Dacryocystorhinostomy: History, evolution and future directions.

Dacryocystorhinostomy (DCR) is a procedure of choice for nasolacrimal duct obstruction and chronic dacryostenosis in the setting of patent canaliculi and a functional lacrimal pump. Two major approaches are utilized: external, via a transcutaneous incision and endonasal endoscopically guided. The surgery has a high success rate via both approaches. We review the history, evolution, current techniques, complications and future directions of DCR.

The quality of life associated with presbyopia.

PURPOSE: To determine the health-related quality of life associated with the presbyopia. DESIGN: Cross-sectional, patient preference-based, time trade-off utility analysis. METHODS: One hundred and ten patients with spectacle-corrected presbyopia and a best-corrected visual acuity of 20/40 or better were interviewed in a cross-sectional fashion using a standardized, validated, time trade-off utility analysis questionnaire. RESULTS: The mean utility associated with the health state of presbyopia in our sample was 0.980 (standard deviation, 0.086; 95% confidence interval, 0.964 to 0.996). Ten percent of the cohort had a presbyopia-associated utility of 0.95 or less. Age, gender, level of education, marital status, and the degree of presbyopia did not significantly affect the time trade-off utilities associated with presbyopia. CONCLUSIONS: Presbyopia corrected with glasses is associated with a nominal decrease in quality of life, similar to that of treated hypertension, for the average person with the condition. Approximately 10% of such patients theoretically may be candidates for an intervention other than spectacles to correct the condition.

Update on the ocular manifestations of systemic arterial hypertension.

PURPOSE OF REVIEW: In a society with a steadily increasing population of patients with hypertension, a significant mortality risk factor, it is important that clinicians be cognizant of the changes seen in ophthalmic examination. This paper demonstrates both the acute and chronic stages of the disease. RECENT FINDINGS: This paper first presents the history of classifying different stages of hypertensive retinopathy, a condition associated with systemic arterial hypertension, as defined by Keith-Wagener-Barker. The most recent recommendations published in the Seventh Report of the Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure are also described; this report defines the current status and classification of hypertension in the United States, as well as recommendations for its treatment and management. Finally, disease management strategies and currently accepted treatment options are presented. SUMMARY: Since systemic arterial hypertension is a key modifiable risk factor for various diseases such as myocardial infarction and stroke, it is crucial that we detect early signs of hypertension to promote better health for our patient population.