1: Surv Ophthalmol. 2010 Jul 20; [Epub ahead of print] 

Health Literacy and Ophthalmic Patient Education.

Muir KW, Lee PP.

Duke University Eye Center, Durham, North Carolina, USA.

In 1997, Ebrahimzadeh, Davalos, and Lee wrote in this journal that only 32% of
the ophthalmic patient educational materials reviewed were written at or below
the recommended eighth-grade reading level. Since that time, the National
Assessment of Adult Literacy found that more than one-third of adult Americans
possess only basic or below basic health literacy skills, defined as the ability
to understand written information in a healthcare setting. Subsequently,
investigators have shown that poor health literacy skills are associated with
poor prescription medication adherence, increased hospital admissions, and
increased mortality. We review the readability of currently available ophthalmic
educational materials, with particular attention to the health literacy status
of the patient population for which the materials are intended. Examples of
prose at various readability levels are provided. Optimizing patient education
and improving clinical outcomes requires understanding the attributes that the
patient brings to the patient-physician relationship, including health literacy.
Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20650503  [PubMed - as supplied by publisher]

2: Surv Ophthalmol. 2010 Jul 16; [Epub ahead of print] 

Wegener's Granulomatosis: Clinical Manifestations, Differential Diagnosis, and
Management of Ocular and Systemic Disease.

Tarabishy AB, Schulte M, Papaliodis GN, Hoffman GS.

Cleveland Clinic, Cleveland, Ohio, USA.

Wegener's granulomatosis (WG) is a systemic inflammatory disease whose
histopathologic features often include necrosis, granuloma formation, and
vasculitis of small-to-medium-sized vessels. WG involves many interrelated
pathogenic pathways that are genetic, cell-mediated, neutrophil-mediated,
humoral, and environmental. WG most commonly involves the upper respiratory
tract, lungs, and kidneys, but has been reported to affect almost any organ.
Ophthalmologic involvement is an important cause of morbidity in WG patients,
occurring in approximately one-half of patients. The presence of unexplained
orbital inflammatory disease, scleritis, peripheral ulcerative keratitis,
cicatricial conjunctivitis, nasolacrimal duct stenosis, retinal vascular
occlusion, or infrequently uveitis should raise the question of possible WG. A
thorough clinical examination, laboratory testing, radiologic imaging, and
histologic examination are essential to diagnosing WG and excluding potential
mimics. Previously a uniformly fatal disease, treatment with cytotoxic and
immunosuppressive agents has greatly improved survival. Treatment-related
morbidity is a serious limitation of conventional therapies, leading to numerous
ongoing studies of alternative agents. Copyright (c) 2010 Elsevier Inc. All
rights reserved.

PMID: 20638092  [PubMed - as supplied by publisher]

3: Surv Ophthalmol. 2010 Jul 15; [Epub ahead of print] 

Posture-induced Intraocular Pressure Changes: Considerations Regarding Body
Position in Glaucoma Patients.

Prata TS, De Moraes CG, Kanadani FN, Ritch R, Paranhos A Jr.

Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil;
Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New
York, USA.

Although glaucoma is a multifactorial disease, elevated intraocular pressure
(IOP) remains the most important known risk factor. Different systemic and local
factors are thought to influence an individual's IOP. There can be a clinically
significant rise in IOP when going from upright to horizontal or inverted body
positions. Although there is a significant interindividual variability, the
magnitude of the IOP change is greater in glaucomatous eyes. As patients usually
spend a significant portion of their lives in the horizontal position, mainly
during sleep, this is highly relevant. In this review we discuss the
relationship between postural changes and IOP fluctuation, including changes in
both body and head position. The possible mechanisms involved and the main
implications for glaucomatous eyes are discussed. Finally, considerations with
regard to sleep position in glaucoma patients are made based on evidence in the
literature. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20637484  [PubMed - as supplied by publisher]

4: Surv Ophthalmol. 2010 Jul 10; [Epub ahead of print] 

Tilted Optic Disks.

Witmer MT, Margo CE, Drucker M.

Department of Ophthalmology, University of South Florida, College of Medicine,
Tampa, Florida, USA.

Tilted optic disks are a common finding in the general population. An expression
of anomalous human development, the tilted disk appears rotated and tilted along
its axes. Visual sequelae described with tilted optic disks include myopia,
astigmatism, visual field loss, deficient color vision, and retinal
abnormalities. Although the natural course of tilted optic disks is
nonprogressive, the anomaly can be mistaken for tumors of the anterior visual
pathway, edema of the optic nerve head, or glaucoma. A thorough examination of
patients with tilted disk includes refraction, dilated fundus examination, and
visual field testing. At times, neuroimaging may be necessary to arrive at the
correct diagnosis. Until normative data are validated for tilted disks, the role
of new imaging technologies for the optic nerve head is limited. Familiarity
with the spectrum of ophthalmoscopic appearance and the clinical manifestations
of tilted disks may be the most critical factors in avoiding misdiagnosis.
Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20621322  [PubMed - as supplied by publisher]

5: Surv Ophthalmol. 2010 Jun 29; [Epub ahead of print] 

Origins of the Keratometer and its Evolving Role in Ophthalmology.

Gutmark R, Guyton DL.

The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

The keratometer, or ophthalmometer as it was originally known, had its origins
in the attempt to discover the seat of accommodation in the eye. Since that
early beginning, it has been re-invented a number of times, with improvements
and modifications made in the original principles of its design for new
applications that arose as ophthalmology advanced. The cornea is not only
responsible for the majority of the refraction in the eye, but is also readily
accessible for measurement and modification. The keratometer's ability to
measure the cornea has allowed it to play a central role in critical advances in
ophthalmic history. This review describes the origins and principles of this
instrument, the novel applications that led to the keratometer's continued
resurgences over its nearly 250-year history, and the modern devices that have
borrowed its basic principles and are beginning to replace it in common clinical
practice. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20591458  [PubMed - as supplied by publisher]