Rehabilitation of children with cataracts.

Over a period of 10 years, 160 children with cataracts underwent operation at the University of Tennessee Medical Center, Memphis. The surgical, optical, and psychosocial rehabilitation of these patients was analyzed and studied. The optical rehabilitation included patients with glasses, intraocular lens implants, epikeratophakia, and contact lenses. Seventy three of these patients were chosen at random and reevaluated as to visual outcome, and 46 were subjected to a psychosocial test to evaluate their quality of life and their rehabilitation. Eighteen of these were also given a psychosocial test to evaluate the quality of life enjoyed by these children at an older age following treatment for the cataract. Surgical, optical, and psychosocial rehabilitation of such children is also discussed. This is the first report of the psychological evaluation of such children. The further needs of these children as they approach adulthood are discussed in detail.

The correction of diplopia after cataract extraction.

The records of 12 patients with persistent diplopia after cataract extraction were reviewed. All patients were corrected surgically using an adjustable-suture technique. After strabismus surgery, the diplopia in nine of the 12 patients resolved without adjunctive therapy. Three patients had occasional diplopia postoperatively. Prismatic correction postoperatively was unwarranted in two patients because diplopia occurred on rare occasions, but the third required postsurgical prismatic correction with improvement.

Refraction, including prisms.

The literature in the past year on refraction is replete with several isolated but very important topics that have been of interest to strabismologists and refractionists for many decades. The refractive changes in scleral buckling procedures include an increase in axial length as well as an increase in myopia, as would be expected. Tinted lenses in dyslexia show little positive effect in the nonasthmatic patients in one study. The use of spectacles or bifocals as a way to control increase in myopia is refuted in another report. It has been shown that in accommodative esotropia not all patients will be able to escape the use of bifocals in the teenage years, even though surgery might be performed. The hope that disposable contact lenses would cut down on the instance of giant papillary conjunctivitis and keratitis has been given some credence, and the conventional theory that sclerosis alone is the cause of presbyopia is attacked. Also, gas permeable bifocal contact lenses are reviewed and the difficulties of correcting presbyopia by this method outlined. The practice of giving an aphakic less bifocal addition instead of a nonaphakic, based on the presumption of increased effective power, is challenged. In the review of prisms, the majority of articles concern prism adaption. The most significant report is that of the Prism Adaptation Study Research Group (Arch Ophthalmol 1990, 108:1248-1256), showing that acquired esotropia in particular has an increased incidence of stable and full corrections surgically in the prism adaptation group versus the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Examination under anesthesia.

Examination under anesthesia, particularly in children, is a common practice in ophthalmology. It may yield valuable information as to the cause and management regimen of the condition under study. The proper equipment should be available to the clinician to expedite the examination. Rapid and useful information thus obtained can justify the risk and expense incurred when this modality is used. Efficient use of the equipment is essential to yield the best examination.

The spectrum of child and parent response to eye disease.

Patient and parent response to the presence or supposed presence of eye disease is a major factor in handling pediatric ophthalmology patients. The response may vary from passive acceptance of a blinding disease to hysteria, neurosis, or even psychosis. A literature review has shown that there is wide variation of understanding by the practitioner of the importance of this phase of ophthalmic practice. The author has drawn on three decades of ophthalmic practice. When blindness, for example, is threatened, our "normal" responses change, and what we judge as normal should also. Ways of evaluating and treating patient or parent responses are suggested, along with guidelines for using consultants and others. This may play a role in malpractice suits.

Adjustable sutures in strabismus surgery.

The benefits of the adjustable suture technique for strabismus surgery include the surgeon's ability to place the eye at the exact position desired in the immediate postoperative period. Depending on the type of deviation, this may be orthophoric, slight esophoric, or slight exophoric. Unexpected postoperative results are prevented which can occur when measurements and classical surgery are done in special problems such as paretic and restrictive strabismus and in reoperations. In addition precise alignment can be made in patients with weak fusion or fusion only in certain fields of gaze, and this should decrease the need for reoperation.

True charity and professional life: a patient advocacy program.

The Patient Advocacy Program, built on an already existing, sympathetic hospital staff, has placed added emphasis on the physician-patient relationship which recently has been obscured by increasing technology, mechanization, and third party process. Furthermore, the Patient Advocacy Program stresses that the patient is the most important reason for the focus of the physician and staff. We have tried to exhibit not only true professionalism, but also true charity, by giving more than is expected and in return receiving an appreciative and satisfying response from patients, parents, and responsible parties.

Transposition procedures in strabismus.

A transfer procedure is very useful in the treatment of strabismus. The most common use of this procedure is to augment an already planned resection or recession procedure so that it can be performed monocularly to reduce an accompanying hypertropia or hypotropia or to collapse the A or V pattern when horizontal surgery is being performed for estropia or exotropia. In transfer procedures, the resultant change of deviation and cosmetic improvement is good or excellent in almost all cases. Some special transfer procedures, such as the Harada-Ito or the Jensen operation, can have dramatic effects on both comfort and change of symptoms for the patient.

Reading problems and the ophthalmologist.

The ophthalmologist is often faced with patients who come to see him, either primarily or secondarily, with a reading problem. A review of the mechanisms of dyslexia and its many ramifications is presented. Also, a classification is given which helps to categorize the various types of reading disorders, as they are seen. The routine eye exam and special testing can lead to a diagnosis in many cases in the ophthalmologist's office. The treatment is highly individualized and personal and should be given by either highly skilled individuals or in a group or institutional therapy. The lack of evidence that visual treatment or motor treatment in any way improves vision is reviewed extensively. The ophthalmologist should be informed, sympathetic and empathetic, but not necessarily the "captain" of this team that deals with reading problems.

General fibrosis syndrome.

Fibrosis of the extraocular muscles can involve multiple muscles, including the levator, and become part of the general fibrosis syndrome, which is characterized by the replacement of normal muscle tissue by fibrous tissue of varying degrees. The characteristics of this syndrome are well described although they are often confused with other similar entities. Fourteen patients are presented who display the typical characteristics of the syndrome with three members of one family being highlighted in our study. It is not currently known or described that visual acuities are problems in these children, but refractive error may not only be significant but it may vary with time and failure to pay particular attention to this fact may lead to amblyopia. The surgical correction of the strabismus is difficult but should be attempted because of the benefit it can offer, particularly from the cosmetic standpoint.

Medical management of accommodative esotropia.

Cycloplegic drugs are the principal medications used in the diagnosis of accommodative esotropia. The same cycloplegics can be used as a "medical patch" in the treatment of amblyopia. Miotics may be as good as glasses in controlling accommodative esotropia but are almost never better. The response to miotics does not rule out the presence of accommodative esotropia. Miotics also may be used as a supplementary agent to glasses, bifocals, or surgery in the treatment of esotropia. The most widely used miotics today include phospholine iodide and DFP with iris cysts being the major local side effect in the eye with the use of miotics in children. Miotics and other drugs are valuable tools in the treatment of accommodative esotropia; however, the use must be correlated with other tools, including surgery, patching, glasses, and orthoptic exercises.

Comparison of atropine and tropicamide in esotropia.

Forty-one patients with esodeviation (82 eyes) were subjected first to 1% tropicamide and retinoscopy and then to retinoscopy after the use of 0.5% to 1% atropine sulfate in children with esodeviation up to the age of 5 years. The ages ranged from 2 months to 5 years, and the esodeviation ranged from 5 to 50 diopters (D). There were 20 male and 21 female patients. The average difference in the cycloplegia showed +.80 D more hyperopia with atropine than with tropicamide therapy. This was believed to be important, particularly in the young age group with esodeviation.

Mucolipidosis IV. Histopathology of conjunctiva, cornea, and skin.

The condition of a 4-year-old white girl of Ashkenazi Jewish parents was diagnosed as mucolipidosis IV on the basis of marked corneal clouding and severe psychomotor retardation, in the absence of facial-skeletal dysplasia or abnormal mucopolysacchariduria. The results of histochemical and ultrastructural studies of conjunctiva, skin, and corneal epithelium confirmed the combined storage of acid mucopolysaccharide and complex lipid substances. An unusual histopathologic feature of mucolipidosis IV is the predisposition of extreme storage involvement of corneal epithelial cells with relative sparing of the keratocytes, which is a finding of potential therapeutic implication. In addition, application of electron microscopic study of cultured amniotic cells and conjunctival biopsy specimens to assess for the parents the mother's subsequent pregnancy additional emphasizes the value of ultrastructural studies in the diagnosis of lysosomal storage disease.

Abnormal head positions due to ocular problems.

This paper involves the research of 30 patients, all of whom exhibited a head tilt, turn, or a combination of the two. We report the sensory aspects of 8 of these individuals and demonstrate the fusional ability of each patient. In the majority of the cases, the results were positive. It was found that most abnormal head positions were developed to maintain fusion.