[Corticosteroids and the risk of glaucoma]. / Corticosteroïden en het risico van glaucoom.

Corticosteroids are used to treat many diseases and are prescribed by both specialists and general practitioners. One serious side effect of steroid use is glaucoma. This complication, which can cause blindness, is often only discovered at the end stage. Three patients, two women aged 20 and 32 and a man aged 28 developed glaucoma as a result of topical steroid use. It is advisable to examine patients annually if they have a family history of glaucoma and are using steroids regularly in or around the eye. Follow-up should also be considered for patients with a family history of glaucoma who are using systemic steroids regularly, and for all other patients using steroids regularly in or around the eye. All patients on steroids should consult their ophthalmologist speedily if visual symptoms occur.

[Diagnostic image (77). A women with retinal hemorrhage]. / Diagnose in beeld (77). Een vrouw met een fundusbloeding. Osteoma retinae.

In a 32-year-old pregnant woman with visus loss due to a macular bleeding ultrasonography and retinoscopy revealed an osteoma.

Two-field photography can identify patients with vision-threatening diabetic retinopathy: a screening approach in the primary care setting.

OBJECTIVE: To compare the effectiveness of two 45 degrees photographic fields per eye in the screening for diabetic retinopathy with the routine ophthalmologist's examination and to study the effectiveness of visual acuity measurement in the detection of diabetic macular edema. RESEARCH DESIGN AND METHODS: Type 1 and 2 diabetic patients without a known history of more than minimal retinopathy (n = 469) had a routine examination by an ophthalmologist, including visual acuity measurement, indirect retinoscopy, and biomicroscopy. At the same time, two-field nonstereoscopic retinal photographs were made of both eyes and assessed in a masked fashion by a retinal specialist. The results were compared. RESULTS: The prevalence was 4.3% for vision-threatening retinopathy and 24% for any retinopathy. The sensitivity of two-field photography in identifying diabetic patients with sight-threatening retinopathy was 95% (specificity 99%) and sensitivity for detecting any retinopathy was 83% (specificity 88%). The percentage of referrals to an ophthalmologist was 6.2%. All patients with macular edema detected by biomicroscopy were classified as having vision-threatening retinopathy on the photographs. CONCLUSIONS: Two-field retinal photography is a promising alternative to the routine ophthalmologist's examination in the screening for diabetic retinopathy. Visual acuity measurement is not a sensitive tool for the detection of macular edema. Screening for diabetic retinopathy using two-field retinal photography is feasible in a primary care setting and can substantially lower the number of ophthalmic referrals.

[Diabetic retinopathy: agreement of fundoscopic assessment by the family physician and the ophthalmologist]. / Diabetische retinopathie: overeenstemming van funduscopische beoordeling door de huisarts en de oogarts.

The quality of retinoscopy in 70 patients with diabetes mellitus performed by 7 general practitioners and one ophthalmologist was compared with a color picture of the central retina. The mean kappa index of the general practitioners was 0.21 (-0.11-0.73). This implies that the skills of general practitioners are currently inadequate to take care of the screening for diabetic retinopathy. The ophthalmologist scored insufficiently by examining without dilating the pupil.