vol. 11 núm. 1 (2013)

<em><strong>Objective:</strong></em> To find a link between the symptoms and signs found when assessing lacrimal function and ocular surface with dry-eye diagnostic tests in a group of apparently healthy Colombian and Spanish subjects. Method: A total of one hundred healthy subjects (fifty Colombians and fifty Spaniards) without previous history of contact lenses were recruited and evaluated. The subjects answered a McMonnies dry-eye questionnaire and were subjected to the Non-Invasive Break-Up Time (NIBUT), Tear Film Breakup Time (TFBUT), fluorescein staining, lissamine staining and impression cytology (IC) tests. For the statistical analysis, the Pearson correlation and multiple statistical tests were used. <em><strong>Results:</strong></em> The McMonnies questionnaire did not corroborate individual findings, even though the signs and tests determined dry-eye. Significant differences between the two population groups were found (p = 0.016). No correlation was found between McMonnies and the NIBUT, TFBUT, fluorescein and lissamine green staining and IC tests. <em><strong>Conclusion:</strong></em> The McMonnies questionnaire, by itself, is not a useful test in the diagnosis of ocular surface Disease.

The contact lens system known as piggyback consists of a combination of a rigid, gas permeable lens superimposed on a soft lens. This combination aims to reduce the discomfort caused by using rigid lenses, especially in patients with corneal ectasia and irregularities, for whom it is a fact that the adaptation of a rigid lens is ideal and will provide the best possible optical image, even better than soft contact lenses, but in most cases the discomforts, particularly when blinking, hinder the process of adaptation in these patients. The Piggyback system is of great importance in the field of contactology, because it is through such system that it is possible to develop the designs and possibilities of correcting irregular astigmatisms and the different types of corneal ectasia in a more comfortable way, providing excellent vision and allowing the patient to see well, feel good and look good, without needing to think about future surgeries. Therefore, this bibliographic review aims to inform visual and ocular health professionals about this adaptation technique, its applications, the determining factors for their adaptation, the advantages and disadvantages of this lens system and, finally, recent developments to improve this technique.

<em><strong>Objective:</strong></em> To determine the clinical applications of the computed axial tomography (CAT) and the magnetic resonance imaging (MRI) in the diagnosis and management of some frequent orbit and optical path pathologies. Materials and <em><strong>Methods:</strong></em> A bibliometric review was conducted by using search strategies in the Pubmed and Medline databases, among others. Results and Discussion: With this review, the preferred exam for some authors between 2009 and 2012 for frequent orbital and optical path pathologies was identified. However, during the search process, it became evident that some of them showed similar frequencies during a determined period, while others showed significant changes in the test of choice through the years, which would make it possible to ensure that both techniques are complementary for the diagnosis, the treatment and the follow-up of the pathology. Nevertheless, it is necessary to recognize the clinical manifestations, because they would have a predictive value when choosing the diagnostic exam; it is likewise important to highlight the benefit of early detection of mortal pathologies, which has favored research in preventive medicine, given that imaging is crucial in the assessment of the extension of ocular disease, retrobulbar extension and intracranial metastasis in certain cases.

The incidence of liberal theory, its ideological application to property and individual liberty, generates a transversal effect on the life quality and health of the Colombian population, which configures the context in which social justice in health and its approach from the principle of equality of opportunities would be determined by the dynamics of the social protection system reforms and work relations and labor flexibilization. This work is a reflection on these issues, made from a systematic review of the literature published in indexed journals, with assessment of the quality of the evidence, and of literature not published in journals. Health is considered as a constituent part of development, which is why categories such as the employment contract with disadvantages have led to a greater social exclusion and vulnerability in health and, therefore, to a high concentration of wealth and power, which increases the bad health of the population. Making visible the effects of distribution and relationship between these primary goods contributes to the generation of human capital for further development and welfare, and this improves the panorama of justice and equity in health.

This article resulted from the work carried out at the Jorge Tadeo Lozano University during 2012 to obtain the title of specialist in Management and Quality Audit in Healthcare. It is based on the regulations established in Decree 1011 of 2006, according to which the standards of the Mandatory System of Quality Guarantee in Healthcare (SOGCS, for its initials in Spanish) were created. <em><strong>Objective:</strong></em> To find out the degree of knowledge of the health staff working at the San Rafael Hospital in Leticia, Amazonas, about this decree. Materials and <em><strong>Methods:</strong></em> A descriptive and evaluative methodology was applied, which made it possible to establish, in a detailed manner, whether or not the staff working at the hospital was aware of this regulation. The staff, composed by a total of 75 people from the different healthcare areas, was interviewed in its entirety. An acceptable level was found in more than half of the population. <em><strong>Results:</strong></em> A huge degree of unfamiliarity with Decree 1011 of 2006 was found. Lack of interest in the topic and lack of training offered by the institution were found to be relevant weaknesses. <em><strong>Conclusion:</strong></em> According to the results obtained from the interviews, it is deduced that healthcare services are currently not being offered while taking the current regulation into consideration.

<em><strong>Objective:</strong></em> To carry out a “dynamic” optometric assessment of special education children. A dynamic assessment is the one that requires the optometrist to adapt the tests to suit the child instead of the child adapting to the tests. Materials and <em><strong>Methods:</strong></em> A non-standardized interview was conducted, similar to the medical records, which recommends the tests for assessing a special education patient, including cranial nerves. Dynamic visual acuity and colorimetry (color vision test) tests were developed and four male patients from 1.9 to seven years old of age were assessed, who attend psychological counseling at the Clínica Universitaria de Salud Integral from the Iztacala School of Higher Education, UNAM (these patients had never been subjected to an optometric assessment before). <em><strong>Results:</strong></em> There was more cooperation from the children (patients with language issues, attention deficit disorder, hyperactivity and Down syndrome) and a comprehensive optometric diagnosis as a result of the optometrist’s dynamic implementation of the tests. Conclusions: Dynamic optometric evaluation affects the cooperation of special education patients in a positive way, combined with a good refractive, pathological and neurological diagnosis. The need to raise awareness in the optometrist that all patients are different and, therefore, that attention will also vary depending on the patient, is emphasized. These professionals must have the proper clinical and methodological skills required to provide a good service.

Ametropia is quantified through refraction techniques. <em><strong>Objective:</strong></em> To determine the reliability of the Merchán monocular dynamic retinoscopy (MDR) in the measurement of refractive errors. <em><strong>Methods:</strong></em> In a descriptive study of concordance, 110 individuals (220 eyes) between the ages of eighteen and thirty were assessed with the MDR, static retinoscopy (SR), Jackson crossed cylinder (JCC) and the net of the MDR obtained by compensating the LAG of Nott’s retinoscopy (MDRc), with independent measurement by two evaluators in two different sessions. In the statistical analysis of refractions, the Fourier Transform notation was used. <em><strong>Results:</strong></em> The reproducibility found through the interclass correlation coefficient (ICC = 0.68) and the limits of agreement (± 1.02) was moderated with the MDR; concordance with SR (ICC = 0.63; LoA 95 % = ± 0.99) and the JCC (ICC = 0.44, LoA 95 % = ± 0.95) was moderated and poor, respectively. Between the MDRc with SR and the JCC the agreement was even poorer (SR, ICC = 0.275, LoA = ± 1.03; JCC, ICC = 0.190, LoA = ± 1.03). Conclusions: The MDR is a test with moderate reliability for quantifying ametropia in people and is not interchangeable with other refractive techniques.

<em><strong>Objective:</strong></em> To determine the changes in the refractive state in three to four month old premature babies, corrected within a period of six months, who participated in the program from the Madre Canguro Foundation at the San Ignacio University Hospital in Bogota. Materials and <em><strong>Methods:</strong></em> Descriptive observational study in which the change of the refractive state under mydriacylen was evaluated in 96 patients (192 eyes) during a period of six months, and its association to other factors such as weight, age and gender, analyzing quantitative variables, describing average and standard deviation, median deviation with interquartile range and maximum and minimum values for each case and their correlation, as well as qualitative variables with absolute and relative frequencies. <em><strong>Results:</strong></em> The most frequent refractive errors are found in the category of +3.00 to +3.75 spheres and of cylinders of –1.00 to –1.75 to zero degrees. There is no relation between weight and corrected age, as well as between change of weight and the refractive change expressed as spherical equivalent. <em><strong>Conclusion:</strong></em> These results show that the change in the refractive state, especially in the sphere, was of 1.00 Dpt, while the cylinder remained stable. On the other hand, the most frequent defect was hypermetropic astigmatism, which coincides with the process of emmetropization.

<em><strong>Objective:</strong></em> To determine the reference values of amplitude of accommodation through the dynamic objective measurement of the amplitude of accommodation (MODAA, for its initials in Spanish) in pre-presbyopic emmetropic people between the ages of 35 and 40, examined at the Optometry Clinic from La Salle University. <em><strong>Methodology:</strong></em> Fifty emmetropic patients were included, distance and near visual acuity with each eye equal or better than 20/30, normal binocularity. Defects of more than 1.50 Dpt in its sphere or more than 1.00 Dpt in the cylinder were excluded, as well as accommodative and vergence alterations, strabismus, amblyopia, anisometropia (≥ 1.00 Dpt in the sphere or the cylinder), systemic diseases, anterior or posterior segment alterations, ocular history of surgery or trauma. Each patient was subjected to three tests of amplitude of accommodation: MODAA, Donders and Sheard, and the values were compared according to Hofstetter and Duane. <em><strong>Results:</strong></em> The reference value found for MODAA in patients between the ages of 35 and 40 was: 4 Dpt (SD 0.25 Dpt). The subjective techniques (Donders and Sheard) gave higher values than MODAA. The reference values of Hofstetter, Donders and Duane have statistical differences from MODAA. Conclusions: The MODAA method has a range of reference in pre-presbyotic patients between 3.75 and 4.25 Dpt, and this value is not comparable to Donders and Duane’s normality value tables nor with the Hofstetter formulas.

Visual and ocular health professionals are currently faced with the typical cases of primary and secondary corneal ectasia, and even though the most frequent ones are keratoconus, it is not always so. Hence the importance of a good clinical correlation, as well as of the request of special tests in order to help achieve a better diagnosis. It is essential to remember that, in most cases, they are asymmetric binocular processes, so that if one eye presents more advanced symptoms, the opposite eye should also be monitored, because the condition will most likely develop further. The case of a sixteen year old Computer Technology student diagnosed with keratoconus is presented.