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      Long-Term Prospective Follow-Up Study of Myopic Photorefractive Keratectomy

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          Abstract

          The aim of this study was to evaluate the long-term outcome of excimer laser myopic photorefractive keratectomy (PRK). We undertook an 11-year prospective follow-up study of visual and refractive outcomes in 46 patients (85 eyes). The main outcome measures were predictability, efficacy, stability and safety of PRK. At 11 years after the operation, 56.5% of eyes were within ±0.5 D of attempted correction and 81.2% were within ±1.0 D; 87% had vision of 20/40 or better, and 52% had 20/20 or better. The best spectacle-corrected visual acuity was unchanged or improved in 91% of eyes at 11 years. Eyes with moderate and severe myopia showed a significant change between 3 and 11 years. PRK surgery for myopia shows predictable and stable results in the long term, with a slight regression in refraction, mainly for patients with severe myopia.

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          The lack of association between signs and symptoms in patients with dry eye disease.

          Kelly Nichols, Jason J. Nichols, G Lynn Mitchell (2004)
          The purpose of this report was to examine the relation between clinical tests and dry eye symptoms in patients with dry eye disease. Seventy-five patients with dry eye disease (ICD-9 code 375.15) were included in these analyses. There was no specific entry criterion for enrollment in addition to a previous dry eye diagnosis in this clinic-based sample. Patients represented varying types and severity of dry eye disease and were previously diagnosed by clinic attending doctors in this university clinic setting. The study examination included a symptom interview that assessed dryness, grittiness, soreness, redness, and ocular fatigue. The interview was followed by a clinical dry eye examination conducted in the following sequence: meibomian gland assessment, tear meniscus height, tear breakup time test, fluorescein staining, the phenol red thread test, Schirmer test, and rose bengal staining. Partial Spearman correlation coefficients, the Wilcoxon rank sum test, chi 2 test, and multivariate logistic regression were used to evaluate the relationship between dry eye tests and symptoms. Symptoms were generally not associated with clinical signs in patients with dry eye disease. There were no significant correlations between signs and symptoms after adjustment for age and artificial tear use. The rank of each clinical test result did not statistically differ when stratified by the presence of patient symptoms in Wilcoxon rank sum analyses. Likewise, the frequency of patient symptoms did not differ statistically when stratified by a positive clinical test result in chi 2 analyses. In multivariate logistic regression analyses, no clinical test significantly predicted frequently reported symptoms after adjustment for age and artificial tear use. These results suggest a poor relation between dry eye tests and symptoms, which represents a quandary in dry eye clinical research and practice.
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            Laser eye surgery for refractive errors.

            Sami Azar, Tohru Sakimoto, J I Rosenblatt (2006)
            Several laser and non-laser refractive surgical procedures have been used to modify the shape of the cornea and correct myopia, hyperopia, astigmatism, and presbyopia. Introduction of the excimer laser to reshape the cornea has resulted in remarkable developments in the correction of these refractive errors. Combined with other advanced ophthalmological instruments, laser refractive eye surgery has resulted in a substantial rise in the safety, efficacy, and predictability of surgical outcomes. Despite these advances, certain limitations and complications persist. In this review, we describe the history, preoperative assessment, surgical techniques, outcomes, and complications of laser refractive surgery.
            Article 0 comments Cited 31 times – based on 0 reviews     Review now
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              Five-year refractive changes in an older population: the Blue Mountains Eye Study.

              Paul Mitchell, J. Wang, Elena Rochtchina … (2003)
              To examine 5-year changes in refractive error and astigmatism in an older population. Population-based cohort study. The Blue Mountains Eye Study examined 3654 residents aged 49 years or older from 1992 to 1994. After excluding 543 persons who died since baseline, 2335 (75.1%) attended 5-year examinations from 1997 to 1999. Both examinations included a detailed eye assessment, with subjective refraction performed according to a modified Early Treatment of Diabetic Retinopathy Study protocol. Spherical equivalent (sum of sphere + cylinder) was used as the measure of refractive error. Only phakic eyes with best-corrected visual acuity >20/40 were included (n = 3701). Similar changes in refractive error were observed for the two eyes. Symmetric changes were found in 72% of participants when the difference between eyes was within 0.5 diopters (D) and in 91% when the difference was within 1.0 D. The 5-year change in spherical power was in a hyperopic direction for younger age groups and in a myopic direction for older subjects, P < 0.0001. The gender-adjusted mean change in refractive error in right eyes of persons aged 49 to 54, 55 to 64, 65 to 74, and 75 years or older at baseline was +0.41 D, +0.30 D, +0.05 D, and -0.22D, respectively. Refractive change was strongly related to baseline nuclear cataract severity; grades 4 to 5 were associated with a myopic shift (-0.33 D, P < 0.0001). Education level and age of onset of myopia, but not gender or diabetes, also predicted refractive change. The mean age-adjusted change in refraction was +0.14 D for hyperopic eyes, +0.32 D for emmetropic eyes, and +0.15 D for myopic eyes. The mean change in cylinder power over the 5-year period was small, irrespective of baseline refraction. The axis of astigmatism remained stable in most cases (64%), whereas 12% changed to "against the rule" and 11% to "with the rule." This report has documented refractive error changes in an older population and confirmed reported trends of a hyperopic shift before age 65 years and a myopic shift thereafter associated with the development of nuclear cataract.
              Article 0 comments Cited 21 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): OPH
                Journal ID (nlm-ta): Ophthalmologica
                Journal ID (doi): 10.1159/issn.0030-3755
                Title: Ophthalmologica
                Publisher: S. Karger AG
                ISSN (Print): 0030-3755
                ISSN (Electronic): 1423-0267
                Publication date Subscription-year: 2008
                Publication date (Print): December 2008
                Publication date (Electronic): 01 September 2008
                Volume: 222
                Issue: 6
                Pages: 386-390
                Affiliations
                aDepartment of Ophthalmology, Qilu Hospital of Shandong University, bDepartment of Ophthalmology, Provincial Hospital affiliated to Shandong University, Jinan, China
                Article
                Publisher ID: 151739 Other ID: Ophthalmologica 2008;222:386–390
                DOI: 10.1159/000151739
                PubMed ID: 18765949
                SO-VID: fda33544-49cb-42e4-8975-8da751951be1
                Copyright © © 2008 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 19 October 2006
                Date accepted : 15 April 2007
                Page count
                Figures: 3, Tables: 2, References: 15, Pages: 5
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Vision sciences,Ophthalmology & Optometry,Pathology
                Keywords: Photorefractive keratectomy,Refraction,Stability
                Data availability:
                ScienceOpen disciplines: Vision sciences, Ophthalmology & Optometry, Pathology
                Keywords: Photorefractive keratectomy, Refraction, Stability

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