Adherence to recommendations of the age-related eye disease study in patients with age-related macular degeneration.

PURPOSE: The purposes of this study were to determine the rate of adherence to the recommendations of the Age-Related Eye Disease Study (AREDS) regarding vitamin supplement use among patients with age-related macular degeneration (AMD) at a tertiary retina center and to identify factors associated with adherence. METHODS: Consecutive patients with a history of AMD were administered an in-person survey designed to assess use of vitamin supplementation as well as to investigate factors that may influence supplementation use patterns. A retina specialist performed dilated funduscopic examinations and categorized patients' AMD severity according to the AREDS classification system. The main outcome measure was rate of adherence to AREDS recommendations. RESULTS: Sixty-four patients with AMD completed the survey. Sixty-three percent of patients met AREDS criteria for vitamin supplementation. Of those patients who met the criteria, only 43% reported taking AREDS vitamins in the recommended dosages. Among patients using AREDS vitamins as recommended, 100% were return patients to the tertiary retina center and reported a retina specialist as the primary recommendation source for supplement use. Of patients who met AREDS criteria for vitamin supplementation but were not taking vitamins as per AREDS recommendations, 87% were new patients to the retina service and 75% reported that vitamin supplementation had never been recommended to them. CONCLUSION: Patients with intermediate or advanced AMD in at least one eye show a low adherence rate to the AREDS recommendations for vitamin supplementation.

Refractive surgical practices in persons with human immunodeficiency virus positivity or acquired immune deficiency syndrome.

PURPOSE: To evaluate current practices of refractive surgeons in terms of performing elective refractive surgery in persons with human immunodeficiency virus (HIV) positivity or acquired immune deficiency syndrome (AIDS). SETTING: Penn State University College of Medicine, Hershey, Pennsylvania, USA. METHODS: A link to an anonymous web-based survey was e-mailed to members of the International Society of Refractive Surgery. Surgeons were asked whether they considered persons with HIV or AIDS to be acceptable candidates for elective refractive surgery and specific precautions, if any, taken when operating on these individuals. RESULTS: Of 1123 surgeons sent the link, 285 (25.4%) responded. Of respondents, 143 (50.2%) said they consider persons with HIV acceptable candidates for elective refractive surgery and 35 (12.5%) said they consider persons with AIDS acceptable candidates for elective refractive surgery. One hundred sixty-five (72.7%) respondents who perform elective refractive surgery in persons with HIV or AIDS said they take additional precautions when operating on these patients; precautions included performing unilateral surgery, scheduling the patient last on the surgery schedule for a given day, wearing a double layer of gloves, and evacuating the laser plume immediately after surgery. CONCLUSIONS: Approximately half of refractive surgeons said they consider HIV-positive persons acceptable candidates for elective refractive surgery; a much lower proportion considered patients with AIDS acceptable candidates. The majority of the surgeons recommended additional precautions when performing refractive surgery on patients with HIV or AIDS.

Bilateral optic neuritis in pediatric systemic lupus erythematosus associated with antiphospholipid antibodies and neuromyelitis optica immunoglobulin.

The authors report a case of a 16-year-old girl with a history of systemic lupus erythematosus who developed bilateral acute optic neuritis. Systemic lupus erythematosus can present with a vast array of neurological and ophthalmic complications, with optic neuritis being a rare but devastating manifestation and the major cause of blindness in these patients. The patient presented with an acute unilateral visual deficit that progressed to bilateral visual loss with no light perception over the course of days. Treatment included high-dose steroids, cyclophosphamide, intravenous immunoglobulin, and eventually rituximab. Furthermore, the patient was also seropositive for both antiphospholipid and neuromyelitis optica antibodies, which can have implications on prognosis and treatment options.

Measurement of biocolloid collision efficiencies for granular activated carbon by use of a two-layer filtration model.

Point-of-use filters containing granular activated carbon (GAC) are an effective method for removing certain chemicals from water, but their ability to remove bacteria and viruses has been relatively untested. Collision efficiencies (alpha) were determined using clean-bed filtration theory for two bacteria (Raoutella terrigena 33257 and Escherichia coli 25922), a bacteriophage (MS2), and latex microspheres for four GAC samples. These GAC samples had particle size distributions that were bimodal, but only a single particle diameter can be used in the filtration equation. Therefore, consistent with previous reports, we used a particle diameter based on the smallest diameter of the particles (derived from the projected areas of 10% of the smallest particles). The bacterial collision efficiencies calculated using the filtration model were high (0.8 < or = alpha < or = 4.9), indicating that GAC was an effective capture material. Collision efficiencies greater than unity reflect an underestimation of the collision frequency, likely as a result of particle roughness and wide GAC size distributions. The collision efficiencies for microspheres (0.7 < or = alpha < or = 3.5) were similar to those obtained for bacteria, suggesting that the microspheres were a reasonable surrogate for the bacteria. The bacteriophage collision efficiencies ranged from > or = 0.2 to < or = 0.4. The predicted levels of removal for 1-cm-thick carbon beds ranged from 0.8 to 3 log for the bacteria and from 0.3 to 1.0 log for the phage. These tests demonstrated that GAC can be an effective material for removal of bacteria and phage and that GAC particle size is a more important factor than relative stickiness for effective particle removal.