Reported symptoms and quality-of-life impacts in patients having laser treatment for sight-threatening diabetic retinopathy.

AIMS: To explore the patient experience of symptoms of eye disease related to diabetes and its treatment, including increase of symptoms over time and their relation to severity of the condition and the effect of multiple treatments and symptoms on quality of life. METHODS: A qualitative interview study was implemented at four eye clinics in the UK. This study design was intended to yield 240 interviews in patients having their first laser treatment or first follow-up and in multi-treatment patients with a clinically documented loss of visual function in at least one eye (VA

Eclipse retinopathy.

PURPOSE: Solar retinopathy is a well-recognised clinical entity of macular damage caused by viewing the sun, induced by a photochemical process. The term 'eclipse retinopathy' is frequently employed when the condition is sustained as a result of viewing a solar eclipse. Considerable public excitement had been raised in anticipation of the full solar eclipse on 11 August 1999. Whilst experience has shown that visual morbidity is likely to be temporary, current evidence is anecdotal and restricted to isolated case reports and series. This study was conducted to establish the true visual morbidity associated with a solar eclipse, and whether it was temporary or permanent. METHODS: A 3 month active case ascertainment study was carried out from July to September 1999 to record cases presenting to ophthalmologists with visual symptoms arising from solar viewing. Further information about the cases was sought using a short questionnaire. A follow-up questionnaire requesting outcome data at 6 months was also employed. RESULTS: There were 70 reported cases of visual loss. The average age was 29.5 +/- 12.9 years. Half the cases presented to an ophthalmologist within 2 days of the eclipse. An abnormal macular appearance was reported in 84% of patients at presentation. There have been no reported cases of continued visual loss or symptoms at 6 months. CONCLUSIONS: This is the largest nationwide study of the visual effects of a solar eclipse ever undertaken. There were no recorded cases of permanent visual loss, which corroborates the previous evidence that visual morbidity is likely to be temporary. It would appear probable that public health education was most effective in reducing visual morbidity and hence keeping the consequent burden on the NHS to a minimum.

What effect does laser photocoagulation have on driving visual fields in diabetics?

Although laser panretinal photocoagulation (PRP) for proliferative diabetic retinopathy is known to cause peripheral field constriction, the risks of failing the UK driving field test following treatment are currently unclear as the small number of previous studies have conflicting results. Following PRP using only argon laser with a 500 microns spot size, both uniocular and binocular Esterman visual fields from 60 diabetic patients were assessed by the Chairman of the Visual Standards Sub-Committee of the Royal College of Ophthalmologists. Forty-two per cent of uniocular fields from treated eyes failed. Twelve per cent of binocular fields from those having bilateral PRP failed. Type II diabetes was associated with a significant increase in the risk of failure. Although there is a high risk of failure in any given treated eye, 88% of diabetics will pass a binocular field test, even if both eyes are treated.

Integrin-linked protein kinase regulates fibronectin matrix assembly, E-cadherin expression, and tumorigenicity.

Fibronectin (Fn) matrix plays important roles in many biological processes including morphogenesis and tumorigenesis. Recent studies have demonstrated a critical role of integrin cytoplasmic domains in regulating Fn matrix assembly, implying that intracellular integrin-binding proteins may be involved in controlling extracellular Fn matrix assembly. We report here that overexpression of integrin-linked kinase (ILK), a newly identified serine/threonine kinase that binds to the integrin beta1 cytoplasmic domain, dramatically stimulated Fn matrix assembly in epithelial cells. The integrin-linked kinase activity is involved in transducing signals leading to the up-regulation of Fn matrix assembly, as overexpression of a kinase-inactive ILK mutant failed to enhance the matrix assembly. Moreover, the increase in Fn matrix assembly induced by ILK overexpression was accompanied by a substantial reduction in the cellular E-cadherin. Finally, we show that ILK-overexpressing epithelial cells readily formed tumors in nude mice, despite forming an extensive Fn matrix. These results identify ILK as an important regulator of pericellular Fn matrix assembly, and suggest a novel critical role of this integrin-linked kinase in cell growth, cell survival, and tumorigenesis.

How good are we at assessing driving visual fields in diabetics?

PURPOSE/BACKGROUND: Following laser panretinal photocoagulation (PRP) for proliferative diabetic retinopathy, patients are at risk of failing the UK driving visual field test due to loss of peripheral field. Although a definition of the minimum field requirement exists, differences in its interpretation may influence whether fields pass or fail. Currently it is not known how fields are interpreted in practice nor to what extent this affects failure rates. METHODS: Uniocular and binocular Esterman visual fields from 60 diabetic patients following PRP were examined both by the chairman of the Visual Standards Sub-Committee of the Royal College of Ophthalmologists and separately by four consultant ophthalmologists. The results were analysed (1) to assess the extent of agreement and (2) to identify, from the chairman's results, the field deficits that are still compatible with passing. RESULTS: Agreement was generally good for binocular fields but was only moderate for uniocular fields. In up to 15% of binocular fields and 43% of uniocular fields the chairman's decision was different from that of the consultants. Several key aspects of the field that influence a pass/fail decision are identified. CONCLUSIONS: Substantial differences in the assessment of driving visual fields following RPR currently exist between consultants and the chairman of the Visual Standards Sub-Committee. Using the information presented here to guide assessment it is now possible to reduce this variation.

The ageing eye.

Most of the problems which occur due to aging of the eye present first to the GP. It is important to make an accurate diagnosis so that appropriate reassurance, treatment or referral can ensue.

The use of video to monitor continuous gold laser photoradiation treatment of an ocular melanoma.

A video system to monitor continuous Gold laser photoradiation treatment of an ocular melanoma is described. We believe this technique considerably improves the safety and accuracy of continuous laser treatment.

Postural response of intraocular pressure in chronic open-angle glaucoma following trabeculectomy.

Forty-six eyes with chronic open-angle glaucoma (COAG) and 24 eyes which had previously undergone trabeculectomy for COAG were studied and the postural response of the intraocular pressure compared with that of 70 normal eyes. In all three groups the greatest rise in intraocular pressure (IOP) occurred when the subject changed from the sitting to the lying position. In the control group this was never more than 2 mmHg in any subject. The rise was greater than 2 mmHg in 93% of the patients suffering from COAG who were treated medically and in 100% of the eyes of those on which trabeculectomy had been performed. The well recognised abnormal postural response of intraocular pressure in COAG appears both to be retained and to be unaffected in those eyes which have undergone trabeculectomy.

The prediction of intraocular pressure rise following argon laser trabeculoplasty.

Forty-five patients with poorly controlled chronic open angle glaucoma underwent pneumotonography immediately prior to argon laser trabeculoplasty. The coefficient of facility of outflow (c-value) was calculated from the pneumotonography and correlated with the intraocular pressure rise one hour after the argon laser trabeculoplasty. It appeared that there was a strong relationship between a low c-value indicating a poor outflow facility and a large intraocular pressure rise following argon laser trabeculoplasty. The implications of being able to predict the intraocular pressure rise after argon laser trabeculoplasty are discussed.

The hazards of hammers.

Fifty-five patients who had received an intraocular foreign body as a result of using a hammer were identified during a 4-year period. Of these, 36 had suffered the injury while at work and 19 while undertaking do-it-yourself activities at home. None had been wearing suitable protection. Seven patients were bystanders and not actually wielding the hammer. Twenty-three patients had a final visual acuity in the affected eye of 6/24 or worse.

A double-blind, cross-over, study of oral N-acetylcysteine in Sjögren's syndrome.

Twenty-six patients with primary or secondary Sjögren's syndrome were treated in a double-blind, cross-over trial for a four week period with oral N-Acetylcysteine and placebo. Before treatment there were significantly elevated salivary lactoferrin levels in the patients when compared to 51 healthy controls (p = 0.0005), and significantly decreased levels of tear lysozyme when compared to 24 controls (p = 0.0003). Salivary sodium, potassium, inorganic phosphate, amylase and immunoglobulin G, A or M levels were not significantly different from control values. After treatment with N-Acetylcysteine, Sjögren's syndrome patients reported improvements in ocular soreness (p = 0.004), ocular irritability (p = 0.006), halitosis (p = 0.033) and daytime thirst (p = 0.033). N-Acetylcysteine, but not placebo improved the van Bijsterveld score (p = 0.026), but neither agent improved the Schirmer test, the tear break up time or any of the laboratory tests. These results suggest that N-Acetylcysteine may have a true therapeutic effect on the ocular symptoms of Sjögren's syndrome and be worthy of a longer study.

Serious eye injury from windscreen contact.

A retrospective survey was carried out of serious eye injury caused by windscreen contact in road traffic accidents over a 6-year period. All 15 patients had contacted toughened windscreens, and all but one did not wear seat belts. The cost in terms of pounds sterling paid out by the National Health Service, and also the cost in terms of visual handicap were assessed. It was found that of the 15 patients admitted during this time, the treatment of the large majority cost at least twice as much as that for patients undergoing routine cataract surgery. This was primarily due to the longer hospitalization necessary. Only 2 patients retained a visual acuity of 6/6.