vol. 11 núm. 2 (2013)

<em><strong>Objective</strong><em> to determine the reference values of visual acuity, refractive status, corneal curvature, stereopsis and color vision in children between the ages of three and seven in the locality of Chapinero in Bogota. <em><strong>Materials and methods</strong><em> cross-sectional descriptive observational study. The population under study consisted of schoolchildren between the ages of three and seven (200 children). Measurements included visual acuity (VA) with the Lea Symbols and HOTV tests, cycloplegic refraction, keratometry with Nidek KM-500 autokeratometer, color vision with Color Vision Testing Made Easy and stereopsis with Randot test. <em><strong>Results</strong><em> The median visual acuity in all age groups was 0.00 (20/20). One hundred percent of the children had hypermetropia (spherical equivalent for astigmats of up to 1.00 Dpt). The medium refractive error was + 0.75 in the groups of three and four-years-old, +0.50 in the groups of five and six-year-old children and +0.62 in the group of seven-year-old children. The median corneal curvature in the horizontal meridian was 42.62 and 41.50 for the vertical meridian of three and four years, 42.75 horizontal meridian and 43.75 the vertical of five and six years, and 41.50 and 42.50 at seven-years-old. All had normal color vision. The median stereopsis was twenty-five arc seconds for three and four-year-old children, twenty arc seconds for five and six-year-old children and twenty-five for the group of seven-year-old children.

A clinical case is reported of a patient attending consultation with an optical prescription of myopic astigmatism in both eyes. The optometric examination does not reveal any significant variation in the existing optical correction. Three years later, the patient has a decreased visual acuity, a slight increase in corneal curvature and in the diopter value of the sphere and cylinder in both eyes, as well as variation in one axis (15 degrees). Previous findings justified requesting supplementary tests that could explain the modifications found in visual and ocular conditions in the period between the two controls. Complementary clinical testing (Pentacam) made it possible to determine the presence of a subclinical keratoconus.

The mucocele is a cystic pseudotumor that is caused by accumulation of mucus secretion and epithelial desquamation of paranasal sinuses. The most common risk factors in the mucoceles are chronic infection and sinus allergy. Previous surgeries and trauma are less common. Other possible causes may be associated with chronic stimulation of inhaled irritants, viral infection, overdose or gene interaction of the reticuloendothelial system. There is a case of a patient whose final diagnosis was mucocele, which compresses the eyeball and causes paralysis of the upper branch of the third eye nerve due to compression, and which yields after removing the frontal benign tumor with supraorbital commitment.

<em><strong>Objective</strong><em> to identify the ophthalmic use of monoclonal antibodies in hypertensive retinopathy and their effect on visual acuity (VA), vascular angiogenesis and changes in the ocular fundus of hypertensive patients. <em><strong>Materials and methods</strong><em> Literature was reviewed in the Pubmed, Medline, Embasi, Lilacs, The Cochrane Controlled Trials Register, Hinari, Micromedex and Science Direct databases, through the MESH terms <em>monoclonal antibody and hypertensive retinopathy</em>, <em>bevacizumab hypertensive retinopathy, monoclonal antibody therapy hypertensive retinopathy and pegaptanib and hypertensive retinopathy</em>, limited to years 2000 to 2012. Two thousand three hundred and forty-five (2345) studies were found related to the topic, among which those written in English, French, Portuguese and Spanish were selected, as well as those associated with efficacy in the treatment of hypertensive retinopathy and angiogenic changes in diabetic retinopathy. The quality of the scientific evidence was classified through the Oxford methodology. A descriptive analysis of the study variables related to tissue responses was conducted. Monoclonal antibodies are involved in the control of VEGF, which decrease the risk of retinal hemorrhages, reducing retinal thickness. Antibodies such as bevacizumab show 95% effectiveness for improvement in VA (ETDRS 3 Lines D.E. 2.15) while ranibizumab and pegaptanib have 86% in VA improvement (<em>p</em> <0.05). Triamcinolone shows improvement in vascular leakage and macular edema in hypertensive retinopathy associated with diabetes, without any significant differences between groups (<em>p</em>=0.03).

<em><strong>Objective</strong><em> to evaluate the degree of compliance with clinical guidelines on refractive errors by optometrists in optometry outpatient consultation during the first half of 2012. <em><strong>Materials and methods</strong><em> A retrospective descriptive study was conducted using dichotomous questions (meets or does not meet). The population universe was made up of 4180 medical records. As a representative sample, 648 of those medical records were calculated; this number was divided by methodological decision into the three venues that make up the Health Providing Institution (IPS, for its initials in Spanish) under study. The ranges by which adherence was evaluated were: from 0 to 20% of questions answered correctly it was considered that adherence was “very poor”; from 21 to 40%, “poor”; from 41 to 60%, “ordinary”; from 61 to 80%, “good”, and from 81 to 100%, “excellent”. <em><strong>Results</strong><em> It was evidenced that in no case 20% or less of the total number of questions was filled out per medical record, while 3.9% of all the records placed in the “poor” rank. 21.2% of the total number of records placed in the “ordinary” rank. The highest assessment values were obtained by ranks “good” and “excellent”, with a total of 35.4 and 39.5 %, respectively. <em><strong>Conclusions</strong><em> The research showed poor adherence to the care guidelines, since none of the records were filled out in all fields.

The purpose of this review paper is to provide information about an aspect that is rarely taken into account (mainly due to the lack of documented material, either written or published) at the time of issuing a prescription for someone requiring optical aid. The contribution of an ophthalmic lens to the safety and health of the patient, regardless of the material it is manufactured with, was analyzed from different points of view. The impact resistance of an optical system depends on many aspects, including: lens thickness, the refractive index of the material, the base curve used for its manufacture and the application or not of optical treatments, such as anti-scratch, anti-glare and photosensitive. All analyzes of this issue are performed on studies based on indications given by institutions such as the ANSI (United States), OLA (United States), CSA (Canada) and AS/NZS (Australia), to apply tests that measure lens resistance, such as the Drop Ball Test, as well as speed and high impact ballistic tests. It can be concluded that polycarbonate is the most durable material and that center thickness is directly related to the strength of the lens. Furthermore, the flatter the base curvature is, the greater the fragility of the material, and the antiglare treatment directly affects the decrease in impact resistance, unlike photosensitive treatments, which do not alter this property.

Low vision is currently a public health problem. It is worrying that the adult population has the highest levels of low vision impairment in the world. It is unknown how this reality affects Costa Rica, socially and productively, as there are no references in this regard; therefore, it is essential to conduct a specific analysis for our region. <em><strong>Objective</strong><em> to determine the prevalence of low vision in older adults in the District of San Isidro from El General, Pérez Zeledón, Costa Rica. <em><strong>Materials and methods:</strong><em> cross-sectional study. 186 seniors were weighed up through random sampling. A visit was made to each of their homes, and their visual acuity was assessed. Those who showed abnormal results were referred to an optometric practice in order to evaluate their low vision with specialized equipment. <em><strong>Results:</strong><em> A total of eight patients (4.3%) with low vision were diagnosed. The cause in four of them was cataract. <em><strong>Conclusion:</strong><em> Although the prevalence of low vision found in older adults was lower than expected, there is a possibility that medical care is not the best, as their health care needs are not covered and chronic diseases are predominant among them. The lack of information about low vision contextualized for Costa Rica was also confirmed, as well as the importance of developing more epidemiological and clinical research on this topic.

Since the enactment of Act 372 of 1997, optometrists are enabled for the diagnosis and treatment of pathologies of the anterior segment of the eye. This must be supported by clinical care guidelines (clinical practice guidelines). It is unknown how optometrists diagnose and treat diseases of their competence and the clinical care guidelines. <em><strong>Objective</strong><em> to determine the percentage of optometrists who have clinical care guidelines, using control of allergic conjunctivitis as reference. <em><strong>Materials and methods:</strong><em> information about the frequency of use of clinical care guidelines, age of the professionals, geographic area of practice and work profile was obtained by means of an anonymous questionnaire. A univariate and bivariate analysis of the data was performed to explore the possible relationship between variables. <em><strong>Results:</strong><em> 180 optometrists were surveyed, 58.3% of whom do not use any guidance for handling allergic conjunctivitis. Those who do (<em>n</em>=35) use the protocols used by the healthcare institutions (IPS, for its initials in Spanish) where they work. <em>Conclusions and recommendations<em> Less than half of the optometrists (41.7%) have a clinical practice guideline (GPC, for its initials in Spanish) for controlling allergic conjunctivitis, and its use is not widespread among these professionals. It is necessary to constitute an entity that creates, compiles, adapts and distributes GPC of interest to optometry, seeking a better professional performance and to benefit patients.

<em><strong>Objective</strong><em> to identify the factors associated to each symptom of the computer vision syndrome (CVS) and analyze their main causes. <em><strong>Methods</strong><em> integrative literature review in the SciELO, Lilacs and Pubmed platforms of the past thirty years. <em><strong>Results</strong><em> 32 articles that met the inclusion criteria were selected, in which the CVS categorization was found in different types of symptoms, each associated with different visual or ocular diagnoses, including accommodative and vergence alterations, or ocular surface alterations, such as dry eye. The terminology used to name the symptoms and the assessment of visual and ocular alterations is varied and makes it difficult to perform a proper analysis of diagnoses and symptoms associated with CVS. <em><strong>Conclusions</strong><em> Visual symptoms of CVS indicate problems of binocular vision and accommodation, caused by high demands of near vision. Dry eye is the main symptom of the ocular category of CVS, but is not always present. In some cases the simple dryness of the eye, caused by extreme environmental factors that increase excessive tear evaporation (air conditioning, fans, high temperatures or low humidity in the workstation), can reproduce ocular symptoms of the syndrome. Poor working habits with the computer, combined with extreme environments at the workstation, threaten the visual and ocular health of computer users.

<em><strong>Objective</strong><em> to determine the prevalence of dysfunctions in saccadic movements, visual perceptual skills and visual-motor integration in emmetropic children between the ages of six and seven from socio-economic levels 1 and 2 in Bogota. This study is part of the macroproject <em><strong>Influence of visual perceptual skills, visual-motor integration and saccadic movements in the reading and writing process</strong></em>. <em><strong>Methodology</strong><em> An observational descriptive study was conducted. Patients between the ages of six and seven were assessed. Clinically emmetropic patients underwent TVPS-3 testing (visual-perceptual skills), Beery VMI (visual motor integration) and DEM (saccadic movements). For statistical analysis, a database in Excel was used to record the results of the test, and correlation tests were used in the SPSS program for the bivariate analysis. <em><strong>Results</strong><em> Results revealed a prevalence of visoperceptual dysfunction by 42.89% (41/91), visual-motor dysfunction by 97.39% (89/91) and saccadic movements dysfunction by 80.14% (73/91) in the group of six-year-old children. They also revealed visoperceptual dysfunction by 36.74% (43/117), visual-motor dysfunction by 100% (117/117) and saccadic movements dysfunction by 61.19% (81/117) in the group of seven-year-old children. <em><strong>Conclusions</strong><em> Children of six and seven years of age have a low prevalence of visoperceptual skill alterations, a high prevalence of dysfunctions in visual-motor integration and a high prevalence of saccadic movement dysfunctions measured by the DEM, where types 3 and 4 are predominant.