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- ItemAcesso aberto (Open Access)Achados oculares em pacientes com mais de 99 anos(Conselho Brasileiro de Oftalmologia, 2006-10-01) Cypel, Marcela Colussi [UNIFESP]; Palácio, Guilherme [UNIFESP]; Dantas, Paulo Elias Correa; Lottenberg, Cláudio Luis [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de Misericórdia de São Paulo Departamento de Oftalmologia Setor de Urgência e Pronto Socorro; Santa Casa de Misericórdia de São Paulo Departamento de Oftalmologia Seção de Córnea e Doenças Externas; Hospital Albert Einstein Instituto Israelita de Ensino e PesquisaPURPOSE: To determine vision conditions and ocular findings in patients older than 99 years. METHODS: Patients were recruited by media advertisement and examined at the Vision Institute of UNIFESP. The following examinations were performed: visual acuity, ectoscopy, refraction, biomicroscopy, tear film break-up time, Schirmer basal test, tonometry, direct and indirect ophthalmoscopy. Complementary examinations such as optical coherence tomography were performed when indicated. RESULTS: Thirty patients older than 99 years were identified. Mean age of 101.5±1.8, 25 females and 5 males. Most common systemic disease, according to history, was arterial hypertension. In 11 patients (55%), the best corrected far visual acuity was 20/100 or better. The best corrected near visual acuity was J4 or better also in 55% (11 patients) and 63.0% (7 patients) of these were the ones that had not been submitted to cataract surgery. The most frequent visual complaint was low vision for reading (55%) and other 8 patients (40%) reported no disturbance (satisfied with their vision). Lens opacity was present in 9 patients (60%) and 8 patients (40%) had previous cataract surgery (5 aphakic eyes, 9 pseudophakic eyes). Cataract was identified as important for impairment of vision in 5 patients but only 2 of them wanted to be submitted to surgery. The main cause of visual impairment was age-related macular degeneration, present in all patients, 95% with no exudative form. Vision improved with new refractive prescription in 4 patients. CONCLUSION: Once we understand the needs we can plan specific diagnostic and treatment strategies. This sample showed that most were female (83.3%), with good general health (35%), most with systemic arterial hypertension (40%), complaining of low vision for reading (55%) because of age-related macular degeneration (100%, 95% dry form). Only 40% had been previously submitted to cataract surgery. Most of the patients with cataract said to be satisfied with their vision; of the 5 patients that could be operated only 2 decided to do it. Low vision for reading, AMD and cataract were the main findings.
- ItemAcesso aberto (Open Access)Acuidade visual, sensibilidade ao contraste, acuidade estereoscópica: estudo de caso controle em escolares com baixo peso ao nascer(Universidade Federal de São Paulo (UNIFESP), 2016-01-04) Ferrari, Maria Valeria [UNIFESP]; Puccini, Rosana Fiorini [UNIFESP]; http://lattes.cnpq.br/1088228713801713; http://lattes.cnpq.br/4439963251732624; Universidade Federal de São Paulo (UNIFESP)Low birth weight (LBW) is one of the most important risk factors for neonatal mortality in addition to being one of the determinants of morbidity in childhood. The emergence of new technologies has provided a high survival rate in this group of infants with low birth weight, however, does not prevent the onset of sequelae that can lead to damage to neurodevelopment. Prematurity and congenital infections as well as intrauterine growth restriction are some factors related to LBW that can lead to intellectual, auditory and visual deficits. Objective: To evaluate the visual functions of visual acuity, contrast sensitivity and stereopsis tests of schoolchildren with low birth weight comparing them to school adequate weight and to analyze the association of visual changes to birth weight, gestational age and Apgar. Methods: Cross-sectional study of the case-control carried out in 520 children at 6 to 10 years old in the municipal Embu das Artes - SP - from August 2011 to March 2012. Results: We found that there was no difference statistically significant between the groups in the functions analyzed in relation to birth weight and Apgar, but in relation to gestational age there was poor results in visual acuity (P = 0.016) and stereo acuity (p = 0.006) in preterm school the which did not occur in the contrast sensitivity function (p = 0.636). Conclusions: Low birth weight is a risk factor for changes in visual functions although limited relevance, underscoring the need for more targeted attention to those students born with small gestational age caused by the marked immaturity of the visual system.
- ItemAcesso aberto (Open Access)Análise da viabilidade econômica da unidade móvel de um serviço de referência em oftalmologia(Conselho Brasileiro de Oftalmologia, 2005-10-01) Lima, Luiz Henrique Soares Gonçalves De; Sousa, Luciene Barbosa De [UNIFESP]; Hospital Oftalmológico de Sorocaba; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To analyse the economic viability of a mobile eye clinic of a tertiary referral Ophthalmology Service. METHODS: The amount of money spent with the purchase and construction of the unit in 2000, and the expenses with its maintenance and operation in 2001 were considered, comparing these expenses with the income obtained from appointments, supplementary tests and eye surgeries through the Sistema Único de Saúde (a health care service provided by the government), in 2001. In order to make an economic analysis, an interest rate of 10% per year and a period of depreciation of 10 years were stipulated. RESULTS: The total amount spent to buy and set up a mobile unit of Hospital Oftamológico de Sorocaba was R$ 184,140,00. The amount spent with its maintenance and operation during 2001 was R$ 28,000.00. The unit was used on average during 2 days each week in 2001 and 6492 appointments were made in this period, generating an income of R$ 32,460.00. The appointments generated complementary tests and eye surgeries making up R$ 51,540.00. Therefore, the total amount received directly with the appointments, complementary tests and eye surgeries during 2001 was R$ 84,000.00 paid by the Sistema Único de Saúde, according to values established beforehand. Using these values it is possible to make an economic analysis of this enterprise and this was done with and without money savings for depreciation, taking into account the income and the expenses. CONCLUSION: Besides attending poor communities that are located in distant neighborhoods, a mobile eye clinic can be a source of income for ophthalmologic services.
- ItemAcesso aberto (Open Access)Aspectos socioeconômicos que influenciam no comparecimento ao exame oftalmológico de escolares com alterações visuais(Conselho Brasileiro de Oftalmologia, 2004-10-01) Abud, Alfredo Borghetto [UNIFESP]; Ottaiano, José Augusto Alves; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina de Marília Setor de Lentes de Contato da Disciplina de Oftalmologia; Universidade de Marília Faculdade de Medicina de MaríliaPURPOSE: To identify socioeconomic aspects influencing the attendance of schoolchildren, who showed visual impairment, at ophthalmologic examination. METHODS: 237 schoolchildren were referred to examinations. A survey questionnaire was applied to the parents or those responsible who accompanied the schoolchildren during the ophthalmologic appointment, of the National Campaign for Visual Rehabilitation Eye to Eye 2002 in Lins (SP) city. The following parameters were analyzed: educational level of the parents or those responsible, family income level, possession of a vehicle, the distance between their homes and the place of the examination and the association with a private medical health plan. The same questionnaire was applied afterwards, by means of a personal house visit, to the parents or those responsible for the absent schoolchildren. RESULTS: 163 schoolchildren (68.8%) attended the ophthalmologic examination and answered the questionnaire; 74 students were absent (31.2%) and 72 of them answered the questionnaire later. Educational level, family income level, possession of a vehicle and the distance between their homes and the place of the examination did not show significant difference between the students. There was a significant difference (p = 0,017) between the schoolchildren who have a private medical health plan and attended the examination (27.6%) and the absentees (44.4%). CONCLUSIONS: The fact that the student was protected by a private medical health plan was associated with the fact that he/she did not attend the examination.
- ItemAcesso aberto (Open Access)Estenose bilateral de seio venoso transverso associado a papiledema: relato de caso(Conselho Brasileiro de Oftalmologia, 2003-06-01) Gouveia, Enéias Bezerra; Lobato, Frederico José Corrêa; Veras, José Filho De Sousa Lobão; Nunes, João Claudio; Muccioli, Cristina [UNIFESP]; Melo Filho, Agenor De; Real e Benemérita Sociedade Portuguesa de Beneficência Hospital São Joaquim Serviço de Oftalmologia; Universidade Federal de São Paulo (UNIFESP)The authors report the case of a female patient, 39 years old, presenting bilateral transverse venous sinus stenosis, associated with papilledema, visual acuity deficit and headache. Cerebral angiographic finding of bilateral transverse venous sinus stenosis elucidated the diagnosis. The patient was treated with cerebral angiographic stent implant, with consequent remission of ophthalmologic and neurological clinical findings.
- ItemAcesso aberto (Open Access)Evaluation of Internet websites about floaters and light flashes in patient education(Conselho Brasileiro de Oftalmologia, 2007-10-01) Barbosa, Andréa Lima [UNIFESP]; Martins, Elisabeth Nogueira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: Flashes of light and floaters are most commonly caused by posterior vitreous separation but may be associated with sight-threatening disorders. Prevention of severe sequelae requires prompt dilated eye examination. Thus, information dissemination is crucial. This study aimed to evaluate the quality of information about floaters and light flashes available for patients on the Internet. METHODS: Cross-sectional study. In July 2005 we evaluated information available on the Internet regarding floaters and light flashes, using two search engines (MetaCrawler and MSN) and three key terms (floaters, dark spots eye, and light flashes eye). The quality of each website was evaluated using a score system. The sites were classified as academic, organizational or commercial. Readability, general quality of the website (based on: ownership, purpose, authorship, author qualification, attribution, interactivity, and currency) and quality of the specific content (definition, causes, epidemiology, diagnosis, treatment, and prognosis) were analyzed. RESULTS: Of 145 websites evaluated, 49 were included. Four sites (8.2%) were academic, 9 (18.4%) organizational, and 36 (73.4%) commercial. In the majority of the sites (53.0%) information was poor and quality was not correlated with website classification. CONCLUSIONS: Information about floaters and light flashes available on the Internet is poor.
- ItemAcesso aberto (Open Access)Hipertensão intracraniana com manifestações oculares associada ao uso de tetraciclina: relato de caso(Conselho Brasileiro de Oftalmologia, 2005-10-01) Santos, Frederico Xavier Dos; Parolin, André [UNIFESP]; Lindoso, Elissandro Márcio Silva; Santos, Fernando Henrique Xavier; Sousa, Luciene Barbosa De [UNIFESP]; Hospital oftalmológico de Sorocaba; Universidade Federal de São Paulo (UNIFESP); Pontifícia Universidade Católica de SorocabaThe authors describe a young female patient with intracranial hypertension associated with ocular manifestations, during treatment with tetracycline. This is a rare adverse effect described in the medication warnings, and in a few reported cases in the scientific literature.
- ItemAcesso aberto (Open Access)Inclusão social do deficiente visual: experiência e resultados de Assis(Conselho Brasileiro de Oftalmologia, 2009-12-01) Andreghetti, Eduardo; Silva, Maria Rosa Bet De Moraes; José, Newton Kara; Maia, Maurício [UNIFESP]; Andreghetti, Mariana De Rezende; Antunes, Valcir Coronado; Universidade Estadual Paulista (UNESP); Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP); Universidade de Santo Amaro; Instituto de Oftalmologia de AssisPURPOSES: To establish the visually impaired resource class users profile in the city of Assis - SP, to estimate the visually impaired employment percentage and to compare employment rate with age, gender, deficiency type and causing disease between two periods:1984 - 1996 and 1997 - 2009. METHODS: Retrospective review of both medical and school records from visually impaired individuals attending visually impaired resource class in Assis - SP between 1984 and 2009. This time period was divided into two intervals: 1984 - 1996 (G1) and 1997 - 2009 (G2). Collected data included demographic features and diseases, type of visual impairment (blindness or low vision), education, optic aids, attendance to visually impaired resource class and employment rate. Employment rate was associated with age, gender, type of visual impaiment and causing disease between both study time intervals. RESULTS: A total of 149 visually impaired individuals were identified - 61.07% male, 38.9% female, 82.5% white, and 17.4% non-white. Mean age was 18 years. Of the 149 visually impaired, 63.75% had low vision and 36.24% were blind. In decreasing order, the more frequent conditions leading to visual impairment were toxoplasmosis retinochoroiditis (17.40%), congenital optic atrophy (9.39%), high hyperopia (8.72%), pigmentary retinosis and high myopia (with 6.71% each) and congenital glaucoma and congenital cataract (with 6.04% each). Attendance to visually impaired resource class was good by over 50% of the patients. Of the individuals >14 years-old, 44.7% and 12.3% were regularly employed during 1984 - 1996 and 1997 - 2009 periods, respectively. Employment rate only correlated with age (individuals with higher mean age were most frequently employed) and there was not correlation with demographic characteristics, deficiency type and causing diseases. CONCLUSIONS: The main characteristics of the individuals attending the visually impaired resource class are: male, white, with low vision and ocular toxoplasmosis. Nearly half of the individuals older than 14 years-old (44.7%) were regularly employed up to 1996, suggesting that the joint effort of ophthalmologists and teachers helps the social inclusion of these patients. Employment rate dropped over 1997 - 2009 period, and the rate of retirees increased.
- ItemAcesso aberto (Open Access)Lentes de contato esclerais: experiência inicial no Setor de Lentes de Contato da Universidade Federal de São Paulo (UNIFESP)/Escola Paulista de Medicina(Conselho Brasileiro de Oftalmologia, 2004-12-01) Lipener, César [UNIFESP]; Leal, Fernando [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To describe initial experiences with patients wearing rigid escleral contact lenses. METHODS: Retrospective study of 13 eyes of 7 patients, 11 fitted with polymethylmethacrylate and two with rigid gas-permeable scleral contact lenses. Age, sex, diagnosis, initial and final visual acuity (VA), time of daily wear, complications and follow-up were recorded. RESULTS: Keratoconus was diagnosed in 6 patients, one was submitted to radial keratotomy. Mean follow-up lasted 8 months. Visual acuity of all eyes improves with scleral contact lenses. CONCLUSION: Visual acuity improvement observed in corneal ectasia and after radial keratotomy, in patients awaiting corneal graft, suggests that scleral contact lenses can be considered clinical treatment alternative.
- ItemAcesso aberto (Open Access)Perda da voz em professores e não professores(Sociedade Brasileira de Fonoaudiologia, 2009-01-01) Park, Kelly [UNIFESP]; Behlau, Mara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Centro de Estudos da VozPURPOSE: To investigate teachers' and non-teachers' perception regarding the implications of an eventual loss of voice. METHODS: Participated in the study 205 individuals (106 women and 99 men), 105 teachers and 100 non-teachers, with ages varying from 23 to 65 years old. The participants were asked to answer a questionnaire with four questions regarding an eventual loss of vision, hearing, voice and deambulation, and the inferred impact degree (from 0 to 4). RESULTS: For the teachers group, not being able to see caused the most negative impact (mean of 3.8), followed by not being able to walk (mean of 3.7), loss of voice (mean of 3.7) and hearing loss (mean of 3.6). For the non-teachers group, loss of sight also caused the most negative impact (mean of 3.4), followed by not being able to walk (3.0), hearing loss (2.2), and loss of voice (2.0). Regarding the impact of an eventual voice loss, the teachers group indicated negative consequences at work, in their social relationships and in their daily routines. The non-teachers group indicated negative consequences to their daily routine, at work, in their social relationships and in their emotional manifestations. CONCLUSION: The teachers showed to value their voices differently from the non-teachers group. Both groups agreed that voice loss would not bring the most negative consequences. Although teachers noticed more the impact of an eventual loss of voice than non-teachers, the feelings towards this hypothetical situation were similar in both groups.
- ItemAcesso aberto (Open Access)Prevalence of visual impairment, blindness, ocular disorders and cataract surgery outcomes in low-income elderly from a metropolitan region of São Paulo - Brazil(Conselho Brasileiro de Oftalmologia, 2008-04-01) Araujo Filho, Arnaud [UNIFESP]; Salomão, Solange Rios [UNIFESP]; Berezovsky, Adriana [UNIFESP]; Cinoto, Rafael Werneck [UNIFESP]; Morales, Paulo Henrique Ávila [UNIFESP]; Santos, Francisco Roberto Goncalves [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To determine prevalence and causes of visual impairment, blindness, ocular disorders and cataract surgery outcomes in a low-income elderly population from a metropolitan area in the city of São Paulo, Brazil. METHODS: Observational study where 801 individuals of 60 years and older underwent presented and best corrected visual acuity measurements as well as ophthalmologic examination. Definition of blindness and visual impairment followed studies conducted in Nepal, China and India. RESULTS: The prevalence of presented and best-corrected visual acuity worse than 20/400 in both eyes was 1.38% (95% CI: 0.69% - 2.45%) and 1.25% (95% CI: 0.60% - 2.29%). Prevalence of visual impairment considering presented and best-corrected visual acuity was, respectively, 24.16% (95% CI: 21.22% - 27.28%) and 12.77% (95% CI: 10.53% - 15.28%). Cataract was the main cause of blindness (30.00%) and visual impairment (54.90%). A total of 54 participants (6.74%) had previous cataract surgery and, with best-corrected visual acuity, 35.12% showed visual acuity better than 20/60 in both eyes. Rates of visual impairment and blindness in this low-income elderly population were high. There was a considerable decrease in prevalence after optical correction emphasizing the importance of uncorrected refractive errors. CONCLUSION: Cataract was the main cause of blindness; poor visual outcomes in eyes previously operated for cataract reinforce the need to seek good quality cataract services and to provide careful postoperative follow-up.
- ItemAcesso aberto (Open Access)A visão funcional e o controle de tronco em crianças com paralisia cerebral e deficiência visual cortical associada(Universidade Federal de São Paulo, 2022-02-18) Nogueira, Ana Paula Martins Moreira [UNIFESP]; Carvalho, Raquel de Paula [UNIFESP]; http://lattes.cnpq.br/7980384093582831; http://lattes.cnpq.br/1419333835042626; Universidade Federal de São Paulo (UNIFESP)Introdução: O controle da postura é o resultado da interação entre as informações sensoriais sobre o corpo em relação ao meio ambiente e a produção de ações motoras adequadas para o gerenciamento de equilíbrio postural e orientação, sendo o sistema visual uma das principais fontes de informação sensorial para este controle. As crianças com Paralisia Cerebral (PC) com déficits no sistema visual podem apresentar alterações na estabilidade da cabeça e tronco. As avaliações de controle de tronco consideram o uso da informação visual, deste modo, as crianças com PC e Deficiência Visual Cortical (DVC) associada podem ser subestimadas em relação à estas ferramentas de avaliação. Objetivo: Verificar o efeito da adequação do estímulo visual na avaliação do nível de controle de tronco de crianças com PC e DVC associada. Método: Este é um estudo transversal e controlado; foram incluídas 8 crianças com PC e DVC, de faixa etária entre 2 anos e 10 meses a 10 anos (MD 5,4 ± 2,5), classificadas nos níveis III, IV e V do GMFCS (Sistema de Classificação da Função Motora Grossa). A avaliação foi composta por quatro momentos: Anamnese (1), Aplicação da Versão Brasileira da Segmental Assessment of Trunk Control (SATCo-Br 1) (2), Avaliação da Visão Funcional baseada na CVI Range (3) e Reaplicação da SATCo-Br (SATCo-Br 2) com estímulo visual baseado nas respostas da CVI Range (4). Realizou-se a análise cinemática 2D no plano sagital e frontal para verificar o alinhamento de cabeça e tronco. Resultados: A SATCo-Br 2 foi maior que a SATCo-Br 1 após adequação do ambiente e materiais (Z= 2,388, p= 0,017). As crianças avaliadas necessitaram de adequação em relação às características próprias do objeto (cor, luz incidente e objetos iluminados) e manipulação na apresentação em relação à distância e movimentação do objeto, além de ajuste do ambiente com redução de complexidade de fundo e controle de iluminação. Observou-se que considerar modificações ambientais melhoram a manutenção da postura sentada e diminui o uso de estratégias compensatórias. Houve forte correlação (r= -0,809) entre o VFCS (Sistema de Classificação da Visão Funcional) e a CVI Range. Não houve diferença nas variáveis cinemáticas de alinhamento de tronco (p>0,05). Conclusão: Há necessidade de adequação do estímulo visual para a correta avaliação do nível de controle de tronco em crianças com PC e DVC associada. Para a aplicação da SATCo-Br em crianças com PC e DVC associada, é interessante que se realize uma Avaliação da Visão Funcional específica para Deficiência Visual Cortical prévia para oferecermos informação visual ideal na aplicação deste instrumento de mensuração de controle de tronco. Melhorar o uso funcional da visão não altera o alinhamento mas melhora o controle de tronco.