Good subjective presbyopic correction with newly designed aspheric multifocal contact lens.

Many people of the so-called 'baby-boom' of 1945, nowadays require presbyopic correction. A lot of them choose for multifocal contact lenses, but this is not the perfect solution. Decreased visual acuity and contrast sensitivity, and appearance of haloes, 'ghosting' and glare are a problem. In this pilot study, with ten randomly, selected, consecutive patients, a newly designed soft aspheric multifocal contact lens was tested for visual performance and comfort on day 1 and after six months' wear. Success rate was 80% after six months. Visual acuity was good with exception for near vision under low illumination conditions. Two patients mentioned haloes. A statistical significant loss of contrast sensitivity was recorded on day 1 for the spatial frequencies 6.0, 12.0 and 18.0 cpd (cycles per degree) under high and low illumination. As well as for the spatial frequencies 12.0 and 18.0 cpd under high illumination and 6.0 cpd under low illumination (p = 0.05) after six months' wear. Mean overrefraction was limited. All patients recorded good comfort.

Acquired von Willebrand disease in Wilms' tumor patients.

PURPOSE: A prospective study was performed to determine the incidence of acquired von Willebrand disease (vWD) in children with newly diagnosed Wilms' tumor. PATIENTS AND METHODS: Fifty consecutive children with newly diagnosed Wilms' tumor were evaluated. Detailed family and bleeding histories were obtained in all cases. Laboratory evaluation included measurement of the circulating platelet count, bleeding time (BT), factor VIII (FVIII) and von Willebrand factor (vWF) levels, and ristocetin cofactor (RCoF) activity. A vWF multimer analysis was obtained in all cases in which vWD was suspected. RESULTS: Four of 50 (8%) consecutive children with a diagnosis of Wilms' tumor were found to have acquired vWD. Laboratory findings indicated type III vWD in two patients and type I vWD in the other two. CONCLUSIONS: The incidence of acquired vWD in association with Wilms' tumor merits further study through a large prospective trial. Such a trial should include careful family and clinical bleeding histories plus measurement of a platelet count, BT, coagulant FVIII and vWF levels, RCoF activity, and vWF multimer analysis. The response to 1-desamino-8-D-arginine vasopressin (DDAVP) should be tested in all patients with Wilms' tumor and acquired vWD, including patients with a type III profile, before an invasive procedure is performed. Successful use of DDAVP may avoid exposure of affected patients to blood products.