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Obesity and elevated intraocular pressure
Letters to the Editor
Obesity and Elevated Intraocular Pressure Dear Editor: In the article by Gonzaga dos Santos et al1 on the intraocular pressure elevation associated with Goldmann applanation tonometry measurements made in obese people, the authors have clearly shown that the positioning required for such a measurement transiently raises the intraocular pressure. The authors further caution that this transient elevation of intraocular pressure could lead to the misdiagnosis of glaucoma. I would like to raise the possibility that the elevation of intraocular pressure measured in obese people at the slit lamp may well be reproduced outside the office during that patient’s average day. There are many people who have job responsibilities that place them behind desks for much of the day. Most office furniture is configured for people of average size. With increasing dependence on computers in the work place, many people need to assume positions that are similar to those experienced at the slit lamp just to accomplish their work responsibilities. This would be further exacerbated if a worker was wearing a buttoned dress shirt and a neck tie.2 Clearly, the elevation of intraocular pressure measured while obese patients are measured at the slit lamp or while their necks are compressed2 is a bona fide elevation of intraocular pressure while the measurement is being made. If a patient’s lifestyle places him or her in similar positional jeopardy, the elevated intraocular pressure measured in obese people at the slit lamp may be clinically important. Therefore, critically evaluating optic nerve anatomy and peripheral visual field function over time is still prudent in obese people with elevated Goldmann applanation tonometry measurements and normal Perkins tonometry measurements if the positions they assume in their daily life put them at risk. MICHAEL S. KORENFELD, MD Washington, MO References 1. dos Santos MG, Makk S, Berghold A, et al. Intraocular pressure difference in Goldmann applanation tonometry versus Perkins hand-held applanation tonometry in overweight patients. Ophthalmology 1998;105:2260 –3. 2. Grehn F, Mackensen G. Die Glaukome, 11th ed. Stuttgart: Kolhammer, 1993;127–38.
Diabetes and Visual Loss Dear Editor: In the paper entitled, “The 14-year Incidence of Visual Loss in a Diabetic Population,”1 by Moss et al, the authors demonstrate that, although blindness has declined, visual loss is still common among diabetic patients. The authors conclude that much still needs to be done to prevent diabetic retinopathy through control of hyperglycemia. I agree with the authors. We need to improve the quality of diabetes care in order to translate the Diabetes Control and Complications
Trial2 results into clinical practice, but unfortunately this is not the only problem that we have to face, at least in Italy. Planning and putting into practice policies to prevent diabetes-related blindness are proving more difficult than expected for many reasons: lack of skilled operators, difficulties in reaching all patients, and, mainly, administrative interests that are in the majority of cases less than desirable. The Diabetic Retinopathy Study,3 the Early Treatment Diabetic Retinopathy Study,4 and the Diabetic Retinopathy Vitrectomy Study5 have already demonstrated the role and the therapeutic potential of eye treatment, but we are still unable to apply their protocols to the majority of our patients. May I ask how we can facilitate the spread of these protocols internationally? FRANCESCO BANDELLO, MD Udine, Italy References 1. Moss SE, Klein R, Klein BEK. The 14-year Incidence of visual loss in a diabetic population. Ophthalmology 1998;105:998 – 1003. 2. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulindependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993;329:977– 86. 3. Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study findings. Ophthalmology 1978;85:82–106. 4. Early photocoagulation for diabetic retinopathy. ETDRS report Number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98(5 Suppl):766 – 85. 5. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial—Diabetic Retinopathy Vitrectomy Study Report Number 3. The Diabetic Retinopathy Vitrectomy Study Research Group. Ophthalmology 1988;95:1307–20.
Authors’ reply Dear Editor: Dr. Bandello writes that “planning and putting into practice policies to prevent diabetes-related blindness are proving more difficult than expected” and asks how to facilitate implementation of surgical interventions (photocoagulation and vitrectomy) that have been shown to reduce the incidence of visual loss. He is correct in his concern about the slow response in translating the findings of clinical trials into public health policy. In the United States, despite findings from the Diabetic Retinopathy Study1 over 20 years ago that early detection and treatment of proliferative retinopathy with high-risk characteristics with panretinal photocoagulation would reduce the incidence of severe visual loss, there are still considerable numbers of people with diabetes in the population at high risk who have not received a dilated eye examination.2–5 In response to these concerns, numerous US government agencies, such as the National Eye Institute and the Centers
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Obesity and Elevated Intraocular Pressure Dear Editor: In the article by Gonzaga dos Santos et al1 on the intraocular pressure elevation associated with Goldmann applanation tonometry measurements made in obese people, the authors have clearly shown that the positioning required for such a measurement transiently raises the intraocular pressure. The authors further caution that this transient elevation of intraocular pressure could lead to the misdiagnosis of glaucoma. I would like to raise the possibility that the elevation of intraocular pressure measured in obese people at the slit lamp may well be reproduced outside the office during that patient’s average day. There are many people who have job responsibilities that place them behind desks for much of the day. Most office furniture is configured for people of average size. With increasing dependence on computers in the work place, many people need to assume positions that are similar to those experienced at the slit lamp just to accomplish their work responsibilities. This would be further exacerbated if a worker was wearing a buttoned dress shirt and a neck tie.2 Clearly, the elevation of intraocular pressure measured while obese patients are measured at the slit lamp or while their necks are compressed2 is a bona fide elevation of intraocular pressure while the measurement is being made. If a patient’s lifestyle places him or her in similar positional jeopardy, the elevated intraocular pressure measured in obese people at the slit lamp may be clinically important. Therefore, critically evaluating optic nerve anatomy and peripheral visual field function over time is still prudent in obese people with elevated Goldmann applanation tonometry measurements and normal Perkins tonometry measurements if the positions they assume in their daily life put them at risk. MICHAEL S. KORENFELD, MD Washington, MO References 1. dos Santos MG, Makk S, Berghold A, et al. Intraocular pressure difference in Goldmann applanation tonometry versus Perkins hand-held applanation tonometry in overweight patients. Ophthalmology 1998;105:2260 –3. 2. Grehn F, Mackensen G. Die Glaukome, 11th ed. Stuttgart: Kolhammer, 1993;127–38.
Diabetes and Visual Loss Dear Editor: In the paper entitled, “The 14-year Incidence of Visual Loss in a Diabetic Population,”1 by Moss et al, the authors demonstrate that, although blindness has declined, visual loss is still common among diabetic patients. The authors conclude that much still needs to be done to prevent diabetic retinopathy through control of hyperglycemia. I agree with the authors. We need to improve the quality of diabetes care in order to translate the Diabetes Control and Complications
Trial2 results into clinical practice, but unfortunately this is not the only problem that we have to face, at least in Italy. Planning and putting into practice policies to prevent diabetes-related blindness are proving more difficult than expected for many reasons: lack of skilled operators, difficulties in reaching all patients, and, mainly, administrative interests that are in the majority of cases less than desirable. The Diabetic Retinopathy Study,3 the Early Treatment Diabetic Retinopathy Study,4 and the Diabetic Retinopathy Vitrectomy Study5 have already demonstrated the role and the therapeutic potential of eye treatment, but we are still unable to apply their protocols to the majority of our patients. May I ask how we can facilitate the spread of these protocols internationally? FRANCESCO BANDELLO, MD Udine, Italy References 1. Moss SE, Klein R, Klein BEK. The 14-year Incidence of visual loss in a diabetic population. Ophthalmology 1998;105:998 – 1003. 2. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulindependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993;329:977– 86. 3. Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study findings. Ophthalmology 1978;85:82–106. 4. Early photocoagulation for diabetic retinopathy. ETDRS report Number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98(5 Suppl):766 – 85. 5. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial—Diabetic Retinopathy Vitrectomy Study Report Number 3. The Diabetic Retinopathy Vitrectomy Study Research Group. Ophthalmology 1988;95:1307–20.
Authors’ reply Dear Editor: Dr. Bandello writes that “planning and putting into practice policies to prevent diabetes-related blindness are proving more difficult than expected” and asks how to facilitate implementation of surgical interventions (photocoagulation and vitrectomy) that have been shown to reduce the incidence of visual loss. He is correct in his concern about the slow response in translating the findings of clinical trials into public health policy. In the United States, despite findings from the Diabetic Retinopathy Study1 over 20 years ago that early detection and treatment of proliferative retinopathy with high-risk characteristics with panretinal photocoagulation would reduce the incidence of severe visual loss, there are still considerable numbers of people with diabetes in the population at high risk who have not received a dilated eye examination.2–5 In response to these concerns, numerous US government agencies, such as the National Eye Institute and the Centers
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