Menstrual Cycle--Dependent Changes in Visual Field of Diabetic Women

Left eyes of 129 regularly menstruating diabetic women and 48 healthy controls were evaluated to determine the effect of menstrual cycle on white-on-white perimetry (WWP) of diabetic women. All subjects underwent complete ocular examination and WWP tests both in the follicular (seventh to 10th day of the cycle) and luteal phases (days three to seven before bleeding) of two consecutive menstrual cycles. WWP was performed using Humphrey Field Analyzer II with SITA Standard, central 30-2 program. Mean sensitivity (MS) of points located at central 3, 9, 15, 21 and 27 degrees retinal locations (4, 12, 18, 24 and 16 points, respectively) were evaluated in all menstrual phases.

The mean age of the patients with mild and severe NPDR and control subjects were 28.8, 30.1 and 29.4 years, respectively. Their mean MS values were 30.7, 30.4 and 30.8 dB, respectively. Diabetic patients with severe NPDR demonstrated significant decreases in mean MS values of peripheral 21 and 27 degrees visual field locations during the luteal phase. However, changes within the central 15 degrees were not significant. Diabetic patients with mild NPDR and control subjects demonstrated no changes in mean MS values of any visual field locations.

Peripheral, rather than central, visual fields of diabetic women with severe NPDR demonstrated a significant retinal sensitivity loss during the luteal phase. These findings should be taken into consideration during the clinical follow-up of diabetic women at risk for glaucoma and ocular hypertension.

SOURCE: Akar ME, Apaydin KC, Taskin O, et al. Menstrual cycle-dependent changes in white-on-white visual field analysis of diabetic women. Gynecol Obstet Invest 2005;60(2):92-7.

A 34-year-old man with Marfan's syndrome developed pigment dispersion bilaterally. In the right eye, elevated intraocular pressure was associated with marked glaucomatous excavation of the right disc and corresponding visual field loss. A localized zonular dehiscence was present at the 6 o'clock position in the right eye. Ultrasound biomicroscopy showed marked iris concavity in the right eye, increased iridolenticular contact and superior subluxation of the right lens, resulting in increased dispersion of pigment unilaterally.

Asymmetric progression of pigmentary glaucoma is uncommon and should prompt a search for some other mechanical factor. The association between the two syndromes in this patient was most likely mechanical due to reduced fibrillin expression throughout the eye and particularly in the iris and the lens zonules, resulting in loss of iris tensile strength and marked iris concavity as well as zonular weakness and partial lens subluxation. No relationship between Marfan's syndrome and pigmentary glaucoma has previously been described in the ophthalmic literature.

SOURCE: Doyle A, Hamard P, Puech M, Lachkar Y. Asymmetric pigmentary glaucoma in a patient with Marfan's syndrome. Graefes Arch Clin Exp Ophthalmol 2005;[Epub ahead of print].

Deep Lamellar Keratoplasty vs. Penetrating Keratoplasty for Keratoconus

Results of 20 consecutive penetrating keratoplasties (PKs) for keratoconus were compared with 20 consecutive deep lamellar keratoplasties (DLKs) for keratoconus. The PKs were performed between June 2000 and July 2001, the DLKs between October 2001 and October 2002. All surgery was performed by one surgeon. Best-corrected visual acuities (BCVA), refraction and complications were recorded at the time of surgery, six and 12 months postoperatively.

All PKs were uncomplicated. Two of the DLK group had microperforations of Descemet's membrane. There was no significant difference between the PK and DLK groups in the proportion of patients achieving 20/30 or better acuity (85 percent vs. 78 percent). PK patients were, however, more likely than the DLKs to achieve 20/20 at one year; 70 percent (14/20) of PKs compared to 22 percent of (4/18) DLKs. Astigmatism was significantly higher in the PKs compared to the DLKs. There were two cases of graft rejection in the PK group and none in the DLKs.

This study confirms good results from both PK and DLK for keratoconus with similarly high percentages reaching 20/30 BCVA. DLK appears to cause less astigmatism and also has the advantage of no endothelial graft rejection. The apparent cost, however, is a reduction in the likelihood of achieving 20/20 BCVA.

SOURCE: Funnell CL, Ball J, Noble BA. Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus. Eye 2005;[Epub ahead of print].

NEWS & NOTES

	NEW CDC STUDY: MANY U.S. CHILDREN NOT RECEIVING PROPER VISION CARE. According to a recent report from the Centers for Disease Control and Prevention (CDC), only about one in three children in America have received eyecare services before their sixth birthday. The "Visual Impairment and Use of Eye-Care Services and Protective Eyewear Among Children" findings, published in the Morbidity and Mortality Weekly Report, were the result of a national survey of more than 12,000 participants. The study also found that compared to black or white children, Asian and Hispanic children in the United States were less likely to get their vision checked. Hispanic children have a higher prevalence of visual impairment and blindness than white children (3.6 percent vs. 2.3 percent), according to the study. The CDC report also examined the issue of eye safety in sports. Only 14.6 percent of all children aged six to 17 consistently wear protective eye gear during sports activities, the study shows--and girls are less likely than boys to wear protection. Of the nearly 36,000 sports-related eye injuries treated in U.S. hospital emergency rooms in 2002, more than 40 percent were to children age 14 and younger, and many were avoidable. The CDC study is available at www.cdc.gov/mmwr/preview/mmwrhtml/mm5417a2.htm.
	PREVENT BLINDNESS AMERICA, BAUSCH & LOMB OFFER NEW ONLINE RESOURCE FOR UVEITIS INFORMATION. Prevent Blindness America (PBA) has announced the launch of a new website for patients and healthcare professionals to obtain information and resources on uveitis. The site, www.preventblindness.org/uveitis, is funded by an unrestricted educational grant from Bausch & Lomb. It includes educational information for patients on the symptoms and treatments of uveitis, and offers recommendations on working with one’s doctor to treat the disease. The site also provides links to uveitis management resources, article abstracts and patient educational materials for eyecare practitioners. For more information on uveitis and other vision-threatening diseases, go to www.preventblindness.org or call 800-331-2020.
	ALLERGAN LAUNCHES EDUCATIONAL WEBSITE FOR CHRONIC DRY EYE PATIENTS. Allergan has launched a new educational website, www.FocusOnDryEye.com, dedicated to providing practitioners and consumers with up-to-date information about dry eye. The site includes patient information on the causes, symptoms and diagnosis of dry eye, a discussion of treatment options, a FAQ page, and a list of resources and links to more information.
	AKORN INTRODUCES GENERIC VERSIONS OF CIPROFLOXACIN AND OFLOXACIN. Akorn, Inc. has introduced two new products in the United States: Ciprofloxacin Ophthalmic Solution USP, 0.3% (ciprofloxacin) and Ofloxacin Ophthalmic Solution USP, 0.3% (ofloxacin), after the patents for both ophthalmic solution versions of ciprofloxacin (Ciloxan) and ofloxacin (Ocuflox) expired. Industry sources expect the combined market potential for both of these products at more than $40 million.

	It’s only been up and running a few short weeks. Yet, it’s already clear that the Check Yearly. See Clearly.(SM) marketing campaign is opening consumers’ eyes to the benefits of regular eye exams. Call the Vision Council of America at 800-424-8422 today or visit checkyearly.com for your free promotional materials.