Assessment of ophthalmology residents' contact lens training.

PURPOSE: To characterize the nature and duration of contact lens training in ophthalmology residency training programs and to ascertain the comfort level of residents in fitting various types of contact lenses and in dealing with common contact lens-related complications. METHODS: Surveys were mailed to 126 ophthalmology residency program directors/coordinators and requested to be distributed to 1,381 ophthalmology residents. The questionnaire addressed issues related to contact lens training, hours of clinical and didactic training, comfort with fitting a variety of different types of contact lenses and dealing with common contact lens-related complications, and plans for incorporation of contact lens dispensing into future practice. RESULTS: Two hundred and forty-nine residents (18%) responded from 84 programs (67%). Most programs (87%) have some form of supervised contact lens training, frequently conducted by an optometrist (61% of programs), that consists of 20 hours or less of clinical experience and 20 hours or less of didactic training. A majority of the responding graduating residents (66%) feel comfortable fitting spherical soft contact lenses, while less than half of all residents feel comfortable fitting any other type of contact lens. In addition, most residents (65%) feel comfortable diagnosing and treating common contact lens-related complications. CONCLUSIONS: Most ophthalmology residency programs offer some form of supervised contact lens training which allows a majority of residents to feel comfortable fitting only spherical soft contact lenses, while also dealing comfortably with most contact lens-related problems. A comparison with previous data suggests increasing comfort with fitting most types of contact lenses over the last decade.

Characterisation of uveitis in patients with psoriatic arthritis.

OBJECTIVE: The purpose of this study is to describe the clinical characteristics of uveitis related to psoriatic arthritis (PsA), and also to compare the uveitis in PsA to the uveitis in spondyloarthropathy (SA). METHODS: Sixteen patients with uveitis and PsA were evaluated in a tertiary care uveitis clinic. These patients were compared retrospectively to a series of 89 patients with uveitis and SA. RESULTS: Eight (50%) of the 16 patients with uveitis had strictly peripheral arthritis, while two (12.5%) had axial only, and six (37.5%) had axial and peripheral arthritis. Patients with uveitis and axial disease were more likely to be male (100% v 38%) and HLA-B27 positive (6 of 6 typed positive v 0 of 3 typed positive) when compared with those with uveitis and peripheral arthritis only. Compared with patients with SA, those with PsA were more likely to have insidious onset (19% v 3%), simultaneously bilateral (37.5% v 7%), chronic duration (31% v 6%), or posterior (44% v 17%) uveitis. Complications of uveitis were similar in the SA and PsA groups. CONCLUSION: Uveitis in patients with PsA was more likely to be insidious in onset, continuous, posterior, and active bilaterally compared with uveitis in patients with SA. Patients with uveitis and axial involvement were more likely to be male and HLA-B27 positive compared with patients with uveitis and peripheral arthritis alone. Patients with seronegative arthritis and uveitis that begins insidiously, lasts longer than six months, is bilateral, or is posterior, should be carefully questioned about the presence of either psoriasis or inflammatory bowel disease.

Sterile interface keratitis after laser in situ keratomileusis: three episodes in one patient with concomitant contact dermatitis of the eyelids.

PURPOSE: To illustrate a case in which sterile interface keratitis after laser in situ keratomileusis (LASIK) occurred concomitantly with an allergic contact dermatitis of the eyelids. METHODS: Retrospective case review. RESULTS: Resolution of the interface keratitis and dermatitis occurred following an intense course of topical corticosteroids and brief course of oral corticosteroids. Despite an attempt to eliminate potential causes, the same patient developed interface keratitis in the fellow eye following both the initial LASIK and an enhancement, in which no microkeratome was used. Intense treatment with both topical and oral corticosteroids led to a final uncorrected visual acuity of 20/20 in the right eye and 20/25+2 in the left eye. CONCLUSION: The etiology and mechanism of sterile interface keratitis after LASIK are unknown, but are probably multifactorial. The concomitant contact dermatitis reaction may indicate a common immune mechanism.

Sterile interface keratitis associated with micropannus hemorrhage after laser in situ keratomileusis.

Numerous etiologies have been suspected to lead to sterile interface keratitis after laser in situ keratomileusis. This tan interface haze with a rippled appearance has been called Sands of the Sahara. We present 2 cases in which red blood cells entered the interface after a small hemorrhage from peripheral corneal vascularization during the microkeratome pass. Although this bleeding was controlled and all visible blood cells were removed at surgery, both patients developed the appearance of a focal interface keratitis on the first postoperative day.

Features of amiodarone-induced optic neuropathy.

PURPOSE: To report clinical features of amiodarone-induced optic neuropathy and outline the differentiation of amiodarone optic neuropathy from nonarteritic anterior ischemic optic neuropathy. METHOD: We reviewed data from 73 patients reported to have developed an optic neuropathy while taking amiodarone. RESULTS: Amiodarone optic neuropathy is characterized by an insidious onset, slow progression, bilateral visual loss, and protracted disk swelling that tends to stabilize within several months of discontinuing the medication. Nonarteritic ischemic optic neuropathy is characterized by acute, unilateral visual loss that is usually complete at onset, with resolution of disk edema over several weeks. CONCLUSION: Unique clinical features of amiodarone-induced optic neuropathy may help clinicians diagnose and distinguish between amiodarone-induced optic neuropathy and nonarteritic anterior ischemic optic neuropathy.