Optometry often beats itself up and may be its own worst enemy, yet we are also among the most caring and giving of all healthcare professions.

Our caring nature is a thread that binds and defines us throughout the world. A graduate from Berkeley and the grad from the very first optometry school in Bangkok, Thailand, share a desire to make people's lives better and healthier.

This is perhaps the greatest quality our profession possess: our ability to put personal issues and internal squabbles aside to focus on our patients' needs.

Looking back, a desire to make a difference in people's lives has defined my own career. The early realization that I could serve as a conduit of information and knowledge to improve the lives of patients not just in my chair, but in many chairs, has led me to author hundreds of articles and lecture and teach in nearly every state in the U.S. and dozens of countries. So when asked to work with Optometry Giving Sight, an organization dedicated to eradicating blindness, often due to uncorrected refractive error, throughout the world, I was honored to serve.

Conceived of and created by optometric visionary and philanthropist Brien Holden, OGS offers each of us the ability to help people and make our world a better place, reaching well beyond our own practices and the people whose lives we can directly touch. It is giving in the most optometric of ways.

This October, World Sight Day Challenge involves many hundreds of practices and industry partners throughout the world in promoting what for most of us is our life's work. By donating exam fees on one day or participating in a variety of other ways, you can make a difference well beyond your own normal reach.

I make it a rule not to impose my beliefs or biases on others, but this once, I hope you will find it in yourself to make the world better through your generosity.

Arthur B. Epstein, OD, FAAO Chief Medical Editor [email protected]

 

 

The objective of this study is to report ocular and orbital findings in a series of six patients (8 eyes) with gunshot wounds and to review the literature on the pathophysiology, management and outcome of such patients. Main outcome measures of this retrospective case series and review of the literature were ocular and orbital injury, surgical intervention and presenting and final visual acuity.

Six male patients (mean age, 32 years) were enrolled. Three patients with globe concussion and low presenting visual acuity were treated by observation. Two patients (25%) underwent primary enucleation or evisceration. Retinal detachment developed in one patient who had a globe perforation, and he underwent vitrectomy and lensectomy with silicone oil injection. Visual acuity remained unchanged in all but one patient who underwent retinal detachment surgery. Final visual acuity was poor in all patients, with five eyes ending in no perception of light. Four patients had orbital fractures, two of whom underwent orbital reconstruction. One of these patients also underwent drainage of orbital abscess, eyelid surgery, and a dacryocystorhinostomy. The mean follow-up time was 26 months.

Gunshot wounds to the eye and orbit cause severe open and closed ocular injuries with guarded outcome and poor visual acuity. When feasible, initial wound closure may preserve the globe and allow further surgical rehabilitation. Primary evisceration may be required in cases of a severely ruptured globe. Orbital surgery may be needed in cases of infection, orbital wall disruption with disfigurement, or late enophthalmos.

A total of 350 adult subjects without ocular disease were examined to evaluate the effects of age and race on optic disc, retinal nerve fiber layer and macular measurements with spectral-domain optical coherence tomography (SD-OCT). Data from SD-OCT imaging of the optic nerve head, peripapillary retinal nerve fiber layer (RNFL) and macula of 632 eyes from 350 subjects without ocular disease were imaged with SD-OCT. Multivariate models were used to determine the effect of age and race on quantitative measurements of optic disc, RNFL and macula.

For optic nerve parameters, participants of European descent had significantly smaller optic disc area than other groups, and Indian participants had significantly smaller rim area than other groups. Indian and Hispanic participants had thicker global RNFL measurements than other groups. Participants of African descent were associated with thinner inner retinal thickness in the macula. Age was associated with several parameters, with rim area reducing by 0.005 mm²/year, RNFL thickness reducing by 0.18 µm/year, and inner retinal thickness by 0.1 µm/year.

Optic nerve, RNFL and macular measurements with SD OCT all varied across racial groups and with age. These differences are important in defining the range of normal variation in differing populations and should be considered in the use of these instruments in the detection of optic nerve and macular disease across these population groups.

The cognitive and physical stigmata of mosaic Down Syndrome (DS) are often considered to be less severe than complete trisomy-21 DS. In contrast to complete trisomy-21 DS, the ophthalmic manifestations in mosaic DS have rarely been reported. The aim of this study is to report clinically significant ophthalmic abnormalities in a cohort of individuals with mosaic DS. A prospective cross-sectional observational case series was designed to evaluate ophthalmic manifestations of mosaic DS. Individuals with mosaic DS were recruited and examined at the biennial meeting of the International Mosaic Down Syndrome Association. A medical, surgical and ocular history was obtained. Each subject received a complete eye examination on site, including assessment of visual acuity, alignment, motility, sensory function, accommodation, anterior segment, fundus and cycloplegic refraction.

Seventeen individuals with mosaic DS (mean age, 9 years; range, 6 months to 32 years) underwent eye examinations. Clinically significant refractive errors were present in 41% of the subjects, accommodative insufficiency in 59%, strabismus in 35%, nystagmus in 6%, and cataract in 6%. Ten individuals completed optotype visual acuity testing. Mean LogMAR acuity of the better eye of each subject was 0.2 (20/32 equivalent).

Clinically significant ophthalmic disorders are common among children and young adults with mosaic DS. Our findings support regular periodic eye examinations for these individuals.