the Cuff: Self-Image and PR
Many of us, especially
in years past, accepted second place as status
quo. This "We are not as good as they are"
attitude infected our profession like a virus.
Damaged by this insidious and pervasive insecurity,
our professional self-image suffered. It wasnt
just our professional self-image either. Our
public-image suffered as well. This was compounded
by our rapid evolution as the primary eyecare
Less than a year after the AOA initiated its
public relations campaign, the profession has
virtually redefined itself in the public eye.
In the process, we have become more comfortable
with ourselves and with each other. As we continue
to evolve as an independent profession, I believe
that we will ultimately discover that professional
growth and expansion starts from within. However,
a little push in the right direction never hurt.
As we celebrate this Memorial Day weekend, let
us not forget those who put themselves in harms
way to protect freedom and our way of life....GBA.
Between Disposable and Goldmann Tonometers
aim of this study was to evaluate the accuracy
and reliability of three single-use devices
(Tonoshield, Tonosafe, Tonojet) as an alternative
to standard Goldmann prisms in an emergency
All patients seen in the emergency department
of the Manchester Royal Eye Hospital for a period
of four months who required intraocular pressure
(IOP) measurement were eligible for this prospective
study. Exclusion criteria were: age below 18
years, corneal anomalies that might affect measurement
and refusal to participate. After giving informed
consent, the patients were examined by one practitioner
who measured IOP three times. In the first part
of the study, standard Goldmann prism vs. Tonoshield
and Tonosafe prisms were compared. The second
part of the study used standard Goldmann, Tonosafe
and Tonojet prisms.
Tonosafe and Tonojet correlated well with standard
Goldmann tonometry, while the measurements obtained
with Tonoshield were higher, especially for
raised IOP measurements. Tonojet and Tonosafe
measurements were more reproducible than Tonoshield
measurements. This study shows that Tonosafe
and Tonojet are accurate and reliable alternatives
to standard Goldmann tonometry.
SOURCE: Maino AP, Uddin
HJ, Tullo AB. A comparison of clinical performance
between disposable and Goldmann tonometers.
Estimation vs. OCT for C/D Ratio Assessment
study assessed the agreement between slit lamp
indirect ophthalmoscopy and Stratus optical
coherence tomography (OCT) when assessing cup-to-disc
Twenty-five ocular hypertensive subjects and
56 patients with primary open-angle glaucoma
(POAG) were included. Estimation of vertical
and horizontal cup-to-disc ratio (VCDR and HCDR,
respectively) with slit lamp ophthalmoscopy
was made by three glaucoma specialists, along
with OCT scanning of optic nerve head.
The mean VCDR and HCDR were significantly higher
with OCT than those estimated by the specialists,
with the difference ranging from 0.08 to 0.11
and from 0.13 to 0.18, respectively. Difference
was higher for cuppings below 0.3 and lost significance
for larger VCDR cups (above 0.7). When data
were plotted according to the Bland-Altman method,
as the cupping increased, the agreement between
OCT and glaucoma specialists also increased.
There is very good agreement among specialists
when estimating CDRs by stereoscopic slit lamp
biomicroscopy. OCT shows higher values than
the specialists; the greatest differences occurred
when assessing small CDRs, and the differences
diminished as the cupping increased. These two
methods of measurement are not interchangeable,
and the difference must be considered, especially
in discs with smaller CDRs.
F, Munoz-Negrete FJ, Rebolleda G, et al. Cup-to-disc
ratio: agreement between slit-lamp indirect
ophthalmoscopic estimation and stratus optical
coherence tomography measurement. Eye 2006;
May 5 [Epub ahead of print].
Motor Differences in Depression
depressive disorder may be a heterogeneous disorder,
yet melancholic depression is the most consistently
described subtype, regarded as qualitatively
different to non-melancholic depression in terms
of cognitive and motor impairments. This study
employed a battery of saccadic eye movement
tasks to explore reflexive saccades, as well
as higher order cognitive aspects of saccades
including inhibitory control and spatial working
memory. Nineteen patients with major depressive
disorder (nine melancholic; 10 non-melancholic)
and 15 healthy controls participated.
Differences were revealed between melancholic
and non-melancholic patients. Melancholia was
associated with longer latencies, difficulty
increasing peak velocities as target amplitudes
increased and hypometric primary saccades during
the predictable protocol. In contrast, the non-melancholic
depression group performed similarly to controls
on most tasks, but saccadic peak velocity was
increased for reflexive saccades at larger amplitudes.
Note that most patients were taking antidepressant
The latency increases, reduced peak velocity
and primary saccade hypometria with more severe
melancholia may be explained by functional changes
in the fronto-striatal-collicular networks relating
to dopamine dysfunction. In contrast, the serotonergic
system plays a greater role in non-melancholic
symptoms, and this may underpin the observed
increases in saccadic peak velocity. These findings
provide neurophysiological support for functional
differences between depression subgroups that
are consistent with previous motor and cognitive
C, Georgiou-Karistianis N, Fitzgerald PB, et
al. Ocular motor differences between melancholic
and non-melancholic depression. J Affect Disord
2006; May 5 [Epub ahead of print].
Pemphigoid with Bronchial Involvement in 17-Year-Old
17-year-old girl presented with worsening dyspnea,
skin rash and bilateral ocular injection, symblepharon
and fornix foreshortening. Conjunctival, skin
and bronchial biopsies were performed along
with imaging and serological tests in an effort
to establish a diagnosis for this unusual constellation
of findings. The surprising occurrence of a
cerebrovascular accident during her hospitalization
prompted a search for a concurrent coagulation
Immunofluorescence studies of conjunctival,
skin and bronchial tissue specimens revealed
deposition of multiple antibody classes at the
basement membrane zone. The patient also possessed
circulating basement membrane zone antibodies
in her serum and a significant titer of antiphospholipid
antibodies. She underwent dilation and stent
placement for subglottic tracheal and left bronchial
stenosis and was treated with immunosuppressive
agents. After a favorable initial response,
the patient experienced progressive bronchial
stenosis and respiratory compromise, culminating
in her death from bronchospasm and cardiopulmonary
This is the first report of mucous membrane
pemphigoid involving the lower airways that
was confirmed by immunofluorescence analysis.
It highlights the potentially lethal systemic
nature of mucous membrane pemphigoid and underscores
the need to question patients about symptoms
of respiratory dysfunction.
SOURCE: Gamm DM, Harris
A, Mehran RJ, et al. Mucous membrane pemphigoid
with fatal bronchial involvement in a seventeen-year-old
girl. Cornea 2006;25(4):474-8.
Pachymetry Mapping with OCT
eyes of 21 normal subjects undergoing LASIK
had high-speed (2000 axial scans/second) 1.3-micron-wavelength
corneal and anterior segment optical coherence
tomography (OCT) corneal scanning performed.
The scan pattern consisted of 10-mm radial lines
on eight meridians centered on the vertex reflection.
The entire scan pattern of 1024 a-scans was
acquired in 0.5 seconds. Corneal thickness was
measured normal to the anterior surface and
presented as color pachymetry maps and zonal
statistics. The maps were then divided into
a central zone (less than 2 mm) and three annular
areas (pericentral, 2mm to 5 mm; transitional,
5mm to 7 mm; peripheral, 7 mm to 10 mm), which
were further divided into quadrantal zones.
The average, minimum and maximum corneal thicknesses
were computed for zones within the 7-mm diameter.
OCT and ultrasound pachymetry were measured
three times at the preoperative and three-month
Before LASIK, central corneal thicknesses (CCTs)
were 546.9 +/- 29.4 microns for OCT and 553.3
+/- 33.0 microns for ultrasound. After LASIK,
CCTs were 513.7 +/- 44.5 microns for OCT and
498 +/- 46.6 microns for ultrasound. OCT and
ultrasound CCT were highly correlated. The differences
were statistically significant, but no more
than the CCT measurement differences between
ultrasound pachymeters. The reproducibility
of the OCT zonal pachymetry averages was roughly
High-speed OCT provided non-contact, rapid,
reproducible pachymetric mapping over a wide
area of the cornea. It is equivalent to ultrasound
for CCT measurement before and after LASIK.
This technology could be valuable for planning
keratorefractive procedures and diagnosis of
SOURCE: Li Y, Shekhar R,
Huang D. Corneal pachymetry mapping with high-speed
optical coherence tomography. Ophthalmol 2006;113(5):799.e1-2.
Aberrations Induced by Soft Contact Lenses in
aberrations (HOA) of 30 eyes of 15 myopic soft
contact lens wearers who had no ocular diseases
were assessed with a Nidek Marco three-dimensional
Wave wavefront analyzer. Zernike's polynomial
was used to describe the wavefront measurements.
Root mean square (RMS) values of the total HOAs,
coma, trefoil and spherical aberrations were
obtained in the same eyes with and without soft
Mean RMS values for all higher order aberration
components with and without soft contact lenses
were: total HOA 0.364 +/- 0.129 microns without
lenses and 0.456 +/- 0.175 with lenses, total
coma 0.203 +/- 0.095 microns without lenses
and 0.220 +/- 0.133 with lenses, total trefoil
0.193 +/-0.074 microns without lenses and 0.254
+/- 0.153 with lenses, total spherical aberration
0.126 +/- 0.121 microns without lenses and 0.148
+/- 0.095 with lenses.
Wavefront analysis showed soft contact lenses
for myopia induced a significant increase in
total HOA. Though total coma, trefoil and spherical
aberrations were also higher with contact lenses,
they were not statistically significant when
individually evaluated and compared to values
without contact lenses.
SOURCE: Roberts B, Athappilly
G, Tinio B, et al. Higher order aberrations
induced by soft contact lenses in normal eyes
with myopia. Eye Cont Lens 2006;32(3):138-42.