Recognition acuity, grating acuity, contrast sensitivity, and visual fields in 6-year-old children.

OBJECTIVE: To measure monocular distance visual acuity (VA), grating VA, contrast sensitivity, and visual field extent in full-term, 6-year-old children. METHODS: Subjects were 59 healthy full-term children aged 5.8 to 6.3 years who had no ocular abnormalities and no myopia of 1.00 diopter (D) or greater, hyperopia of 4.00 D or greater, astigmatism of 1.50 D or greater, or anisometropia of 1.50 D or greater spherical equivalent or cylinder, as evaluated by a standard eye examination with cycloplegic refraction. All were tested monocularly for recognition acuity (Early Treatment Diabetic Retinopathy Study VA charts), grating acuity (Teller acuity cards), contrast sensitivity (Pelli-Robson contrast sensitivity charts), and visual field extent (white-sphere kinetic perimetry). RESULTS: Right and left eye values did not differ significantly. Mean values for the right eye were 0.040 logMAR (SD, 0.075 log units) for Early Treatment Diabetic Retinopathy Study VA, 24.5 cycles per degree (SD, 0.3 octaves) for grating acuity, and 1.63 (SD, 0.12 log units) for contrast sensitivity. Mean visual field extent for the inferonasal, superonasal, superotemporal, and inferotemporal meridians was 59.1 degrees (SD, 9.7 degrees), 57.8 degrees (SD, 9.6 degrees), 71.2 degrees (SD, 12.3 degrees), and 100.4 degrees (SD, 6.6 degrees), respectively. CONCLUSIONS: The results provide additional normative monocular data on visual function in 6-year-old children and indicate that their thresholds are less than those of adults for distance recognition VA, grating VA, and contrast sensitivity, but similar to those of adults for white-sphere kinetic perimetry.

Upper GI tract findings in patients with heartburn in whom proton pump inhibitor treatment failed versus those not receiving antireflux treatment.

BACKGROUND: Failure of proton pump inhibitor (PPI) treatment in patients with heartburn is very common. Because endoscopy is easily accessible, it is commonly used as the first evaluative tool in these patients. OBJECTIVE: To compare GERD-related endoscopic and histologic findings in patients with heartburn in whom once-daily PPI therapy failed versus those not receiving antireflux treatment. DESIGN: Cross-sectional study. SETTING: A Veterans Affairs hospital. PATIENTS: Heartburn patients from the GI outpatient clinic. INTERVENTION: Recording of endoscopic results. MAIN OUTCOME MEASUREMENTS: Endoscopic findings and association between PPI treatment failure and esophageal mucosal injury by using logistic regression models. RESULTS: A total of 105 subjects (mean age 54.7 +/- 15.7 years; 71 men, 34 women) were enrolled in the PPI treatment failure group and 91 (mean age 53.4 +/- 15.8 years; 68 men, 23 women) were enrolled in the no-treatment group (P = not significant). Anatomic findings during upper endoscopy were significantly more common in the no-treatment group compared with the PPI treatment failure group (55.2% vs 40.7%, respectively; P = .04). GERD-related findings were significantly more common in the no-treatment group compared with the PPI treatment failure group (erosive esophagitis: 30.8% vs 6.7%, respectively; P < .05). Eosinophilic esophagitis was found in only 0.9% of PPI treatment failure patients. PPI treatment failure was associated with a significantly decreased odds ratio of erosive esophagitis compared with no treatment, adjusted for age, sex, and body mass index (adjusted odds ratio 0.11; 95% CI, 0.04-0.30). CONCLUSIONS: Heartburn patients in whom once-daily PPI treatment failed demonstrated a paucity of GERD-related findings compared with those receiving no treatment. Eosinophilic esophagitis was uncommon in PPI therapy failure patients. Upper endoscopy seems to have a very low diagnostic yield in this patient population.