ABSTRACT
PURPOSE: To examine (1) reproducibility of cycloplegic retinoscopy (C-RNS), cycloplegic autorefraction (C-Autoref), and noncycloplegic autorefraction (NC-Autoref), and (2) validity of C-Autoref and NC-Autoref compared with C-RNS in preschoolers with astigmatism. METHODS: Subjects were 36 Native American preschoolers. Three measurements of right eye refractive error were obtained with each of three methods: C-RNS (by three different retinoscopists), C-Autoref, and NC-Autoref (Nikon Retinomax K+). Vector methods (vector dioptric distance, VDD) were used in the analyses. RESULTS: Mean reproducibility was 0.41 D (SD = 0.18) for C-RNS, 0.25 D (SD = 0.17) for C-Autoref, and 0.37 D (SD = 0.21) for NC-Autoref. Mean agreement between C-Autoref and C-RNS ranged from 0.51 to 0.61 VDD (SD = 0.24 to 0.35), and ranged from 1.66 to 1.74 VDD (SD = 1.11 to 1.25) for agreement between NC-Autoref and C-RNS. Mean bias was -0.07 +0.21 x 149 and -1.33 +0.34 x 178 for C-Autoref and NC-Autoref, respectively. CONCLUSIONS: C-Autoref provided reliable and valid measurements of refractive error in young children. NC-Autoref measurements were reliable within subjects, but there was large variability in validity among subjects.
Subject(s)
Astigmatism/diagnosis , Astigmatism/ethnology , Indians, North American , Refraction, Ocular , Vision Tests/instrumentation , Arizona , Child, Preschool , Cyclopentolate/administration & dosage , Humans , Pupil/drug effects , Reproducibility of ResultsABSTRACT
BACKGROUND: We present a case report on a rare presentation of a conjunctival malignant melanoma in a Native American woman. Malignant melanoma is a rare finding in the general population, and even more rare in Native Americans. Ultraviolet radiation (UVR) damage is postulated as a causal agent for its development and may explain why the vast majority of lesions are found in sun-exposed areas of the body. Human beings with lighter complexion are known to have a higher risk of malignant melanoma as well. Diagnosis and management issues are discussed. CASE REPORT: A 44-year-old Native American woman manifested symptoms of general eye irritation for a period of 3 to 4 months. Examination revealed healthy eyes, except for the presence of an irregularly pigmented lesion on the tarsal conjunctiva of her left eye. Incisional biopsy further revealed this lesion to be malignant melanoma. Surgical excision of the entire lesion was performed. Six months status--post excision, the surgical wound site has healed completely and the patient has shown no signs of recurrent melanoma. CONCLUSIONS: Our case is unique in that melanoma was found in a non-sun-exposed area of the body in a patient with a very dark complexion. Because of the high mortality rates and the association of malignant melanoma with cancer in other parts of the body, it is important for all eye care providers to recognize this lesion when present.
