Cycloplegic refraction in preschool children: comparisons between the hand-held autorefractor, table-mounted autorefractor and retinoscopy.

AIMS: It is common for refraction to be measured using different testing methods in children, with much debate still ongoing on the preferred method. Therefore, we compared cycloplegic refraction measurements using three objective methods in a large cohort of children. METHODS: We present the findings from a total of 51 children who were recruited and examined as part of the Strabismus, Amblyopia and Refractive error in Singapore preschool children (STARS) study. Each child underwent a comprehensive eye examination, which included cycloplegic refraction using a hand-held autorefractor (Retinomax), a table mounted autorefractor (Canon FK-1) and streak retinoscopy. Spherical equivalent (SE) was calculated as (sphere + half of minus cylinder) and astigmatism was determined using the negative cylindrical component. RESULTS: The current study sample consisted of 29 boys and 22 girls aged between 24 and 72 months (mean age 52.3 months). The mean spherical equivalent (SE) using the table-mounted autorefractor (1.03 +/- 1.64 D) was not significantly different from the streak retinoscopy (1.09 +/- 1.58 D, p = 0.66). However, the mean SE using the hand-held Retinomax (0.80 +/- 1.43 D) was significantly different (more 'minus'p = 0.0004) to streak retinoscopy. The astigmatism measured using the hand held (-0.89 +/- 0.51 D) and table-mounted autorefractor (-0.83 +/- 0.61 D) were significantly greater than that obtained with streak retinoscopy (-0.58 +/- 0.56, p = 0.0003). CONCLUSIONS: The table-mounted autorefractor provided a reading more similar to that of streak retinoscopy than to that of the hand-held autorefractor. However, there were only small differences in mean SE (<0.32 D) between the hand-held Retinomax and the other methods, which will have implications in research investigations of refractive error.

Industrial accident-related ocular emergencies in a tertiary hospital in Singapore.

INTRODUCTION: We present a review of industrial accident-related ocular trauma, from the perspective of the emergency setting of a tertiary hospital in Singapore. METHODS: A retrospective analysis of patients seen by Tan Tock Seng Hospital's emergency ophthalmology service over a six-month period was performed. Data on clinical presentation, cause of injury, use of protective eyewear and subsequent losses of days-of-work were collected via a standardised telephone interview and review of case-sheets. RESULTS: A total of 300 persons presented with a diagnosis of industrial accident-related ocular trauma, out of the 1,460 patients seen during the study period. 95.7 percent were non-residents and the average age was 31 years. 99.3 percent were males. 66.0 percent were provided with protective eyewear, while 44.7 percent of those were non-compliant. The most common types of injuries were superficial foreign body (71.3 percent), chemical injury (10 percent) and blunt trauma (4 percent), while severe injury requiring admission and emergency surgery occurred in 15 cases. Average loss of days of work was 3.4 days. CONCLUSION: Industrial accident-related ocular trauma comprises a relatively large proportion of the patients requiring ophthalmic review at the emergency service level in Singapore. These patients are mainly young, non-resident men and the injuries were generally minor. These are largely preventable with the use of well-fitting protective eyewear and strict compliance. This would greatly reduce the unnecessary loss of workdays. Therefore, there is a need to review the design, and reinforce the strict implementation of occupational eye safety programmes, especially among non-resident workers.

Primary meningococcal arthritis and endogenous endophthalmitis: a case report.

INTRODUCTION: Arthritis and endophthalmitis are both recognised complications of meningococcal infection. They may occur in the presence or absence of meningitis or meningococcaemia. Primary meningococcal arthritis (PMA) and endophthalmitis are important diagnoses to recognise as delayed treatment would result in permanent joint and eye damage. We report the first patient with both PMA and meningococcal endophthalmitis and present a review of the literature. CLINICAL PICTURE: An afebrile, non-toxic, 54-year-old female presented with arthritis and a painful red left eye following an episode of diarrhoea. An initial diagnosis of reactive arthritis with uveitis was made. However, subsequent microbiological investigations isolated Neisseria meningitides thus confirming the final diagnosis. TREATMENT: Antibiotics were instituted. OUTCOME: There was complete resolution of the arthritis but her left eye vision had deteriorated to just perception of light. CONCLUSION: The presentations of PMA and meningococcal endophthalmitis are often confusing. This should be considered in the differential diagnosis of reactive arthritis and acute dermatitis-arthritis syndrome.

Incidence of retinopathy of prematurity in Singapore.

The study was done to investigate the incidence and severity of retinopathy of prematurity (ROP) in Singapore over a one-year period. Its relation to factors like birth weight, gestational age are also explored so as to identify high risk groups and provide guidelines for the implementation of a screening programme in Singapore. At the various government restructured hospitals from Dec 1993 to Nov 1994, 34.4% (72 out of 209) of babies, with birth weights less than 1250 g or gestational ages less than 32 weeks, developed ROP. The incidence of ROP correlated significantly with low birth weight, early gestational age, multiple births; the severity correlated with low birth weight and multiple births. There was a notably higher proportion of Malays in the study population (premature babies) than all the live births of the same period. From the results, an optimal screening programme should include babies weighing less than 1250 g or of gestation earlier than 32 weeks. A first examination at 33 weeks of post-menstrual age is suggested.