Variability in doses obtained from a multi-dose ophthalmic solution: a potential source of error in the assessment of compliance.

BACKGROUND: Assessment of compliance with prescribed therapy is an important aspect of patient management that can be overlooked. Compliance with topical ophthalmic medications is frequently assessed without knowledge of doses obtained per bottle. METHOD: Thirty-three normal subjects who agreed to participate were asked to instill one drop of Refresh Tears in each eye twice daily until a 3-ml bottle was empty. Each subject was also asked to record the date and time of each drop instillation using a calendar log sheet. On enrollment, the subjects were required to demonstrate proper drop instillation technique. With the use of the log sheets, doses obtained and administrations missed by each subject were tabulated. The 'expected count' per bottle was determined by counting the drops in Refresh Tears under laboratory conditions. RESULTS: Of the 26 subjects, who completed the study, the mean (SD) number of doses reportedly obtained was 63.7 +/- 17.1 (range = 26 to 110). The mean number of drops counted per bottle was 63.5 +/- 1.0 (range = 62 to 65). CONCLUSIONS: The range of doses reportedly obtained per bottle was quite large. This variability could represent a significant source of error if patient compliance is assessed by how long a bottle lasts.

Pigmented striae of the anterior lens capsule and age-associated pigment dispersion of variable degree in a group of older African-Americans: an age, race, and gender matched study.

PURPOSE: To investigate pigmented striae of the anterior lens capsule in African-Americans, a potential indicator of significant anterior segment pigment dispersion. METHODS: A group of 40 African-American subjects who exhibited pigmented lens striae (PLS) were identified from a non-referred, primary eye care population in Chicago, IL, USA. These subjects were then compared to an age, race, and gender matched control group relative to refractive error and the presence or absence of diabetes and hypertension. RESULTS: The PLS subjects (mean age = 65.4 +/- 8.8 years, range = 50-87 years) consisted of 36 females and 4 males. PLS were bilateral in 36 (85%) of the 40 subjects. Among the eyes with PLS, 21 (55%) of 38 right eyes and 22 (61%) of 36 left eyes also had significant corneal endothelial pigment dusting, commonly in the shape of a Krukenberg's spindle. Ten (25%) of the PLS subjects had either glaucoma or ocular hypertension (7 bilateral, 3 unilateral). The presence of trabecular meshwork pigment varied from minimal to heavy. The mean +/- SD (range) refractive error of the PLS right eyes was +1.61 +/- 1.43D (-1.50 to +5.00D) and +1.77 +/- 1.37D (-1.00 to +5.00D) for the left eyes. Based on these data, the PLS right eyes were +1.63D (Student's t, p = 0.0001; 95% CI = +0.82 to +2.44D) more hyperopic on average than the control right eyes, and the PLS left eyes were +1.77D (p = 0.0001; 95% CI = +0.92 to +2.63D) more hyperopic on average than the control left eyes. Trend analysis showed a gradually increasing likelihood of PLS with increasing magnitude of hyperopia in both eyes (Mantel-Haenszel chi-square, p = 0.001). Among PLS subjects, 24 (60%) of 40 were hypertensive and 9 (23%) of 40 were diabetic. However, these proportions were not significantly different (two-tailed Fisher's exact test; hypertension: p = 0.30; diabetes: p = 0.70) from the randomly selected controls. CONCLUSIONS: Among our African-American group, which consisted predominately of females >50 years of age, the likelihood of PLS increased with increasing hyperopic refractive error. This finding is consistent with the possibility that PLS may, in some circumstances, indicate a significant pigment dispersal process due to iris-lens rubbing that may be associated with crowding of anterior segment structures. Additional study is warranted to further assess the nature of PLS, their precise relationship with an age-related pigment dispersal process, and their true significance as a risk factor for development of glaucoma.

Management of sports-related concussions.

Mild head injury is a frequent occurrence in a multitude of athletic endeavors across all levels of play. Clinicians should carefully consider all interventions at their disposal to reduce the prevalence and severity of injury to protect those involved. The exploration and evaluation of using properly fitted mouthguards to provide effective, albeit limited, defense against brain injury merits attention. The minimal costs of such an intervention when properly applied would no doubt reap numerous benefits in terms of reducing the medical, financial, cognitive, psychological, and social consequences of mild head injury. The cosmetic salvation would be no small side effect to efficacious, properly fitted mouthguard use.

Private practice and community activities in sports dentistry.

For dentists interested in sports dentistry, there are a wide variety of private practice and community activities available for involvement. These activities include, among others, volunteering for mouth guard programs, participating as a sports team dentist, and becoming an active member in the Academy for Sports Dentistry.

Prevention of intraoral trauma in sports.

Dental, oral, facial, and cranial injuries can be reduced by the use of mouthguards and faceguards. Disadvantages of mouthguard use are based mostly on lack of information. There is a growing endorsement for the use of mouthguards and faceguards, presenting the dental profession with a major opportunity to improve the oral health of athletes.