Self-reported dry eyes and diabetic history.

PURPOSE: Dry eyes and diabetes have been linked in previous studies. However, the connection between a family history of diabetes and self-reported dry eyes needs to be explored. Patients with self-reported dry eyes were screened for self-reported diabetes or a family history of diabetes. METHODS: A total of 392 patients were given a simple questionnaire about diabetic history and asked to categorize their level of discomfort owing to ocular dryness as none, trace, mild, moderate, or severe (scored as 0 to 4). RESULTS: A total of 34.4% (135 of 392) of the sample had some self-reported symptom of dryness, 29.8% (117 of 392) could be considered clinically relevant (mild, moderate or severe), 7.4% (29 of 392) reported that they had diabetes, and 35.7% (140 of 392) reported a positive family history for diabetes. A total of 52.9% of those with either diabetes or borderline diabetes had self-reported clinically relevant dry eyes. A total of 35.7% of those patients with a family history of diabetes and 25.6% with no family history had self-reported clinically relevant dry eyes. The patients-with-diabetes group had a median dryness score of 2 (mild) and nondiabetics had a score of 0 (none). For both those with a diabetic family history and for those with no history of diabetes, the median dryness score was 0 (none). However, the dryness score distributions for those patients with a family history of diabetes and those patients with no family history of diabetes were significantly different (P = 0.031); those with a family history tended to have higher dryness scores. The distributions of dryness scores of the diabetic and nondiabetic groups were also significantly different (P = 0.0076). CONCLUSIONS: Patients in this study who self-reported diabetes were found to have higher levels of dryness than those without diabetes. Patients with a family history of diabetes also had a greater tendency to report dry eyes in this cohort. These results are consistent with earlier reports of a link between diabetes and dry eye disease and identify diabetes as another aspect of family history that may be relevant to risk for dry eyes.

Validity of fluorexon disodium versus sodium fluorescein for use in Goldmann tonometry.

PURPOSE: To evaluate the safety, validity, and comfort of 0.35% fluorexon disodium and 0.4% benoxinate (Flura-Safe) compared with the gold standard of 0.25% sodium fluorescein and 0.4% benoxinate for Goldmann applanation tonometry (GAT). METHODS: This was a double-masked, randomized, crossover clinical trial. Subjects received either the standard or study formulation for GAT on visit 1 and the other formulation 1 week later. At each visit, tonometer mire quality, adequacy of fluorescence, ease of intraocular pressure (IOP) measurements, the IOP value, and anesthetizing efficacy of the formulation were assessed. Subjects graded general comfort, soreness and irritation, and burning and stinging of each formulation at 1 and 5 minutes after drop instillation. RESULTS: Sixty-seven subjects completed the study. The mean IOP was 13.9 +/- 2.7 with fluorexon and 13.9 +/- 2.8 mm Hg with fluorescein OD and 14.0 +/- 2.8 with fluorexon and 13.9 +/- 2.5 mm Hg with fluorescein OS. The measurements with the 2 formulations were highly correlated for OD and OS, and the differences between the 2 measurements were not clinically significant. There was also no significant difference between the 2 drops in mire clarity, adequacy of fluorescence, or corneal anesthesia. However, fluorexon was statistically more comfortable (P = 0.039) and caused less stinging and burning (P = 0.014) at 1 minute versus the fluorescein formulation. CONCLUSION: Not only was the new fluorexon product accurate and effective in GAT, it was also statistically more comfortable and had a less stinging and burning effect at 1 minute after drop instillation than the traditional fluorescein formulation. Because fluorexon is less likely to stain soft contact lenses, this may be the dye-anesthetic formulation of choice for practices that routinely perform GAT.

Accommodative insufficiency is the primary source of symptoms in children diagnosed with convergence insufficiency.

PURPOSE: Accommodative insufficiency (AI) and convergence insufficiency (CI) have been associated with similar symptomology and frequently present at the same time. The severity of symptomology in CI has been linked to the severity of the CI, suggesting a dose-dependent relationship. However, with increasing severity of CI also comes increased comorbidity of AI. AI alone has been shown to cause significant symptomology. We hypothesize that AI drives the symptoms in CI with a comorbid AI condition (CIwAI) and that it is the increased coincidence of AI, rather than increased severity of CI, which causes additional symptomology. METHODS: Elementary school children (n = 299) participated in a vision screening that included tests for CI and AI and the CISS-V15 symptom survey. They were categorized into four groups:1) normal binocular vision (NBV); 2) AI-only; 3) CI-only; and 4) CIwAI. One hundred seventy elementary school children fell into the categories of interest. RESULTS: Pairwise comparison of the group means on the symptom survey showed: 1) children with AI-only (mean = 19.7, p = 0.006) and children with CIwAI (mean = 22.8, p = 0.001) had significantly higher symptom scores than children with NBV (mean = 10.3); and 2) children with CI-only (mean = 12.9, p = 0.54) had a similar symptom score to children with NBV. Using a two-factor analysis of variance (AI and CI), the AI effect was significant (AI mean = 21.56; no AI mean = 11.56, p < 0.001), whereas neither the CI effect (p = 0.16) nor the CI by AI interaction effect (p = 0.66) were significant. CONCLUSION: CI is a separate and unique clinical condition and can occur without a comorbid AI condition, our CI-only group. Past reports of high symptom scores for children with CI are the result of the presence of AI, a common comorbid condition. When AI is factored out, and children with CI only are evaluated, they are not significantly more symptomatic than children with NBV.

The effect of laser refractive surgery on the on-field performance of professional baseball players.

BACKGROUND: The aim of this study was to determine the effect of laser refractive surgery on the offensive performance of professional baseball players. METHODS: Extensive search of the public media was conducted to determine which major league baseball players had undergone laser refractive surgery and when the procedure was performed. Baseball performance data were then used to determine presurgery and postsurgery baseball performance averages. A total of 17 position players were identified; however, 5 of these players were not considered in the analysis owing to insufficient playing experience either before or after the laser procedure. RESULTS: No statistically significant or practically significant difference was found between the presurgery and postsurgery means on either on-base percentage (P = 0.31), batting average (P = 0.39), slugging percentage (P = 0.66) or on-base plus slugging (OPS; P = 0.997) of major league baseball players. CONCLUSIONS: These preliminary findings suggest that professional baseball players should not expect a laser refractive surgical procedure to significantly improve their offensive baseball performance, despite the elimination of glasses or contact lens wear.

Prevalence and severity of symptomatic dry eyes in Hispanics.

PURPOSE: Past studies have not addressed the prevalence of dry eyes in the growing US Hispanic population. 463 Hispanic patients were screened in an optometric practice located in Southern California. METHODS: A single symptom variable of self-assessed ocular dryness was used to categorize patients. RESULTS: Of the patients 43.6% had some symptoms of dryness. Twenty-five percent had clinically relevant (mild, moderate or severe) scores that may merit treatment. The findings were 16.4% classified as mild (dryness score 2), 6.2% were moderate (dryness score 3) and 2.3% were severe (dryness score 4). Age was a significant predictor of dryness level. As age increased, severity of dryness increased (p <.001). The mean age for None or Trace were significantly lower than for Mild and Moderate (p <.05). Gender was not a useful as a second predictor of self-reported dryness. CONCLUSION: Southern Californian Hispanics seen in a optometric practice have a higher prevalence for dry eye symptoms than most other previously studied ethnic populations not selective for age.

Ocular and systemic findings and their correlation with hemodynamically significant carotid artery stenosis: a retrospective study.

BACKGROUND: Optometrists often encounter patients with ocular signs and/or symptoms suggestive of carotid artery disease, but criteria for eye care practitioners concerning when to order carotid studies are not well established. A retrospective study in an optometry clinic was performed to determine if certain ocular findings and associated systemic risk factors were associated with hemodynamically significant carotid artery stenosis (HSCAS). METHODS: A retrospective analysis was performed on all patients examined in the optometry clinic at the Sepulveda Ambulatory Care Center from January 1, 1998 through December 31, 1999 to identify all patients who had carotid studies ordered. Charts were then reviewed to determine the ocular finding that prompted the carotid study. Statistical analysis using an odds-ratio was performed to determine whether any ocular sign/symptom or systemic risk factor was associated with HSCAS. RESULTS: Of 3822 patients, 48 (1.26%) had carotid studies ordered. Eight (17%) had HSCAS of >50% and symptomatic patients were 1.6 times more likely to have HSCAS than asymptomatic patients. Patients with HSCAS were 1.8 times more likely to have retinal vascular occlusions, 1.9 times more likely to have normotensive glaucoma, 2.4 times more likely to have peripheral retinal hemorrhages, and 2.6 times more likely to be smokers, although none of these factors were found to be a statistically significant indicator of HSCAS. However, the number of systemic diseases tended to be greater for the HSCAS patients compared with the non-HSCAS patients (HSCAS median = 3.5 and the non-HSCAS median = 2, p = 0.049). CONCLUSION: Although no single ocular or systemic risk factor was found to be a statistically significant indicator of HSCAS, the number of systemic disease risk factors tended to be greater for the HSCAS patients compared with the non-HSCAS patients (p = 0.049). An extensive literature review was also performed to help establish guidelines for when to order carotid studies on the basis of ocular signs and/or symptoms as well as the presence of additive associated systemic risk factors.

A survey of treatment modalities for convergence insufficiency.

BACKGROUND: Convergence insufficiency (CI) is a common and distinct binocular vision disorder. However, there is a lack of consensus regarding the treatment most appropriate for Cl. Possible treatment modalities include base-in prism, pencil pushup therapy (PPT), reading glasses, home-based vision therapy/orthoptics (HBVT), and office-based vision therapy/orthoptics (OBVT). The purpose of this study was to investigate the care process for Cl by surveying eyecare professionals regarding the most common treatment modalities used by both optometrists and ophthalmologists across the United States. METHODS: Surveys requesting doctors to indicate which treatment(s) they prescribed and believed to be most effective for symptomatic CI patients were mailed to 863 optometrists and 863 ophthalmologists in the United States. RESULTS: Fifty-eight percent of the optometrists responded to the survey; the most common treatment prescribed was PPT (36%) followed by HBVT (22%) and OBVT (16%). For the ophthalmologists (who had a 23% response rate), the most common treatment prescribed was PPT (50%) followed by HBVT (21 %) and base-in prism (10%). CONCLUSIONS: This survey suggests that most eyecare practitioners prescribe PPT as the initial treatment for CI.