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THYROID ORBITOPATHY IN CHILDREN: WHY SO BENIGN?
Ophthalmologists are familiar with the vision threatening and ocular motility defects associated with thyroid orbitopathy. Although children are affected by hyperthyroid disease less frequently than adults, a study by Chan and co-workers from Hong Kong emphasises that they do develop some complications. However, the complications are mild indeed and comprise, primarily, conjunctival irritation, lid position change, and proptosis. In none of the 83 patients studied was vision threatened and none of the patients developed strabismus in primary gaze. It would be of interest to understand why hyperthyroid disease in children promotes such a relatively modest reaction in the orbit and eyes. See 740
NEED FOR MORE LOW VISION SERVICES
Most visually impaired adult patients have some residual function and might therefore benefit from rehabilitation needs. A study by Culham and co-workers suggests that the current low vision services in the United Kingdom are inadequate. The authors suggest that over one million people in the UK might benefit from low vision support and yet the current system offers no more than 155 000 appointments per annum. Moreover, the authors emphasise that the need for low vision services will only expand in the future as the baby boom generation ages. Low vision aid services are relatively inexpensive items in the healthcare system and ophthalmologists should be concerned about whether adequate services are offered to the population they serve. See 743
INTERESTED IN ME OR INTERESTED IN MY MACULA?
Age related maculopathy is now the leading cause of visual impairment in adults in most developed nations. Regrettably, effective treatment of this disorder still eludes us. It is no doubt frustrating for ophthalmologists to spend time with patients who are losing visual function for which they have little to offer. Is this perhaps the reason why in a questionnaire study of the Macular Disease Society, over 50% of patients with macular disease reported that their consultant eye specialists appeared not to be interested in them as people? Even more disturbing, 40% were dissatisfied with their diagnostic consultation. The authors of this study emphasise that with advances in technology and medicine some unfortunate consequences for patients has taken place. The perception is that doctors are less concerned about patients and the impact their disorder has on their lives. See 777
IMPROVING COMPLIANCE WITH OCCLUSION THERAPY WITH WRITTEN INFORMATION
In all fields of medicine a major obstacle in successfully providing adequate care is to make certain that patients comply with recommended therapy. Studies have frequently shown that patients rarely if ever follow precisely the directions for the administration of medication. In the case of patching therapy for amblyopia, it is well known that many families do not comply with the recommended treatment. Newsham suggests that providing a written instruction leaflet to the parents of children with amblyopia increases treatment compliance. Although this study did not utilise an objective measurement of parent compliance, it does suggest that the more information provided to patients about their recommended therapy the more likely they are to successfully complete it.See 787