Cataract is the leading cause of blindness in the world. At present, the only current method for treatment of cataract is surgical extraction. However, efforts are being made to reduce the incidence by identifying the risk factors. This past year additional evidence has linked cigarette smoking with cataract. Most of the persons who are blind from cataracts live in developing countries and are twice as likely to die as age-matched persons without cataract in other countries. High-volume intracapsular cataract camps have good, short-term results in restoring vision; however, blindness from uncorrected aphakia is a significant problem. Thus, there is an increasing inclination toward provision of extracapsular cataract extraction with intraocular lens implantation in these developing countries. The long-term complication of posterior capsular opacification in this setting needs to be addressed.
Purpose: To develop current treatment recommendations for dry eye disease from consensus of expert advice. Methods: Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome. Results: A new term for dry eye disease was proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease. Conclusion: Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances.
To assess the relative risk of contact lens—associated ulcerative keratitis by lens type and related lenswearing behavior.
Design:
Case-control study.
Setting/Participants:
Forty practice-based case patients with contact lens—associated ulcerative keratitis and 180 control patients matched to the case patients' dispensing practitioner and date of contact lens prescription.
Results:
Compared with users of daily-wear soft lenses, users of disposable soft contact lenses had a 13.33-fold (95% confidence interval [CI], 5.35 to 33.20) excess risk of ulcerative keratitis. However, after adjusting for overnight wear, the excess risk associated with disposable contact lenses is reduced to 3.21 (95% CI, 1.22 to 14.36). Overall, overnight wear of contact lenses conferred an 8.25-fold excess risk (95% CI, 3.33 to 25.58) of ulcerative keratitis after controlling for lens type. No protective effect of standard compared with substandard lens hygiene was found. The risk of ulcerative keratitis attributable to overnight wear was estimated at 49% for users of daily-wear lenses and 74% for users of lenses approved for overnight wear.
Conclusion:
Overnight wear of contact lenses is the overwhelming risk factor for ulcerative keratitis among contact lens users. We estimate that 49% to 74% of cases of contact lens—associated ulcerative keratitis could be prevented by eliminating overnight wear.
Purpose: To examine the distribution and association of dry eye symptoms, Schirmer test results, and rose bengal scores in a population-based sample of elderly Americans. Design: Population-based prevalence survey. Participants: Involved were 2240 noninstitutionalized residents of Salisbury, Maryland, aged 65 years and older as of September 1993, and identified by the Health Care Financing Administration Medicare database. Main Outcome Measures: A standardized dry eye symptom questionnaire, rose bengal scoring of ocular surface staining, and Schirmer tests. Results: Fourteen percent of participants reported one or more symptoms to be present often or all the time. The mean Schirmer score in the lower testing eye was 12.4 and 42% had a rose bengal score of 1 or greater. No significant differences by age, gender, or race were seen for symptoms, Schirmer, or rose bengal testing. No association was seen between lower Schirmer scores and presence of more frequent symptoms. Higher rose bengal scores were weakly associated with symptoms. The Schirmer and rose bengal test results, both individually and in combination, were insensitive in identifying individuals who had symptoms. Conclusions: Although symptoms of ocular irritation are common among the elderly, these population-based data indicate that there is minimal overlap between individuals identified by questionnaire, Schirmer tests, and rose bengal scoring. Purpose: To examine the distribution and association of dry eye symptoms, Schirmer test results, and rose bengal scores in a population-based sample of elderly Americans. Design: Population-based prevalence survey. Participants: Involved were 2240 noninstitutionalized residents of Salisbury, Maryland, aged 65 years and older as of September 1993, and identified by the Health Care Financing Administration Medicare database. Main Outcome Measures: A standardized dry eye symptom questionnaire, rose bengal scoring of ocular surface staining, and Schirmer tests. Results: Fourteen percent of participants reported one or more symptoms to be present often or all the time. The mean Schirmer score in the lower testing eye was 12.4 and 42% had a rose bengal score of 1 or greater. No significant differences by age, gender, or race were seen for symptoms, Schirmer, or rose bengal testing. No association was seen between lower Schirmer scores and presence of more frequent symptoms. Higher rose bengal scores were weakly associated with symptoms. The Schirmer and rose bengal test results, both individually and in combination, were insensitive in identifying individuals who had symptoms. Conclusions: Although symptoms of ocular irritation are common among the elderly, these population-based data indicate that there is minimal overlap between individuals identified by questionnaire, Schirmer tests, and rose bengal scoring.
