vision

Importance Age-related cataract, defined as progressive opacification or clouding of the eye’s natural lens, is a leading cause of visual disability and blindness. Cataract surgery is one of the most commonly performed procedures in high-income countries. More than 3.5 million cataract operations are performed annually in the US.

Observations Older age is the primary risk factor for cataracts, with approximately two-thirds of the population older than 80 years affected. As the population ages, the number of people with cataracts in the US is expected to increase to 50 million by 2050. Additional risk factors for cataracts include a hereditary or genetic predisposition, certain medications (corticosteroids), ocular trauma, significant UV exposure or radiation therapy, and certain medical conditions such as uncontrolled diabetes, retinitis pigmentosa, Down syndrome, and congenital rubella. Painless, progressive blurring of vision and visual glare are common symptoms of cataracts. Cataracts are diagnosed during an eye examination by an ophthalmologist or optometrist. Surgery to remove the cataract and implant a permanent intraocular lens (IOL) is indicated if visual impairment impedes activities of daily living and is associated with lower rates of falls (>30%) and dementia (20%-30%). Most cataract operations are performed with topical anesthesia. Therefore, patients do not require preoperative general medical testing such as bloodwork or electrocardiogram, and do not need to discontinue anticoagulants for cataract surgery. Systemic α1-adrenergic antagonists for symptomatic benign prostatic hyperplasia, such as tamsulosin, increase the risk of surgical complications and some ophthalmologists temporarily discontinue the drug preoperatively. Intraocular antibiotics, such as moxifloxacin or cefuroxime, delivered intraoperatively have reduced the rates of sight-threatening postsurgical endophthalmitis from 0.07% to 0.02%. In addition to reversing and preventing progressive vision loss, cataract surgery can reduce dependence on eyeglasses. These optional refractive benefits are achieved with advanced technology IOL designs, such as multifocal IOLs. However, multifocal and other advanced technology refractive IOLs are associated with increased costs that are not covered by medical insurance.

Conclusions and Relevance Cataracts are common among older adults and may cause visual disability and blindness without treatment. Cataract surgery reverses and prevents progressive vision loss, and advanced technology lens implants facilitate reduced dependence on eyeglasses.

Author/s:

Stephanie P Chen, Fasika Woreta, David F Chang

Characteristics of Concussion in Elementary School-Aged Children: Implications for Clinical Management

Brian Desmarais — Fri, 05 Jun 2020 18:53:50 +0000

Date Added:

June 5, 2020

Journal/Publication:

The Journal of Pediatrics

Publication Date:

June 4, 2020

URL:

Characteristics of Concussion in Elementary School-Aged Children: Implications for Clinical Management

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.jpeds.2020.04.001

Keywords

concussion

vision

vestibular

traumatic brain injury

school-aged

MeSH

brain concussion

This article provides information on the typical presentation and course of concussion in elementary school-age children and focuses on the elements of the visuo-vestibular exam recommended for evaluation of these children. James W. Mold, MD, MPH

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Objective

To comprehensively characterize the clinical presentation and course of care for concussion among 5- to 11-year-old children, identifying preinjury and injury factors potentially influencing clinical outcomes.

Study design

A single-institution retrospective cohort study using electronic health record data from children ages 5- to 11 years with a concussion from July 1, 2014, through June 30, 2015. Electronic health record data were abstracted for a 20% random sample of 292 patients.

Results

Three-fourths of patients (74.3%) presenting for concussion care had a standardized visiovestibular assessment performed. Almost all of those who eventually sought specialty care (92.9%) also had such an assessment, and only 42.9% patients initially seen in the emergency department or urgent care were examined in this manner. Of those assessed, 62.7% (n = 136) demonstrated deficits, with children ages 9-11 years more frequently exhibiting deficits than their younger counterparts (67.9% vs 53.2%; P = .03). Almost all patients (95.9%) reported at least 1 somatic symptom (eg, headache, dizziness), and one-half to two-thirds reported problems with sleep (54.1%) and visiovestibular symptoms (66.1%). Only 11.6% of children were referred for rehabilitation therapies and less than one-half of concussed patients (43.8%) were provided with a letter recommending school accommodations.

Conclusions

Somatic symptoms, sleep problems, and visiovestibular deficits are common in elementary school-aged children with concussion, but specific visiovestibular clinical assessments are often not performed, particularly in the emergency department setting. Recommendations for school accommodations are often not provided at the time of concussion diagnosis. Incorporating a standardized visiovestibular assessment into practice could facilitate early targeted school accommodations and thereby improve return to learning for elementary school-aged children with concussion.

Author/s:

Master, C.L., Curry, A.E., Pfeiffer, M.R., Metzger, K.B., Kessler, R.S., Haarbauer-Krupa, J., DePadilla, L., Greenspan, A., Breiding, M.J., Arbogast, K.B.

Assessing and Counseling the Older Driver: A Concise Review for the Generalist Clinician

John Bayhi — Fri, 02 Aug 2019 18:51:18 +0000

Date Added:

August 9, 2019

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Mayo Foundation for Medical Education and Research

Publication Date:

August 1, 2019

Issue:

Volume:

Pages:

1582–1588

URL:

Assessing and Counseling the Older Driver: A Concise Review for the Generalist Clinician

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2019.03.023

Keywords

MeSH

referral and consultation

A concise review of issues and counseling strategies relevant to older drivers. James W. Mold, MD, MPH

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Older drivers are putting more miles on the road during their “golden years” than generations prior. Many older adults have safe driving habits, but unique age-related changes increase the risk for crash-related morbidity and mortality. Generalists are poised to assess and guide older adults' driving fitness. Although there is no uniformly accepted tool for driving fitness, assessment of 5 key domains (cognition, vision, physical function, medical comorbidities, and medications) using valid tools can help clinicians stratify older drivers into low, intermediate, and high risk for unsafe driving. Clinicians can then make recommendations about fitness to drive and appropriate referrals for rehabilitation or alternative transportation resources to optimize mobility, independence, and quality of life for older adults.

Author/s:

Hill, Larisa J.N., Pignolo, Robert J., Tung, Ericka E.