Poster 46

284 routine eye examination. Her best-corrected visual acuities were 20/20-2 O.D. and 20/15 O.S. She was unaware of the mild gradual painless vision loss in her right eye. She showed 20% red desaturation O.D. and, despite the desaturation, her pupils were normal in response and size. Ishihara color vision test was normal. Her right optic nerve revealed an area of temporal pallor. She admitted to 2 and a half years of heroin addiction and concomitant alcohol abuse. She was currently in a drug rehabilitation program and had been clean for 30 days. Methods: The complications of toxic or nutritional effects of alcohol are well documented. The neuropathy manifests as a painless, progressive, and symmetrical process ascribed to the deficiency of Vitamin B 12, thiamine, and folate. It responds well to vitamin supplementation. The visual fields tend to show central or centro-cecal field defects. Alcohol potentiates the body’s natural opiates and— combined with heroin—is even more potent. The affects of heroin can be due to dosage toxicity or due to a toxin released when drug is heated. An acute side affect of heroin is orthostatic hypotension and pulmonary hypertension; ischemic or hemorrhagic strokes are common. Complications include peripheral neuropathy, myelopathy, Parkinsonism, leukoencephalopathy, cerebellar ataxia, and, most significantly, optic atrophy. Conclusions: It is almost impossible to separate the role alcohol abuse played in the development of optic atrophy of this patient addicted to heroin versus an interior ischemic optic neuropathy due to orthostatic hypotension induced by heroin highs. Elimination of the toxic agents, rehabilitation, and nutritional supplementation are key. Repeated visual fields and monitoring of the patient’s optic nerve function over time is recommended. PHARMACOLOGY Poster 46 Could the Darkened Skin Color be a Result from Latanoprost, Psychiatric Drugs or from Argyria? Elaine Chung, O.D., Palo Alto VA Hospital, 10858 South Blaney Avenue, Cupertino, California 95014 Background: Argyria, also known as silver poisoning, is described as permanent blue-to-bronze discoloration of the skin due to excessive oral intake of silver salts. Usage of silver was first introduced in the Middle Ages to treat nervous disorders. Modern usage of silver includes using silver sulfadiazine cream to treat burn wounds, Crede’s solution for prevention of gonorrheal conjunctivitis, and silver nitrate for management of superior limbic keratitis. Case Report: A 60-year-old man came to the optometry clinic with unusual darkened skin color. His medical history is significant for diabetes, hypertension, hyperlipidemia, and post-traumatic stress disorder. The purpose of the optometric visit was a glaucoma followup for intraocular pressure check. Best-corrected visual acuities were 20/20 – in each eye. Externals, slit-lamp examination findings were within normal limits, with no signs of ocular agyrosis.

Optometry, Vol 77, No 6, June 2006 Tonometry readings were 16 mmHg O.D. and 17 mmHg O.S. Ophthalmoscopy findings revealed optic cup-to-disk ratios of 0.30 O.D., 0.50 O.S. with thinned rim tissue appearance. No signs of diabetic or hypertensive retinopathy were identified. Conclusion: Aside from latanoprost ophthalmic solution, our patient’s medication list includes haloperiodol decanoate, risperidone, and mirtazapine. However, these mentioned medications are not the cause of his darkened skin color. Our patient has been ingesting a solution of silver particles by dissolving silver wire in water and baking powder with an electrical generator. He drinks this silver solution twice a year due to the belief of its “antibiotic properties.” The diagnosis of Argyia is made after a skin biopsy. Aside from addressing the chief symptom, social history and a detailed review of systems are also an important part of a primary care optometric examination. Poster 47 Comfort Comparison of Three Ophthalmic NSAID Eye Drops Linda Edmondson, A.M., O.D., Earlena Mckee, M.A., O.D., and William Edmondson, M.A.T., O.D., Northeastern State University, College of Optometry, 1001 North Grand Avenue, Tahlequah, Oklahoma 74464 Purpose: Compliance with prescribed use of ophthalmic medications is recognized as a significant problem when treating patients with ocular disease. Patient compliance is increased by emphasizing patient education and prescribing patient-friendly medications. More comfortable medications or those requiring fewer doses per day make it more likely patients will use them as directed. This study was designed to compare the comfort level of three ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) with 2 lubricant eye drops. Methods: Four subjects participated in this study. Five different eye drops were compared. Comfort was assessed on a scale of 1 to 10, with a rating of 1 indicating most comfortable and a 10 indicative of least comfortable. Preservative-free Theratears was the first drop instilled by each subject as a reference drop and was given the comfort rating of 1. The subjects then instilled each of the 4 remaining drops in a random order in either eye, allowing a minimum of 10 minutes between instilling drops in the same eye. Results: The agents ranked from most to least comfortable using the mean comfort ratings were: TheraTears preservative-free; Systane® Free Liquid Gel; 0.1% nepafenac suspension (Nevanac); 0.4% ketorolac solution (Acular LS); and 0.1% diclofenac solution (Voltaren). The responses were evaluated on a pair-wise basis using a two-tailed t-test for difference of means. No significant difference (p ⬍ 0.005) in comfort was demonstrated between Systane Free, a lubricant eye drop, and Nevanac, an ophthalmic NSAID