Trends in Hawai'i Ophthalmologists' Recommendations to Patients for Prevention of Age-Related Macular Degeneration.

The purpose of this study is to determine the current trends in recommendations made to patients by ophthalmologists in Hawai'i regarding the prevention of age-related macular degeneration (AMD) and to compare these recommendations to preventative therapies described in the literature. A review of the literature was done to determine the preventative interventions that can be made to significantly lower the risk of developing AMD. An anonymous survey was sent to 95 ophthalmologists in clinical practice in Hawai'i in 2020. The survey assessed recommendations for the prevention of age-related macular degeneration. The 4 interventions assessed were avoidance of smoking, utilization of antioxidant vitamins called AREDS2, adherence to a Mediterranean diet, and maintaining a normal body mass index (BMI). Responses were received from 41 ophthalmologists were received. Overall, 100% of participants responded "yes" to recommending smoking cessation to their patients, 76% of participants recommended AREDS 2, 42% recommended a Mediterranean diet, and 37% of participants recommended maintaining a normal BMI. Smoking cessation or avoidance was universally recommended by the respondents, and 22% recommended all the assessed interventions. The survey results suggest that some interventions, such as maintaining a normal BMI and adopting a Mediterranean diet are not as widely implemented into ophthalmologists' recommendations compared to others, such as AREDS2 formulation vitamins and smoking cessation.

Complete Anterior Capsule Phimosis following Cataract Surgery in a Patient with a History of Retinopathy of Prematurity, Nystagmus, and a Narrow Angle.

The authors present a case of complete anterior capsule phimosis and vision decline which developed 4 weeks postoperatively in the right eye after uncomplicated cataract surgery. Prior ocular history included retinopathy of prematurity in both eyes, acute angle closure glaucoma in the left eye, prophylactic laser peripheral iridotomy for a narrow angle in the right eye, and nystagmus in both eyes. This condition was addressed by surgically releasing the anterior capsule with microscissors to open the pupillary space which had been completely obscured by the anterior capsule, also causing the haptics of the 1-piece intraocular lens to deform. When cataract surgery was performed on his left eye, the surgeon performed prophylactic relaxing incisions at 4 points on the capsular opening. It is notable that his left eye did not develop anterior capsule phimosis postoperatively.

Extraocular and Intraocular Infections Following Strabismus Surgery: A Review.

An extensive literature review of various types of infections following strabismus surgery was facilitated by using the search engines PubMed and Google Scholar. In both search engines, the phrases "infection following strabismus surgery," "infection strabismus surgery," "complications of strabismus surgery," "endophthalmitis strabismus surgery," and "strabismus scleral perforation" were used for the review. The type of infection, surface involved, and site of the infection determined the type of therapy. Infections involving deeper tissues, such as periocular infection or orbital cellulitis, required systemic therapy. Sub-Tenon's abscesses required incision and drainage, as well as systemic antibiotics. The development of endophthalmitis following strabismus surgery was rare, but was usually devastating to the visual result. Symptoms of an adverse intraocular condition began by mean postoperative day 3, but the definitive diagnosis and treatment of endophthalmitis was not made until mean postoperative day 6. Despite early detection of this latter type of infection and early surgical intervention with vitreous paracentesis and intraocular injection of antibiotics, the visual result was extremely poor in more than two-thirds of the reported cases. Although there is no known way to truly prevent all infections following strabismus surgery, several techniques may be prudent for the strabismus surgeon to adopt to decrease the bacterial load and minimize the risk of infection. The surgeon should be encouraged to consider preoperative use of povidone-iodine on the operative field and avoid scleral perforation during surgery. [J Pediatr Ophthalmol Strabismus. 2019;56(4):214-221.].

The Long Term Outcome of the Management of the Posterior Capsule in Pseudophakic Children.

This is a long term study of the treatment of the posterior lens capsule in the management of bilateral cataract extraction and insertion of 42 intraocular lenses in 21 children. The purpose of the current study was to compare the long-term outcome of eyes treated by the two different methods of surgery of the posterior lens capsule in bilateral cataract and intraocular lens implantation in children. The author performed an independent ocular exam on the children selected from a consecutive series at 4 different institutions, followed for a minimum of 5 years. The eyes of children in Subgroup A (n=24), had surgery in which an intact capsule was left at the time of initial surgery. The eyes of patients in Subgroup B (n=18) received a primary central lens capsulectomy and limited anterior vitrectomy at the time of the initial surgery. The eyes of Subgroup A (mean age 7.7 years) were found to be in children older than those eyes in Subgroup B (mean age 3.9 years) (P=.001). The eyes in the two subgroups also differed in the necessity of a secondary YAG laser capsulectomy. Twenty one of the 24 eyes in Subgroup A had received a secondary YAG laser capsulectomy and no eyes of the patients in Subgroup B had required a secondary YAG laser capsulectomy at the time of the author's examination (P=.001). A central capsulectomy during the initial surgery was more likely to be chosen for surgery on eyes of younger children (P=.001).

Stability of the Functional Cure in Congenital Esotropia.

PURPOSE: To report the stability of the functional cure in a chart review of patients with congenital esotropia. METHODS: The charts of 31 patients with congenital esotropia, encountered in 2007-2012 with functional cure, were studied. The stability of the cure and duration of follow-up were determined by comparing the first recorded date of cure with the date of the last examination. The mean age of the patients analyzed was 19.5 years. RESULTS: Two patients decompensated in the subgroup of 24 patients who did not require hyperopic correction and 1 patient decompensated in the subgroup of 7 patients who required hyperopic correction. All patients with decompensation were realigned by secondary surgery. A small subgroup of 4 patients demonstrated gradual improvement of stereoacuity to 60 arc seconds or better. CONCLUSIONS: The functional cure of congenital esotropia is relatively stable in patients within the first 20 years. The secondary use of hyperopic correction and secondary surgery increased this stability.

Transcutaneous electrical nerve stimulation for chronic post-herpetic neuralgia.

Postherpetic neuralgia remains a therapeutic challenge for the clinician. Many modalities have been utilized with limited success. In this pilot randomized study of patients who were refractory to previous medicinal treatment, the patients were treated with transcutaneous nerve stimulation with a biofeedback capability. After every two treatments with the sham and true device, the patients were required to fill out a standard neuropathic pain scale score. The patients were allowed to select the other device after three consecutive treatments if they felt an inadequate decrease in their pain. The true device was chosen over the sham device by all patients. The majority of these patients treated by the true device reported a statistically significant decrease in pain scores (P < 0.001). Further investigation of this Food and Drug Administration, class 2 accepted, electronic device for relief of pain is warranted for patients with a history of recalcitrant postherpetic neuralgia.

The stability of the monofixation syndrome.

PURPOSE: To determine etiology, characteristics, and stability of the monofixation syndrome (MFS) in a chart review of 63 consecutive patients in a private practice of pediatric ophthalmology. DESIGN: Retrospective, consecutive chart review. METHODS: The charts of 63 consecutive patients with MFS, encountered from 2007-2012 followed for a minimum of 3 years were included. Best visual acuity, motor angle deviation at near, fusion, and stereoacuity as recorded on the most recent visit during the follow-up period were examined. Stability of the MFS was determined by comparing the dates of diagnosis with the last examination for those patients who remained stable. Decompensated patients were also studied for characteristics and results of secondary surgery. RESULTS: The etiology of the MFS was esotropia in 58 (92.1%), anisometropia in 2 (3.2%), and exotropia in 3 patients (4.8%). The majority of patients, 57 of 63 (92%), had stable MFS for a mean of 13.9 years. Six esotropic patients decompensated after a mean of 6 years; 5 of these patients were restored to MFS by secondary surgery and 1 spontaneously recovered. Five patients were found to have improved stereoacuity to 60 arc seconds or better by the end of the study. CONCLUSIONS: The MFS is a relatively stable binocular status during the first 2 decades of follow-up. A small percentage of patients decompensated, requiring secondary surgery to restore the MFS binocular status. A similar small percentage of MFS patients developed a higher grade of stereoacuity when followed for a sufficient interval of time.

Binocular function in pseudophakic children.

PURPOSE: The author reports the results of visual and binocular tests performed on patients who had primary insertion of intraocular lenses following the removal of cataracts in their childhood. METHODS: Monocular and binocular tests were performed on 21 patients using the same equipment for sensory testing for binocularity on all patients before the history was abstracted from the clinical records. These patients were selected from a consecutive series and observed for a minimum of 5 years by their surgeons. RESULTS: The mean age at surgery performed on the first eye was 6.3 years. The mean age at the date of the author's examination was 16.5 years and the mean length of follow-up was 10.3 years. All but 2 patients had motor alignment within 8 prism diopters of orthotropia at near. Fusion and some stereopsis was found in 15 patients, but only 4 of these demonstrated fine (60 seconds of arc or better) stereoacuity. Patients with fine versus gross stereoacuity were compared and found to be similar in type of cataract, age at first surgery, interval between surgeries, length of follow-up, and refraction, but different in the quality of best-corrected visual acuity. CONCLUSION: Although satisfactory motor alignment, fusion, and some stereopsis is present in the majority of patients, fine stereoacuity is uncommon in pseudophakic children.

Binocular function in pseudophakic children.

PURPOSE: There have been few reports on the binocular vision results in bilateral pseudophakic children. The author reports on the results of visual and binocular tests personally performed on patients who had the primary insertion of intraocular lenses following the removal of cataracts in their childhood. METHODS: The author visited 4 different medical centers to perform monocular and binocular tests on 21 patients using the same equipment for sensory testing for binocularity on all patients before the history was abstracted from the clinical records. These patients were selected from a consecutive series and followed up for a minimum of 5 years by their ocular surgeons. RESULTS: The mean patient age at surgery performed on the first eye was 6 years 4 months. The mean age at the date of the author's examination was 16 years 5 months, and the mean length of follow-up was 10 years 4 months. All but 2 patients had motor alignment within 8 prism diopters of orthotropia at near. Fusion and some stereopsis were found to be present in 15 patients, but only 4 of these patients demonstrated fine (60 seconds of arc or better) stereoacuity. Patients with fine vs gross stereoacuity were compared and found to be similar in type of cataract, age at first surgery, interval between surgeries, and length of follow-up and refraction, but to differ in the quality of best-corrected visual acuity. CONCLUSION: Although satisfactory motor alignment, fusion, and some stereopsis are present in the majority of patients, fine stereoacuity is uncommon in pseudophakic children.

The use of electronic biofeedback for the management of post-herpetic neuralgia--a report of 3 cases.

The purpose of these case reports is to describe treatment of three consecutive patients with post-herpetic neuralgia using a bioelectronical device (SCENAR). The instrument is approved as a Class II device in the United States. The electrode of the device was stroked gently over the involved skin area for up to 15 minutes per session. No more than 5 sessions over a 3-week period was required. All patients experienced substantial relief of pain from the first treatment. One patient required only 1 treatment lasting 10 minutes. The other 2 patients required 4 to 5 treatments over a 3-week period. One patient required a treatment for skin itch after one year with a follow up period of 6 months to 24 months. An electronic biofeedback device (SCENAR) may be successfully utilized in the management of post-herpetic neuralgia.

A prospective study of alternating occlusion before surgical alignment for infantile esotropia: one-year postoperative motor results.

INTRODUCTION: Alternating occlusion before surgical alignment has been suggested by some strabismologists as a possible method to enhance the treatment of infantile esotropia. PURPOSE: This report presents 1-year outcome results of a prospective trial of patients with infantile esotropia who were assigned randomly to alternating occlusion or control groups. METHODS AND MATERIALS: Forty-four patients with infantile esotropia were measured at entry into the study, at the time of surgery, at 6 weeks, and 1 year postoperatively. Alternating occlusion was full time and symmetric for those with no amblyopia but asymmetric for those with amblyopia. The control group that did not receive alternating occlusion had occlusion for amblyopia only. Initial surgeries were performed when the patients were between the ages of 6 and 13 months. RESULTS: Overall, the patients showed an increase of 9.14 prism diopters (PD) during a mean preoperative follow-up of 4.2 months. Seventy-five percent of all patients were aligned by the initial surgery. Ninety-one percent of those patients aligned within 10 PD at 6 weeks also were aligned 1 year postoperatively. The results were similar for the alternate occlusion group and the control group. CONCLUSION: In our sample of patients, alternating occlusion does not detectably alter the increase in angle of deviation between the dates of entry and the date of the initial surgical alignment procedure, nor does it influence the postoperative alignment at 6 weeks or at 1 year.

A prospective study of alternating occlusion prior to surgical alignment for infantile esotropia: one-year postoperative motor results.

PURPOSE: Alternating occlusion prior to surgical alignment has been suggested by some strabismologists to possibly enhance the treatment of infantile esotropia. This report presents the data for 44 patients prospectively enrolled by random assignment to an alternating occlusion or no occlusion subgroup followed for 1 year postoperatively. METHODS: All patients were measured at entry into the study, at the time of surgery, and at 6 weeks and 1 year postoperatively. Alternating occlusion was full-time and symmetric for those with no amblyopia but asymmetric for those with amblyopia. The subgroup that did not receive alternating occlusion had occlusion for amblyopia only. Initial surgeries were performed between the ages of 6 and 13 months. RESULTS: The patients, as a whole, showed a significant increase of 9.14 prism diopters when followed for a mean of 4.2 months prior to initial surgery (P < .00027). Seventy-five percent of all patients were aligned by the initial surgery. Ninety-one percent of those patients aligned at 6 weeks were also aligned at the 1-year postoperative date. The results were similar for both the control group and the patients treated with alternating occlusion. CONCLUSION: In our sample of patients, alternating occlusion does not detectably alter the increase in angle of deviation between the dates of entry and the date of the initial surgical alignment procedure, nor does it influence the postoperative alignment at 6 weeks or at 1 year.

Outcome study of the development of fusion in patients aligned for congenital esotropia in relation to duration of misalignment.

PURPOSE: The results of recent studies have shown that the presence and quality of stereopsis in patients with congenital esotropia and subsequent surgically alignment are dependent upon the duration of the misalignment during the first 2 years of life. The purpose of this study was to investigate the presence of fusion in patients with different durations of misalignment whose eyes were aligned at different ages by age 2 years. METHODS: Data previously obtained in a study of 90 patients with congenital esotropia aligned by 2 years of age, examined in a masked independent evaluation for binocularity, were analyzed. Patient age at alignment and duration of misalignment were correlated with the presence of fusion. RESULTS: Fusion was present in 94% of all patients aligned by age 2 years and in 94% of patients with < or =21 months of misalignment. There was no statistically significant difference between those aligned by 6, 12, or 24 months (P > 0.05, power = 0.8). No significant difference was found between those aligned with duration of misalignment < or = 6, between 7 and 12, or between 13 and 21 months. CONCLUSION: Unlike the findings of stereopsis studies, there was no significant difference in the proportion of patients who achieved fusion in congenital esotropes who had up to 21 months of misalignment and whose eyes were aligned at different ages within the first 24 months of life.