Recent Articles

Refraction after intraocular lens exchange.

[This letter was peer-reviewed and published in the official journal of the American Academy of Ophthalmology. The citation is: Leffler C, Pradhan H, Nguyen N. Refraction after intraocular lens exchange. Ophthalmology. 2008;115:754.]
[This letter describes how to determine the appropriate power of intraocular lens when a lens exchange is required.]


Pediatric Ophthalmology in the setting of developmental disability.

Visual impairment in infants and children with developmental disabilities.

If the visual system does not receive clear images from well-aligned eyes during childhood, the ability to develop normal binocular vision is lost permanently. Therefore, proper assessment and treatment of visual disorders in childhood can have a profound influence on life-long visual function. For instance, childhood refractive correction, optical treatment of visual deprivation or suppression (amblyopia), removal of media opacities such as congenital cataracts, and laser treatment to prevent retinal detachments in premature babies are some of the most effective treatments in all of medicine.

The fundamentals of visual assessment and treatment in the developmentally disabled are the same as for all children. Proper assessment of the red reflex, eye alignment, ocular motility, visual acuity, stereopsis, and pupils will result in appropriate ophthalmologic referrals. Timely treatment of retinopathy of prematurity, refractive errors, cataracts, amblyopia, and strabismus can have a lifelong impact on ultimate visual outcome. Numerous developmental disorders affect both the neurologic and visual systems. Therefore, ophthalmologic disorders are more common in the developmentally disabled, and and a baseline assessment by an ophthalmologist is essential. Whenever there is doubt about the proper functioning of the visual system, an ophthalmologic evaluation is warranted.

Strabismus surgery dosage.

Provides mm of recession or resection of extraocular muscles for given magnitude of strabismus (esotropia, exotropia, hypertropia). These are for educational / informational purposes. Bibliography follows the tables. Do not use this web page for clinical purposes. The author makes no assertion about their accuracy, and will not assume any liability.

Posttraumatic Stress Symptoms among U.S. Navy Divers Recovering TWA Flight 800.

Posttraumatic Stress Symptoms among U.S. Navy Divers Recovering TWA Flight 800.  Christopher T. Leffler, MD1 Mark L, Dembert, MC, USN, M.D., M.P.H. 2   Author Information 1 Medical Department, Mobile Diving and Salvage Unit Two, Naval Amphibious Base Little Creek, Norfolk, Virginia. 2 Department of Psychiatry, Naval Medical Center, Portsmouth, Virginia 23708-2197. Send reprint requests to […]

Glucosamine and chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a double-blind, placebo-controlled study.

A 16-week randomized, double-blind, placebo-controlled crossover trial of a combination of glucosamine HCl (1,500 mg/day), chondroitin sulfate (1,200 mg/day), and manganese ascorbate (228 mg/day) in degenerative joint disease (DJD) of the knee or low back was conducted.

Thirty-four males from the U.S. Navy diving and special warfare community with chronic pain and radiographic DJD of the knee or low back were randomized. A summary disease score incorporated results of pain and functional questionnaires, physical examination scores, and running times. Changes were presented as a percentage of the patient’s average score.

Knee osteoarthritis symptoms were relieved as evidenced by the summary disease score (-16.3%; p=0.05), patient assessment of treatment effect (p=0.02), visual analog scale for pain recorded at clinic visits (-26.6%; p=0.05) and in a diary (-28.6%; p=0.02), and physical examination score (-43.3%; p=0.01). Running times did not change. The study neither demonstrated, nor excluded, a benefit for spinal DJD. Side effect frequency was similar to that at baseline. There were no hematologic effects.

The combination therapy relieves symptoms of knee osteoarthritis. A larger data set is needed to determine the value of this therapy for spinal DJD. Short-term combination therapy appears safe in this setting.