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This case report highlights the successful use of telepsychiatric consultation by secure video chat to remotely assess a mariner expressing suicidal ideation. As a result of this intervention, telemedicine providers initiated psychiatric stabilisation while the mariner was still aboard the vessel, determined that he was safe for repatriation under the care of qualified medical escorts, and facilitated admission to a psychiatric facility near his home in the United States. Mental health emergencies are a significant cause of morbidity and mortality among mariners. Telepsychiatry is a validated method of establishing a psychiatric diagnosis and disposition as well as assessing risk of suicidality and the potential for violent decompensation. It has the potential to be a valuable adjunct to any traditional maritime telemedicine service.

Purpose: To evaluate the outcome of indirect diode laser treatment for threshold retinopathy of prematurity (ROP) and to report demographic changes observed over 10 years. Methods: Retrospective chart review and statistical analysis of 111 eyes of 61 infants treated for threshold ROP between 1991 and 2001 at a single academic institution. Results: Ninety-six of 111 (86%) eyes showed regression of neovascularization after laser treatment. Fourteen (13%) eyes had zone 1 disease and 97 (87%) eyes had zone 2 disease. Thirty-six percent of eyes with zone 1 disease progressed to stage 4 or 5 disease despite treatment, whereas 10% of the zone 2 eyes progressed. Based on multivariate logistic regression, zone and female gender were found to be predictive of progression, whereas birth weight was predictive of zone. Between 1991 and 2001, a significant trend toward lower mean gestational age at time of birth (Pearson correlation = −0.36, P = .005) and mean birth weight (Pearson correlation = −0.35, P = .0041) was found. However, progression rates to stage 4 and 5 disease following laser treatment were similar for infants born before and after 1997 ( P = .0796). Conclusion: Regression of neovascularization was noted in 86% of eyes following laser treatment for threshold ROP. Zone was predictive of progression to stage 4 or 5 despite treatment. Premature infants being treated for threshold ROP tended to be born at an earlier gestational age and with lower birth weights over time, but progression rates to more severe stages did not increase following laser treatment, suggesting that optimal treatment can yield favorable ocular outcomes.

Purpose To quantify factors affecting test-retest variability of threshold measurements over a series of 3 serial visual fields (VF). Design Prospective comparative observational study. Participants Forty-one normals, 10 suspects and 35 stable glaucoma patients. Methods All subjects performed 3 standard and 3 short-wavelength automated perimetry (SWAP) VFs. At each VF location, severity (defined as age-corrected total deviation) and test-retest variability (TRV), defined as the standard deviation of 3 serial threshold values, were calculated. A multiple regression model (constructed separately for standard VF and SWAP) incorporated 13 factors: severity, location, eccentricity, study group, diagnosis, superior versus inferior hemifield, nasal versus temporal hemifield, one-versus-two thresholds, age, mean pupil size, pupil size variability, between-subject variation, and residual variation. Main outcome measures Variability in threshold sensitivity VF values. Results Mean TRV (± standard deviation) for normal, suspect and glaucoma eyes, respectively, was: 1.28 ± 0.87, 1.53 ± 1.04 and 2.20 ± 1.79 dB for standard VF, and 1.87 ± 1.35, 1.86 ± 1.24 and 2.68 ± 1.85 dB for SWAP. The contribution of each factor to the model for standard VF and SWAP (SWAP in parentheses) were: severity 15.5% (6.9%); location 2.7% (4.1%); eccentricity 1.1% (0.64%); diagnosis 2.9% (5.9%); “superior versus inferior” hemifield 0.17% (1.7%); “nasal versus temporal” hemifield 0.06% (0.02%); one-versus-two thresholds 0.04% (0.16%); age 0.1% (0.06%); mean pupil size 0.59% (0.1%); pupil size variability 3.2% (2.8%); between-subject 8.0% (13.5%) and residual variation 61.0% (66.6%). Excluding between-subject and residual variation, the 11-factor model was able to account for less than one third of the variability seen in both standard VF and SWAP. Conclusions Severity of defect and between subject variation exerted the largest effect on TRV. However, even if all 11 factors could be adjusted for, it would reduce the magnitude of TRV by only 30%. More work is needed to reduce the remaining variability inherent in psychophysical testing and to better understand the intrinsic physiological variability present both in healthy and diseased eyes. It is possible that a larger number of VFs used for the calculation of TRV might further reduce the magnitude of the remaining variability found in this study.

Acetabular fractures are frequently missed on plain view radiographs of the hip and pelvis. A high degree of clinical suspicion for an acetabular fracture should be maintained in any patient with persistent traumatic hip, pelvic, or buttock pain, and inability to ambulate.

Purpose: To determine the efficacy of a nonendoscopic brow/forehead lift. Methods: Case series of 12 patients. Small scalp and upper eyelid blepharoplasty incisions were used to elevate the brows/forehead and perform protractor myectomy. Results: All patients achieved an aesthetically pleasing eyebrow and forehead lift with reduction of vertical and horizontal glabellar creases. Complications included one patient who experienced prolonged ecchymosis after corrugator muscle resection and one patient who had asymmetric lid folds after surgery. The length of follow-up ranged from 9 to 35 months. Conclusions: The small incision nonendoscopic browlift technique provides a useful alternative to the endoscopic approach.

Purpose To evaluate the effects of laser trabeculoplasty on 24-hour intraocular pressure (IOP) in a group of medically treated open-angle glaucoma patients. Design Prospective experimental study. Participants Eighteen open-angle glaucoma patients. Methods Laser trabeculoplasty (180°) was performed on 28 eyes of 18 glaucoma patients. Twenty-four–hour IOP data were collected in a sleep laboratory before and 45 to 80 days after the procedure. Measurements of sitting and supine IOP were taken during the 16-hour diurnal/wake period, and measurements of supine IOP were taken during the 8-hour nocturnal/sleep period in 2-hour intervals. Main Outcome Measures Changes in the mean, peak, and range of IOP during the office-hour, diurnal, nocturnal, and 24-hour periods. Results Compared with the baselines, changes in the mean, peak, and range of IOP were not significant during the office-hour period and during the diurnal period in either the sitting or the supine position. The mean, peak, and range of IOP were reduced significantly during the nocturnal period in the supine position. Mean and peak 24-hour IOP were reduced significantly in the habitual body positions (sitting during the diurnal period and supine during the nocturnal period). The reduction of mean 24-hour IOP in the supine position also was significant. Conclusions In this group of medically treated open-angle glaucoma patients, laser trabeculoplasty reduced IOP more consistently during the nocturnal period than during the diurnal period.

To evaluate the use of combined mucous membrane and hard palate mucosal grafts in the reconstruction of contracted eye socket.Thirteen eyes of 13 patients with contracted sockets underwent socket reconstructive surgery with combined mucosal membrane and hard palate mucosal grafts.The average follow-up period was 33 months. Five of 13 patients required additional surgery after initial socket reconstruction. However, all patients who underwent socket reconstruction with hard palate mucosal grafts were able to wear a cosmetically acceptable ocular prosthesis postoperatively.Combined mucosal membrane and hard palate mucosal grafts can be effectively used in the reconstruction of contracted sockets.

To evaluate the effects of the repeatability criteria on the detection of change in visual fields by six progression algorithms used in standard automated perimetry.Retrospective, observational case seriesFifty-one glaucoma patients, each with multiple visual fields performed between May 1990 and December 1998, were included.Each patient's set of visual fields were analyzed using the glaucoma change probability, the Early Manifest Glaucoma Trial (EMGT) algorithm, a modified glaucoma change probability score, a modified EMGT score, the Advanced Glaucoma Intervention Study algorithm, and the Collaborative Initial Glaucoma Treatment Study algorithm.The effects of repeatability on the detection of field change, the level of agreement among algorithms, as well as the number of eyes identified as changed with each algorithm, were assessed.Mean follow-up was 34 months (range, 12-87 months). The average percentage of eyes with change based on three consecutive follow-up fields was 8.2% (4.0%-12.5%). However, of those showing change on the initial follow-up, this change from baseline was observed in subsequent examinations on average in 23% (18%-33%), depending on the algorithm. When change was based on just one field, four of the six algorithms noted a significantly greater number of eyes with change. The algorithms, however, did not differ significantly when confirmation of field change required two versus three consecutive follow-up visual fields.Although current algorithms may help identify change, there are inconsistencies among them. We found that requiring repeatable change from baseline significantly reduces the number of changed eyes identified with each subsequent follow-up field. Identification and confirmation of change in visual fields plays an important role in helping to identify true glaucoma progression; however, the specific methods to do so have yet to be determined.

To compare progression in short-wavelength automated perimetry (SWAP) and white-on-white (standard) perimetry in eyes with progressive glaucomatous changes of the optic disc detected by serial stereophotographs.Forty-seven glaucoma patients with at least 2 disc stereophotographs more than 2 years apart, along with standard perimetry and SWAP examinations within 6 months of each disc photo of the same eye, were included in the study. The mean follow-up time was 4.1 years (range, 2.0-8.9 years). Baseline and follow-up stereophotographs were then graded and compared for the presence of progression. Progression in standard perimetry and SWAP, using the Advanced Glaucoma Intervention Study scoring system and a clinical scoring system, was compared between eyes with progressive change on stereophotographs and those without.Twenty-two of 47 eyes showed progressive change by stereophotographs. There was a statistically significant difference in the mean change in Advanced Glaucoma Intervention Study scores for both standard perimetry (P.004) and SWAP (P.001) between the progressed and nonprogressed groups. The sensitivity, specificity, and area under the receiver operator characteristic curve were higher using SWAP than standard perimetry when evaluated by either algorithm. This was statistically significant only in the area under the receiver operator characteristic curve for the Advanced Glaucoma Intervention Study scoring system (P =.04).Short-wavelength automated perimetry identified more patients than standard perimetry as having progressive glaucomatous changes of the optic disc. Compared with standard perimetry, SWAP may improve the detection of progressive glaucoma. Arch Ophthalmol. 2000;118:1231-1236

To quantify and compare, on a point-by-point basis, the long-term variability of standard and short-wavelength automated perimetry in a group of stable glaucoma patients.From a group of 53 glaucoma patients experienced in visual field testing, we identified one eye, randomly chosen, from each of 25 glaucoma patients whose condition was found to be stable, based on both standard and short-wavelength automated perimetry visual field criteria. On each of three visits during a period of up to 3 months, each patient performed one standard and one short-wavelength automated perimetry 24-2 visual field in a random order on a Humphrey visual field analyzer. The long-term variability (also referred to as test-retest variability) was defined as the SD of the three threshold decibel values at each test location. The long-term variability for each test point (mean +/- SD) was determined separately for both standard visual fields and short-wavelength automated perimetry.With all 52 test locations of the 24-2 field averaged, the global long-term variability, mean (+/- SD) for standard visual fields and short-wavelength automated perimetry was 2.37 +/- 2.03 dB (95% confidence interval, 2.26-2.48 dB) and 2.92 +/- 2.03 dB (95% confidence interval, 2.81-3.03 dB), respectively (P.0001). In 16 of the 52 visual field locations, long-term variability on short-wavelength automated perimetry was significantly higher than long-term variability on standard visual fields. In addition, the long-term variability increased with greater distance from the point of fixation for both standard visual fields and short-wavelength automated perimetry. The long-term variability decreased closer to fixation, more for standard visual fields than for short-wavelength automated perimetry.In a group of stable glaucoma patients, mean long-term variability was 0.55 dB higher for short-wavelength automated perimetry than for standard visual fields. This needs to be taken into consideration when serial visual fields are evaluated for change.