Ophthalmol Clin North Am
· 2004 Sep · PMID 15337197
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Endocrine and metabolic disorders that cause neuro-ophthalmologic manifestations are frequently encountered by ophthalmologists in clinical practice. This review focuses on three of the most common entities for which neu...Endocrine and metabolic disorders that cause neuro-ophthalmologic manifestations are frequently encountered by ophthalmologists in clinical practice. This review focuses on three of the most common entities for which neuro-ophthalmologic signs and symptoms are a prominent feature. These entities include pituitary disorders (adenoma, apoplexy, and hypophysitis), thyroid-associated ophthalmopathy, and neuro-ophthalmologic complications of diabetes mellitus, such as ischemic ocular motor mononeuropathies and diabetic papillopathy.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337196
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Systemic infectious disease may present with or include neuro-ophthalmic findings. Many of these signs and symptoms are related to topographical location of the infectious process,but some entities have distinctive and c...Systemic infectious disease may present with or include neuro-ophthalmic findings. Many of these signs and symptoms are related to topographical location of the infectious process,but some entities have distinctive and characteristic features that allow specific diagnosis. This article updates and reviews the neuro-ophthalmic features of infectious disease.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337195
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Rheumatologic and inflammatory systemic diseases often cause similar neurologic and neuro-ophthalmologic manifestations. A wide variety of conditions can be included in these categories. This article summarizes the most...Rheumatologic and inflammatory systemic diseases often cause similar neurologic and neuro-ophthalmologic manifestations. A wide variety of conditions can be included in these categories. This article summarizes the most common of these conditions, including sarcoidosis, idiopathic orbital inflammation, inflammatory bowel disease, Wegener's granulomatosis, polyarteritis nodosa, Churg-Strauss syndrome, Behcet's disease, systemic lupus erythematosis, scleroderma, Sjogren's syndrome, and rheumatoid arthritis.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337194
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The hematopoietic system is a complex mixture of circulating blood cells, plasma, and plasma proteins. Disorders of the hematologic system may result from excess or impaired production of blood cells, destruction of bloo...The hematopoietic system is a complex mixture of circulating blood cells, plasma, and plasma proteins. Disorders of the hematologic system may result from excess or impaired production of blood cells, destruction of blood cells, or abnormal function of existing blood cells. The afferent and efferent visual systems may both be affected by blood cell disorders, and the specific manifestation is dependent upon which cell line is involved, the type of dysfunction, and the characteristics of the target tissue. This article reviews the ocular and neuro-ophthalmic manifestation of hematologic disorders.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337193
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Ophthalmologists are often the first physicians to evaluate patients with headaches, eye pain, and headache-associated visual disturbances. Although ophthalmic causes are sometimes diagnosed, most eye pain and many types...Ophthalmologists are often the first physicians to evaluate patients with headaches, eye pain, and headache-associated visual disturbances. Although ophthalmic causes are sometimes diagnosed, most eye pain and many types of visual disturbances are neurologic in origin. Afferent and efferent symptoms and signs are associated with headache disorders. This article reviews the primary headache disorders and focuses on their ophthalmic manifestations. The major divisions are migraine and the trigeminal autonomic cephalgias.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337192
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Vascular diseases of the brain affect vision owing to a variety of mechanisms and cause a range of signs and symptoms. These conditions may result from diminished bloodflow, from leakage of blood through vessel walls, or...Vascular diseases of the brain affect vision owing to a variety of mechanisms and cause a range of signs and symptoms. These conditions may result from diminished bloodflow, from leakage of blood through vessel walls, or from the compression of adjacent structures by enlarged vessels. Vascular disease may affect the arterial or venous systems and may be caused by abnormal communications between arteries and veins. In some cases, these visual manifestations have a significant impact on quality of life; in other cases, they may be warning signs of serious underlying neurologic or systemic disease. This article emphasizes the conditions that present most commonly to ophthalmologists.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337191
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Functional visual loss is a common problem encountered in practice. It must be recognized that this problem occurs in patients who have organic illness. Manual perimetry is the most effective method for evaluating functi...Functional visual loss is a common problem encountered in practice. It must be recognized that this problem occurs in patients who have organic illness. Manual perimetry is the most effective method for evaluating functional visual loss, and the presence of a central scotoma in a functional visual field strongly suggests that organic pathology is present. Neuropsychological and psychiatric intervention can be useful in treating these patients.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337190
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Patients who have neurodegenerative disease frequently present to the ophthalmologist with visual complaints. The causes of the symptoms are varied and include visual sensory and ocular motor dysfunction. This article pr...Patients who have neurodegenerative disease frequently present to the ophthalmologist with visual complaints. The causes of the symptoms are varied and include visual sensory and ocular motor dysfunction. This article provides an overview of the neuroophthalmic manifestations of the most common neurodegenerative diseases presenting with visual dysfunction, including Alzheimer's disease, Parkinson's disease, progressive supranuclear palsy, and others. Evaluation of visual function in patients who have neurodegenerative disorder can be challenging, but familiarity with the type of visual dysfunction most commonly associated with each disorder will allow for a focused assessment and treatment when possible.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337189
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Myasthenia gravis may be limited solely to the eyes (ocular myasthenia) or may have systemic manifestations (generalized myasthenia). Most patients display blepharoptosis or ophthalmoparesis, resulting in diplopia, but t...Myasthenia gravis may be limited solely to the eyes (ocular myasthenia) or may have systemic manifestations (generalized myasthenia). Most patients display blepharoptosis or ophthalmoparesis, resulting in diplopia, but the ocular motility disorder may take many forms. The diagnosis is often elucidated by variable muscle weakness with fatigability noted in the history and on examination. The ice test has supplanted the need for the edrophonium (Tensilon) test in many cases of ocular myasthenia. Therapy may be challenging, because many ocular myasthenics do not achieve significant clinical improvement with acetylcholinesterase inhibitors alone. Immunomodulatory treatment,such as systemic corticosteroids, is frequently effective, and emerging data suggest that this type of therapy may reduce the likelihood of ocular myasthenia becoming generalized.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337188
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Visual symptoms frequently complicate the course of multiple sclerosis (MS). The ophthalmologist must be familiar with the neuro-ophthalmologic manifestations of MS to facilitate the initial evaluation and treatment of p...Visual symptoms frequently complicate the course of multiple sclerosis (MS). The ophthalmologist must be familiar with the neuro-ophthalmologic manifestations of MS to facilitate the initial evaluation and treatment of patients. Magnetic Resonance Imaging has become an important tool to confirm the diagnosis of MS or to assess the risk of MS in patients with clinically isolated demyelinating syndromes. This article reviews the neuro-ophthalmologic manifestations of MS and the management issues that arise in early MS.
Ophthalmol Clin North Am
· 2004 Jun · PMID 15207566
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The possibility of achieving supernormal vision in terms of acuity and contrast has fueled the imagination and creativity of vision researchers to pursue the goal of customized wavefront refractive surgery. This goal is...The possibility of achieving supernormal vision in terms of acuity and contrast has fueled the imagination and creativity of vision researchers to pursue the goal of customized wavefront refractive surgery. This goal is achieved by generating an optimal ablation pattern based on individual anatomical and functional characteristics of the treated eye. However, increasing concerns regarding the clinical applicability of customized wavefront correction have emerged, and the possibility of achieving supernormal vision in all patients has been challenged. It is by understanding current optical, physiologic,and technological challenges faced by treating physicians and basic researchers that we can develop clear objectives for the future development of customized refractive surgery.
Ophthalmol Clin North Am
· 2004 Jun · PMID 15207565
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This article describes two currently available intraocular lenses (IOLs) that have special design features allowing for correction of optical aberrations other than spherical refractive errors. Although they are not yet...This article describes two currently available intraocular lenses (IOLs) that have special design features allowing for correction of optical aberrations other than spherical refractive errors. Although they are not yet fully "customized" lenses, their development has involved average aberrations measured with wavefront technology. An experimental IOL manufactured with a special technology is also described that, when used in conjunction with wavefront sensing, has the potential for full customization.
Ophthalmol Clin North Am
· 2004 Jun · PMID 15207564
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Corneal wound healing makes important contributions to the outcomes of both traditional excimer laser ablation procedures and custom corneal ablations and contributes to the poor predictability of keratorefractive surger...Corneal wound healing makes important contributions to the outcomes of both traditional excimer laser ablation procedures and custom corneal ablations and contributes to the poor predictability of keratorefractive surgery in some patients. In addition, wound healing makes important contributions to some complications of PRK, LASEK or LASIK,including haze and diffuse lamellar keratitis. Detailed characterization of the wound healing cascade that occurs following refractive procedures is fundamental to pharmacological and molecular approaches for controlling or normalizing the response to surgery,thereby reducing biological diversity in variables such as epithelial hyperplasia and stromal remodeling that often tend to mask attempts at custom ablation.
Ophthalmol Clin North Am
· 2004 Jun · PMID 15207563
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The authors' study evaluated subjective reports of mesopic visual function after LASIK for spherical and spherocylindrical myopia and evaluated whether age, pupil size, treatment amount, residual postoperative refractive...The authors' study evaluated subjective reports of mesopic visual function after LASIK for spherical and spherocylindrical myopia and evaluated whether age, pupil size, treatment amount, residual postoperative refractive error, or other factors correlated with subjective findings. Preoperative, 3-month, and 6-month subjective patient questionnaires were administered. Results for questions about glare with night driving and glare with bright lights were tallied and evaluated using standard statistical methods. The results indicated that subjective reports of mesopic visual function after myopia LASIK improve overall. Worsened symptoms are most likely to occur in eyes with poor refractive outcomes. Correction of residual refractive errors may improve night driving and glare symptoms after LASIK.
Reinstein DZ, Neal DR, Vogelsang H
… +5 more, Schroeder E, Nagy ZZ, Bergt M, Copland J, Topa D
Ophthalmol Clin North Am
· 2004 Jun · PMID 15207562
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The Carl Zeiss Meditec platform for custom ablation incorporates a suite of technology integrating high-resolution wavefront aberrometry (WASCA), corneal surface shape data (TOSCA), energy stabilized excimer laser delive...The Carl Zeiss Meditec platform for custom ablation incorporates a suite of technology integrating high-resolution wavefront aberrometry (WASCA), corneal surface shape data (TOSCA), energy stabilized excimer laser delivery (MEL80), and surgeon-controlled individualization of the ablation profile (CRS-Master). Together, these components deliver increasingly higher accuracy and sophistication in treatment planning for corneal refractive surgery.
Ophthalmol Clin North Am
· 2004 Jun · PMID 15207561
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The NIDEK Advanced Vision Excimer Laser (NAVEX) platform has been used to treat primary eyes and in a wide variety of therapeutic applications. Use of an extremely robust scanning slit skiascopy aberrometer has enabled t...The NIDEK Advanced Vision Excimer Laser (NAVEX) platform has been used to treat primary eyes and in a wide variety of therapeutic applications. Use of an extremely robust scanning slit skiascopy aberrometer has enabled the treatment of eyes in the latter category. Primary outcomes using NAVEX have shown a reduced induction of higher order aberrations, a maintenance or gain of contrast sensitivity in most patients, and excellent refractive outcomes. By using an ablation profile that minimizes the amount of induced spherical aberrations, large effective optical zones are seen postoperatively.
Ophthalmol Clin North Am
· 2004 Jun · PMID 15207560
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The Bausch & Lomb Zyoptix system provides a customized approach to corneal sculpting resulting in improvements in best-corrected visual acuity and contrast sensitivity over that achieved in conventional laser in situ ker...The Bausch & Lomb Zyoptix system provides a customized approach to corneal sculpting resulting in improvements in best-corrected visual acuity and contrast sensitivity over that achieved in conventional laser in situ keratomileusis surgery.
Ophthalmol Clin North Am
· 2004 Jun · PMID 15207559
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The Alcon CustomCornea platform is a basis of refractive surgery using a wavefront sensor (LADARWave) to provide the desired ablation profile, and an excimer laser(LADARVision) to administer it to the eye. These two syst...The Alcon CustomCornea platform is a basis of refractive surgery using a wavefront sensor (LADARWave) to provide the desired ablation profile, and an excimer laser(LADARVision) to administer it to the eye. These two systems are linked using identical software features to align the wavefront measurement and the ablation such that there fractive correction is delivered to the correct location on the eye. The technology behind these two systems and the clinical outcomes achieved using CustomCornea will be discussed.
Ophthalmol Clin North Am
· 2004 Jun · PMID 15207558
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The introduction of wavefront sensing technology and customized corneal ablation has revolutionized the field of refractive surgery. Yet, in order for customized laser vision correction to reach its full potential, a num...The introduction of wavefront sensing technology and customized corneal ablation has revolutionized the field of refractive surgery. Yet, in order for customized laser vision correction to reach its full potential, a number of technological requirements must be addressed by the specific laser vision correction platform offering this customized procedure. At present,several different technology platforms exist. A more thorough understanding of these platforms will help in evaluating which system is best at eliminating aberrations. The following technology is required to provide what is considered optimal within the current state of knowledge in this field: (1) scanning spot laser delivery, (2) robust eye tracking,(3) an accurate wavefront device, and (4) the wavefront-laser interface.
Ophthalmol Clin North Am
· 2004 Jun · PMID 15207557
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Standard refractive surgery (photorefractive keratectomy and laser in situ keratomileusis)induces optical changes in the wavefront aberrations of the eye. Higher-order optical changes are induced, especially spherical ab...Standard refractive surgery (photorefractive keratectomy and laser in situ keratomileusis)induces optical changes in the wavefront aberrations of the eye. Higher-order optical changes are induced, especially spherical aberration and coma. Wavefront sensing performed after refractive surgery has revealed a decrease in low-contrast acuity and contrast sensitivity, comprising the patient's night vision and leading to symptoms such as halos, starburst, and glare.