the general US population (1.8-3.3%). We also note a seeming three-fold greater incidence of CI in the ADHD population. This may simply represent an association and not be a causative relationship. Until further studies are performed, however, patients diagnosed with ADHD should be evaluated to identify the small subset that may have CI -- a condition that responds well to treatment at home.

Validation of a predictive model to estimate the risk of conversion from ocular hypertension to glaucoma.

OBJECTIVES: To develop and validate a predictive model to estimate the risk of conversion from ocular hypertension to glaucoma. METHODS: Predictive models for the 5-year risk of conversion to glaucoma were derived from the results of the Ocular Hypertension Treatment Study (OHTS). The performance of these models was assessed in an independent population of 126 subjects with ocular hypertension from a longitudinal study (Diagnostic Innovations in Glaucoma Study [DIGS]). The performance of the OHTS-derived models was assessed in the DIGS cohort according to equality of regression coefficients, discrimination (c-index), and calibration. RESULTS: Thirty-one patients (25%) developed glaucoma during follow-up. Hazard ratios for DIGS- and OHTS-derived predictive models were similar for age, intraocular pressure, central corneal thickness, vertical cup-disc ratio, and pattern standard deviation but were significantly different for the presence of diabetes mellitus. When applied to the DIGS population, the OHTS-derived predictive models had reasonably good discrimination (c-indexes of 0.68 [full model] and 0.73 [reduced model]) and calibration. CONCLUSIONS: The OHTS-derived predictive models performed well in assessing the risk of glaucoma development in an independent population of untreated subjects with ocular hypertension. A risk scoring system was developed that allows calculation of the 5-year risk of glaucoma development for an individual patient.