Faculty Bibliography

A 54-year-old African-American woman developed a pigmented papillary squamous cell carcinoma in the palpebral and bulbar conjunctiva of the right eye in areas that received no sun exposure. In situ hybridization performed on the tumor showed human papilloma virus 16. The left eye showed a pedunculated nonpigmented conjunctival dysplasia. The tumors were extirpated by cryosurgery and topical interferon alfa 2b in the right eye and simple surgical excision in the left eye.

PURPOSE: To determine differences in wearing patterns of sunglasses and/or photochromic lenses in spectacle and contact lens wearers, to assess patient awareness of the indications for the use of tinted lenses, and to identify wearers' lens tint preferences. METHODS: A total of 100 individuals wearing some combination of contact lenses and spectacles participated in a survey questionnaire composed of 14 questions. Participants were asked if they used sunglasses/photochromic lenses, why they used them, their preferred lens tints, and temporal and seasonal patterns of use. They were also queried on their awareness of the potential adverse effects of ultraviolet radiation (UVR) exposure on the health of the eye and appropriate protective measures. Participants were categorized based on their use of spectacles and/or contact lenses. Demographic characteristics of sex and age were taken into account for the analysis. The data were imported and analyzed using commercial statistical analysis software. RESULTS: A total of 52% of the participants wore spectacles exclusively, while 48% wore some combination of spectacles and contact lenses. In the spectacle group, 36% and 20% wore sunglasses and photochromic lenses, respectively. In the contact lens group, 20% and 10% wore sunglasses and photochromic lenses, respectively. Overall gray was the preferred lens tint, especially in the younger age groups. Summer was the primary season for use of tinted lenses. Approximately one-third of the sample were not aware of the UVR protective properties of their eyewear. A total of 77% believed that UVR could be harmful to the eyes, but only a small percentage of the participants wore sunglasses or photochromic lenses specifically for UVR protection. CONCLUSION: There was no statistically significant difference (P = 0.07) for preference between sunglasses versus photochromic lenses and in seasonal patterns for tinted lens use among spectacles and contact lens wearers. Spectacle wearers (as well as contact lens wearers) used sunglasses more than photochromic lenses (P = 0.004). Most of the participants wore sunglasses in the summer and to protect their eyes from bright light. Overall gray was the preferred lens tint. Potentially adverse effects of UVR exposure to the eye and the importance of proper UVR eye protection were not generally appreciated by the subjects queried

PURPOSE: To describe two siblings with bilateral corneal anesthesia associated with multiple systemic abnormalities. DESIGN: Interventional case report. METHODS: A 38-year-old Hispanic woman was seen for bilateral corneal ulcers, exposure keratitis, hemorrhagic retinopathy, and multiple systemic abnormalities. A younger sibling with similar but milder findings was also examined. Medical and genetic evaluation was investigated in these two siblings with bilateral decreased sensation and multiple abnormalities from a consanguineous union. RESULTS: Examination of the patient showed bilateral corneal anesthesia, and multiple systemic abnormalities included diaphragmatic paralysis, ovarian failure, multiple thrombotic cerebrovascular accidents, pedal edema, mandibular hypoplasia, and developmental delay. Milder findings were seen in a sibling. Corneal ulcers were stabilized after treatment that included bandage contact lens, pressure patching, topical antibiotics, and tarsorrhaphy. CONCLUSIONS: The combination of corneal anesthesia and systemic abnormalities, with parental consanguinity, suggests an inherited syndrome

PURPOSE: This study examined physician hygiene patterns in the eye clinic of a major medical center to assess compliance with recommended practice patterns to avoid nosocomial infection during patient encounters. METHODS: One hundred ophthalmology resident-patient encounters were observed anonymously by the authors. Examining physicians were evaluated in handwashing between patients, cleaning and disinfecting of tonometer tips after each use, and recapping of diagnostic drop bottles after each use. RESULTS: Physicians washed their hands 74% of the time between patient encounters. The surfaces of tonometer tips were disinfected with an alcohol pad 100% of the time. Diagnostic drop bottles were recapped 57% of the time after each use. CONCLUSIONS: There is ample clinical evidence in the ophthalmic literature that practitioners' hands and tonometer tips can be vectors for transmission of nosocomial infection and that vigorous handwashing and disinfection of instruments can decrease the rates of transmission. Sometimes, however, physicians neglect to follow these simple and effective steps. We suggest posting visual educational materials in examination rooms as a reminder to ophthalmology residents and clinic personnel to adhere to these precautions, benefiting doctors and patients

PURPOSE: A body of clinical and laboratory evidence suggests that tinted spectacle lenses may have an effect on visual performance. The aim of this study was to quantify the effects of spectacle lens tint on the visual performance of 25 subjects with cataracts. METHODS: Cataracts were scored based on best-corrected acuity and by comparison with the Lens Opacity Classification System (LOCS III) plates. Visual performance was assessed by measuring contrast sensitivity with and without glare (Morphonome software version 4.0). The effect of gray, brown, yellow, green and purple tinting was evaluated. RESULTS: All subjects demonstrated an increase in contrast thresholds under glare conditions regardless of lens tint. However, brown and yellow lens tints resulted in the least amount of contrast threshold increase. Gray lens tint resulted in the largest contrast threshold increase. CONCLUSIONS: Individuals with lenticular changes may benefit from brown or yellow spectacle lenses under glare conditions

PURPOSE: A two-period, crossover study was undertaken comparing next-generation gray photochromic Transitions Lenses (Transitions Optical, Inc., Pinellas Park, FL) with clear lenses and a study purple-colored photochromic lens to evaluate enhancement to vision-related quality of life (VRQOL). METHODS: Fifty-two patients were randomized into one of four lens crossover groups: gray-->clear; clear-->gray; gray-->purple; and purple-->gray. Each lens was worn for 30 days. VRQOL was measured using a previously administered questionnaire, the Transitions Vision Related Quality of Life' (TVRQOL) survey instrument (see Appendix to this article). Differences in responses related to each lens worn in the comparison were recorded. RESULTS: Overall, next-generation gray Transitions Lenses were associated with the greatest improvement in VRQOL compared to clear or purple lenses. The gray lens proved statistically superior to the clear lens, across four of the five subscales. When given the choice of which lens they would like to continue to wear, 85% (23 of 27) of the patients preferred the gray lens. No statistically significant difference was observed between the gray lens and the study purple lens. CONCLUSIONS: Next-generation gray Transitions Lenses offer patients significant and clinically meaningful improvements in VRQOL, and are superior to clear lenses. A patient's overall visual experience is best served by proper product selection to provide optimal visual acuity and VRQOL performance

PURPOSE: To evaluate quantitatively the effects of tinted spectacle lenses on visual performance in individuals without visual pathology. METHODS: Twenty-five subjects were assessed by measuring contrast sensitivity with and without glare. Gray, brown, yellow, green, purple, and blue lens tints were evaluated. Measurements were repeated with each lens tint and with a clear lens, and the order was counterbalanced within and between subjects. Glare was induced with a modified brightness acuity tester. RESULTS: All subjects demonstrated an increase in contrast thresholds under glare conditions for all lens tints. However, purple and blue lens tints resulted in the least amount of contrast threshold increase; the yellow lens tint resulted in the largest contrast threshold increase. CONCLUSIONS: Purple and blue lens tints may improve contrast sensitivity in control subjects under glare conditions

PURPOSE: To determine the correlation between the aesthetics of lens tints preferred for cosmesis and lens tints preferred for viewing. METHODS: Thirty-five subjects (mean age: 25; 49% male, 51% female) with no significant ocular pathology participated in the study. Median visual acuity was 20/20. Color vision testing was performed on each subject using Ishihara plates, and those with abnormal scores were excluded from the study. Subjects were shown nine pre-selected tinted lenses (50% transmittance) of variable wavelengths. These lenses were mounted on two separate color backgrounds, one white and the other approximating their skin tone. Subjects were asked to choose from each background which tinted lens they would most prefer to wear and which lens they would least prefer to wear. The subjects were then shown a series of eight pictures (four nature photographs and four paintings) with different dominant wavelengths. Subjects were asked to grade the aesthetic effect of a clear lens and each of the nine tinted lenses on the appearance of the pictures. Chromaticity coordinates were calculated for each lens and picture. RESULTS: The blue lens was the most frequently chosen preferred lens to wear, followed by green, purple, and gray. The least preferred lenses were yellow, brown, and pink. For viewing the nature photographs, the clear lens was preferred over any of the tinted lenses. For viewing the paintings, the purple lens was most preferred. The yellow lens was least preferred for both photographs and paintings. CONCLUSIONS: Younger individuals with no significant ocular pathology preferred viewing both nature photographs and paintings through tinted lenses that did not, or only slightly, altered the chromaticity of the image. Whereas a clear lens was favored over the tinted lenses for viewing the photographs, some tinted lenses (purple and pink) were preferred for viewing paintings. There was no correlation between the most favored lens tint chosen based purely on cosmesis and the most favored lens tint based on viewing preference. However, the least preferred lens tint for cosmesis and viewing was yellow